Development of the Care Model for Patients with Septicemia using Fast Tract System at Surin Hospital
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Published:
Aug 7, 2019
Keywords:
care model development patient with septicemia fast track system
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Abstract
Abstract: Sepsis is a critical illness and needs urgent treatment and care. This research and development are: to develop “Fast Track Care Service Model” for patients with septicemia and to evaluate outcomes of the development in Surin hospital during October 2016 to September 2018. Samples were purposively selected which comprised of 54 registered nurses and multidisciplinary team members and 70 patients with septicemia. Data collection tools included: Sepsis Fast Track audit form, patients’ record forms, and nurse’s opinion questionnaire. Research tools were validated by five experts. This study comprised of three phases: 1) situation analysis phase; 2) Fast Track Service Model development phase; and 3) evaluation phase. Data were analyzed by descriptive statistics. The comparisons of clinical outcomes before- and after- the implementation of the model were analyzed by using Chi-square test. Results of the developed “Fast Track Care Service Model” consist of: 1) pre-hospital care, 2) in-hospital care, and 3) continuing care. Outcomes of the developed “Fast Track Service Model” revealed that: accurate and timely fluid replacement therapy, increased from 70% to 86.7%; hemo-culture taken before antibiotic administration rate, increased from 83.3% to 100%; antibiotic administration rate within one hour after diagnosis, increased from 80.0% to 96.7%; and mortality rate from sepsis decreased from 40.0% to 23.3%. Registered nurses’ opinion on the developed model was that it is applicable and be effective in practice at the high level with the mean score of 3.48 (SD=0.18). The developed care model helped patients get access to standard care treatment and let to better outcomes. This care model can be applied to other hospitals within the similar contexts.
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รุ่งธนเกียรติ ป., พรมตวง ส., & แพงบุดดี จ. (2019). Development of the Care Model for Patients with Septicemia using Fast Tract System at Surin Hospital. Thai Journal of Nursing and Midwifery Practice, 6(1), 36–51. Retrieved from https://he02.tci-thaijo.org/index.php/apnj/article/view/192024
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Research report
References
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8. Kumar A, Roberts D, Wood KE. Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Critical Care Medicine 2006;34(6):1589-96.
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10. Levy MM, Rhodes A, Phillips GS. Surviving Sepsis Campaign: Association between performance metrics and outcomes in a 7.5-year study. Critical Care Medicine 2015;43:3-12.
11. Rhodes A, Evans LE, Alhazzani W. Surviving Sepsis Campaign: International guidelines for management of sepsis and septic shock: 2016. Intensive Care Medicine 2017;43:304-77.
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19. Xu JY, Chen QH, Liu SQ, Pan C, Xu XP, Han JB, Xie JF, et al. The effect of Early goal-directed therapy on outcome in adult severe sepsis and septic shock patients: A meta-analysis of randomized clinical trials. International Anesthesia Research Society 2016;123(2):371-381.
20. Yu H, Chi D, Wang S, Liu B. Effect of early goaldirected therapy on mortality in patients with severe sepsis or septic shock : A meta-analysis of randomized controlled trial. BMJ 2016; 63:e008330. Doi:10.1136/bmjopen-2015-008330.
21. Castellanos-Ortega A, Suberviola B, GarciaAstudillo LA, Holanda MS, Ortiz F, Llorca J, et al. Impact of the Surviving Sepsis Campaign protocols on hospital length of stay and mortality in septic shock patients: Results of a three-year follow-up quasiexperimental study. Critical Care Medicine 2010;38Z4X:1036-1043.
22. Onswadipong P, Sungkard K, Kusuma Na Ayuthya S, Rongrungruan Y. The effect of early goal-directed nursing intervention on severity of organ failure in patients with sepsis syndrome. Journal of Nursing Science 2011;29(2):102-10. (In Thai)
23. Unburee J. Effectiveness of implementing early goal-directed therapy nursing practice guidelines among patients with sepsis, Kamphaengphet Hospital. [Master Thesis]. Chiang Mai:Chiang Mai University;2012. (In Thai)
24. Srithundorn S. Nursing practice system development in using protocol for persons with sepsis syndrome in emergency department. [Master Thesis]. Bangkok:Rangsit University;2013. (In Thai)
25. Niyompruksa A, Chantara P, Yimyam P. System development in using clinical practice guideline in caring patients with sepsis syndrome. Journal of Nurses’ Association of Thailand, North-Eastern Division 2013;31(2):14-24. (In Thai)
26. Zoler ML. Systematic sepsis screening shows efficacy : Infection Diseases. 2009.[Serial on the Internet] [cited 2017 May 2]. Available from: www. Ehospitalistnews.com.
27. Tromp M, Hulscher M, Bleeker-Rovers CP, Peter L, Berg DT, Borm GF, et al. The role of nurses in the recognition and treatment of patients with sepsis in the emergency department : A prospective beforeand-after intervention study. International Journal of Nursing Studies 2010;47:1464-1473.
28. Askim A, Moser F, Gustad LT, Stene H, Gundersen M, Asvold BO, Dale J, Bjornsen LP, Damas JK, Solligard E. Poor performance of quick-SOFA (qSOFA) score in predicting severe sepsis and mortality – a prospective study of patients admitted with infection to the emergency department. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2017; 25-26.
29. Milano PK, Desai SA, Eiting EA, Holfmann EF, Lam CN, Menchine M. Sepsis bundle adherence is associated with improved survival in severe sepsis or septic shock. Western Journal of Emergency Medicine 2018; 19(5):774-781.
30. Andersson M, Ostholm-Balkhed A, Fredrikson M, Holmbom M, Hallgren A, Berg S, Hanberger H. Delay of appropriate antibiotic treatment is associated with high mortality in patients with communityonset sepsis in a Swedish setting 2018; https://doi. org/10.1007/s10096-019-03529-8.
31. Khuri CE, Dagher GA, Chami A, et al. The impact of EGDT on sepsis mortality in a single tertiary care center in Lebanon 2019;2019:1-8.
32. Worapratya P, Wanjaroenchaisuk A, Joraluck J, Wuthisuthimethawee P. Success of applying early goal-directed therapy for septic shock patients in the emergency department. Open Access Emergency Medicine 2016;8:1-6.
33. Kassyap CK, Abraham SV, Krishnan SV, Palatty BU, Rajeev PC. Factors affecting early treatment goals of sepsis patients presenting to the emergency department. Indian Journal of Critical Care Medicine 2018; 22(11):797-800.
34. Powthai S. Knowledge management in the development in the development of clinical nursing practice guideline for sepsis patients. [Master Thesis]. Bangkok:Christian University;2013.(In Thai)
35. Nueng Nasuwan W, Normkusol J, Thongjam R, Panaput T. Development of the nursing service system for patients with severe sepsis. Journal of Nursing and Health Care 2014;32(2):25-36. (In Thai)
36. Kowtragool N. Effects of using a case management system to improve the quality of care for the sepsis patients in Sakaeo Crown Prince Hospital. Thai Journal of Cardio-Thoracic Nursing 2014;25 (2):121-34. (In Thai)
37. Thiemsuwan Y, Malahom O, Yindesuk T, Kwanchang P, Prasertsri N. The development caring system of critical sepsis patients by case management at Sunprasithtiprasong Hospital, Ubon Ratchathani. Journal of Nursing and Health Care 2017; 35(1): 184-93. (In Thai)
38. Amphon K, Bunyoprakarn C, Sinkincharoen P. The outcomes of the development of the patients with septicemia, Prapokklao Hospital. Journal Prapokklao Hospital Clinical Medicine Education Center 2017;34(3):222-36. (In Thai)
39. Komol P. Quality of care management in persons with sepsis syndrome at emergency department in Singburi Hospital. The Association of Private Higher Education Institutions of Thailand Journal 2017;6(2):32-43. (In Thai)
40. Punvittayakool J, Maneeprai J. The development of care model for sepsis. Journal of Nursing Division 2018;45(1):86-104. (In Thai)
41. Suranatchayanan P, Kenthongdee W, Kamonrat S. Nursing care system development for sepsis patients at Loei Hospital. Journal of Nursing and Health Care 2018;36(1):207-15. (In Thai)
42. Jozwiak M, Monnet X, Teboul JL. Implementing sepsis bundles. Annals of Translational Medicine 2016; 4(17):332339.
43. Keeley A, Hine P, Nsutebu E. The recognition and management of sepsis and septic shock : A guide for non-intensivists. Postgrad Med J 2017; 93:626-634.
44. Baird MS. Manual of Critical Care Nursing : Nursing Intervention and Collaborative Management. Philadelphia:Elsevier Mosby;2011.
45. Khwannimit B. Advances in the Treatment of septic shock. In: Khwannimit B, Editors. Consultative International Medicine. Songkla: Chanmuengkanpim;2011. (In Thai)
46. Aitken LM, Williams G, Harvey M, Blot S, Kleinpell R, Labeau S, Marshall A, Barruel GR, et al. Nursing consideration to complement the surviving sepsis campaign guidelines. Critical Care Medicine 2011;39(7):1800-1018.
47. Pibunnakit P. Sepsis. In: Srisawat C, Suitichamroon A, Ruengkanchanasate P, Payunwiwat W, Editors. Emergency Medicine. Bangkok: Namaksonkarnpim; 2551. (In Thai)
48. Ruth K, Leanne A, Christa AS. Implications of the new international sepsis guideline for nursing care. AJCC 2013;22(3):212-222.
49. Melnyk BM, Fineout-overholt E, Mays MZ. The evidence-based practice beliefs and implementation scales: Psychometric properties of two new instruments. Worldview on Evidence-Based Nursing 2008;5(4):208-16.
50. Shin TG, Jo IJ, Choi DJ, Kang MJ, Jeon K, Suh GY, et al. The effect of emergency department crowding on compliance with the resuscitation bundle in the management of severe sepsis and septic shock. Critical Care 2013;17:R224.
51. Andersson M, Ostholm-Balkhed A, Fredrikson M, Holmbom M, Hallgren A, Berg S, Hanberger H. Delay of appropriate antibiotic treatment is associated with high mortality in patients with communityonset sepsis in a Swedish setting 2018; https://doi. org/10.1007/s10096-019-03529-8
52. Yousefi H, Nahidian M, Sabouhi F. Reviewing the effects of an educational program about sepsis care on knowledge, attitude, and practice of nurse in intensive care units. Iranian Journal of Nursing and Midwifery Research 2012;17(2):S91.
หมายเหตุ: รายการหลักฐานเชิงประจักษ์ที่ใช้ในการพัฒนารูปแบบการดูแลผู้ป่วยภาวะติดเชื้อในกระแสโลหิตด้วยระบบทางด่วน (34 เรื่อง) คือ เอกสารอ้างอิงหมายเลข 13, 16-48
2. Song YH, Shin TG, Kang MJ, Sim MS, Jo IJ, Song KJ, et al. Predicting factors associated with clinical deterioration of sepsis patients with intermediate levels of serum lactate. Shock 2012;38(3): 249-54.
3. Dellinger RP, Levy MM, Rhodes A. Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock. Critical Care Medicine 2013;41:580-637.
4. Jason HM, David FG, Mark EM. Early Recognition: The real-limiting step to quality care for severe sepsis patients in the emergency department. Journal of Clinical Outcomes Management 2015;22 (5):211-21.
5. Rhee C, Dantes R, Epstein L, et al. Incidence and trends of sepsis in US hospitals using clinical vs claims data, 2009-2014. Journal of the American Medical Association 2017;318(13):1241-49.
6. Ministry of Public Health. Health Statistics 2017; 2017. (In Thai)
7. Martin GS, Mannino DM, Eaton S, Moss M. The epidemiology of sepsis in the United States from 1979 through 2000. New England Journal 2003;348:1546-54.
8. Kumar A, Roberts D, Wood KE. Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Critical Care Medicine 2006;34(6):1589-96.
9. Levy MM, Delinger RP, Townsend SR. The Surviving Sepsis Campaign: results of an international guideline-based perfoemance improvement program targeting severe sepsis. Intensive Care Medecine 2010; 36:222-31.
10. Levy MM, Rhodes A, Phillips GS. Surviving Sepsis Campaign: Association between performance metrics and outcomes in a 7.5-year study. Critical Care Medicine 2015;43:3-12.
11. Rhodes A, Evans LE, Alhazzani W. Surviving Sepsis Campaign: International guidelines for management of sepsis and septic shock: 2016. Intensive Care Medicine 2017;43:304-77.
12. Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, et al. Early Goal-Directed Therapy in the treatment of severe sepsis and septic shock. New England Journal Medicine 2001;345:1377-86.
13. Leelarassamee A. Sepsis and Septic Shock. In: Wanachiwanawin W, Siodsadaporn S, Somritchai W, Editors. Textbook of Internal Medicine: Disease of the 1. Bangkok: Pimdeekarnpim;2009. (In Thai)
14. Standard and quality improvement division Surin hospital. Sepsis review 2016;2016. (In Thai)
15. Diloksakulchai P. Evidence-base nursing: principle and method. Bangkok: Faculty of Nursing, Mahidol University; 2011. (In Thai)
16. Rowan MK, Augus DC, Bailey M, Barnato AE, Bellomo R, Canter RR, et al. Early, Goal-directed therapy for septic shock – A patient level metaanalysis. New Engl J Med 2017; 376(23):22232234. doi: 10.1056/NEJMoa1701380.
17. Chen X, Zhu W, Tan J, Nie H, Liangming L, Dongmei Y, Zhou X, Sun X. Early outcome of early-goal directed therapy for patients with sepsis or septic shock: A systematic review and metaanalysis of randomized controlled trials. Oncotarget 2017;8(16):27510-27519.
18. Jiang L, Zhang M, Jiang S, Ma Y. Early goaldirected resuscitation for patients with severe sepsis and septic shock : A meta-analysis and trial sequential analysis. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2016; 24:26. DOA 10.1 186/s13049-016-0214-7.
19. Xu JY, Chen QH, Liu SQ, Pan C, Xu XP, Han JB, Xie JF, et al. The effect of Early goal-directed therapy on outcome in adult severe sepsis and septic shock patients: A meta-analysis of randomized clinical trials. International Anesthesia Research Society 2016;123(2):371-381.
20. Yu H, Chi D, Wang S, Liu B. Effect of early goaldirected therapy on mortality in patients with severe sepsis or septic shock : A meta-analysis of randomized controlled trial. BMJ 2016; 63:e008330. Doi:10.1136/bmjopen-2015-008330.
21. Castellanos-Ortega A, Suberviola B, GarciaAstudillo LA, Holanda MS, Ortiz F, Llorca J, et al. Impact of the Surviving Sepsis Campaign protocols on hospital length of stay and mortality in septic shock patients: Results of a three-year follow-up quasiexperimental study. Critical Care Medicine 2010;38Z4X:1036-1043.
22. Onswadipong P, Sungkard K, Kusuma Na Ayuthya S, Rongrungruan Y. The effect of early goal-directed nursing intervention on severity of organ failure in patients with sepsis syndrome. Journal of Nursing Science 2011;29(2):102-10. (In Thai)
23. Unburee J. Effectiveness of implementing early goal-directed therapy nursing practice guidelines among patients with sepsis, Kamphaengphet Hospital. [Master Thesis]. Chiang Mai:Chiang Mai University;2012. (In Thai)
24. Srithundorn S. Nursing practice system development in using protocol for persons with sepsis syndrome in emergency department. [Master Thesis]. Bangkok:Rangsit University;2013. (In Thai)
25. Niyompruksa A, Chantara P, Yimyam P. System development in using clinical practice guideline in caring patients with sepsis syndrome. Journal of Nurses’ Association of Thailand, North-Eastern Division 2013;31(2):14-24. (In Thai)
26. Zoler ML. Systematic sepsis screening shows efficacy : Infection Diseases. 2009.[Serial on the Internet] [cited 2017 May 2]. Available from: www. Ehospitalistnews.com.
27. Tromp M, Hulscher M, Bleeker-Rovers CP, Peter L, Berg DT, Borm GF, et al. The role of nurses in the recognition and treatment of patients with sepsis in the emergency department : A prospective beforeand-after intervention study. International Journal of Nursing Studies 2010;47:1464-1473.
28. Askim A, Moser F, Gustad LT, Stene H, Gundersen M, Asvold BO, Dale J, Bjornsen LP, Damas JK, Solligard E. Poor performance of quick-SOFA (qSOFA) score in predicting severe sepsis and mortality – a prospective study of patients admitted with infection to the emergency department. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2017; 25-26.
29. Milano PK, Desai SA, Eiting EA, Holfmann EF, Lam CN, Menchine M. Sepsis bundle adherence is associated with improved survival in severe sepsis or septic shock. Western Journal of Emergency Medicine 2018; 19(5):774-781.
30. Andersson M, Ostholm-Balkhed A, Fredrikson M, Holmbom M, Hallgren A, Berg S, Hanberger H. Delay of appropriate antibiotic treatment is associated with high mortality in patients with communityonset sepsis in a Swedish setting 2018; https://doi. org/10.1007/s10096-019-03529-8.
31. Khuri CE, Dagher GA, Chami A, et al. The impact of EGDT on sepsis mortality in a single tertiary care center in Lebanon 2019;2019:1-8.
32. Worapratya P, Wanjaroenchaisuk A, Joraluck J, Wuthisuthimethawee P. Success of applying early goal-directed therapy for septic shock patients in the emergency department. Open Access Emergency Medicine 2016;8:1-6.
33. Kassyap CK, Abraham SV, Krishnan SV, Palatty BU, Rajeev PC. Factors affecting early treatment goals of sepsis patients presenting to the emergency department. Indian Journal of Critical Care Medicine 2018; 22(11):797-800.
34. Powthai S. Knowledge management in the development in the development of clinical nursing practice guideline for sepsis patients. [Master Thesis]. Bangkok:Christian University;2013.(In Thai)
35. Nueng Nasuwan W, Normkusol J, Thongjam R, Panaput T. Development of the nursing service system for patients with severe sepsis. Journal of Nursing and Health Care 2014;32(2):25-36. (In Thai)
36. Kowtragool N. Effects of using a case management system to improve the quality of care for the sepsis patients in Sakaeo Crown Prince Hospital. Thai Journal of Cardio-Thoracic Nursing 2014;25 (2):121-34. (In Thai)
37. Thiemsuwan Y, Malahom O, Yindesuk T, Kwanchang P, Prasertsri N. The development caring system of critical sepsis patients by case management at Sunprasithtiprasong Hospital, Ubon Ratchathani. Journal of Nursing and Health Care 2017; 35(1): 184-93. (In Thai)
38. Amphon K, Bunyoprakarn C, Sinkincharoen P. The outcomes of the development of the patients with septicemia, Prapokklao Hospital. Journal Prapokklao Hospital Clinical Medicine Education Center 2017;34(3):222-36. (In Thai)
39. Komol P. Quality of care management in persons with sepsis syndrome at emergency department in Singburi Hospital. The Association of Private Higher Education Institutions of Thailand Journal 2017;6(2):32-43. (In Thai)
40. Punvittayakool J, Maneeprai J. The development of care model for sepsis. Journal of Nursing Division 2018;45(1):86-104. (In Thai)
41. Suranatchayanan P, Kenthongdee W, Kamonrat S. Nursing care system development for sepsis patients at Loei Hospital. Journal of Nursing and Health Care 2018;36(1):207-15. (In Thai)
42. Jozwiak M, Monnet X, Teboul JL. Implementing sepsis bundles. Annals of Translational Medicine 2016; 4(17):332339.
43. Keeley A, Hine P, Nsutebu E. The recognition and management of sepsis and septic shock : A guide for non-intensivists. Postgrad Med J 2017; 93:626-634.
44. Baird MS. Manual of Critical Care Nursing : Nursing Intervention and Collaborative Management. Philadelphia:Elsevier Mosby;2011.
45. Khwannimit B. Advances in the Treatment of septic shock. In: Khwannimit B, Editors. Consultative International Medicine. Songkla: Chanmuengkanpim;2011. (In Thai)
46. Aitken LM, Williams G, Harvey M, Blot S, Kleinpell R, Labeau S, Marshall A, Barruel GR, et al. Nursing consideration to complement the surviving sepsis campaign guidelines. Critical Care Medicine 2011;39(7):1800-1018.
47. Pibunnakit P. Sepsis. In: Srisawat C, Suitichamroon A, Ruengkanchanasate P, Payunwiwat W, Editors. Emergency Medicine. Bangkok: Namaksonkarnpim; 2551. (In Thai)
48. Ruth K, Leanne A, Christa AS. Implications of the new international sepsis guideline for nursing care. AJCC 2013;22(3):212-222.
49. Melnyk BM, Fineout-overholt E, Mays MZ. The evidence-based practice beliefs and implementation scales: Psychometric properties of two new instruments. Worldview on Evidence-Based Nursing 2008;5(4):208-16.
50. Shin TG, Jo IJ, Choi DJ, Kang MJ, Jeon K, Suh GY, et al. The effect of emergency department crowding on compliance with the resuscitation bundle in the management of severe sepsis and septic shock. Critical Care 2013;17:R224.
51. Andersson M, Ostholm-Balkhed A, Fredrikson M, Holmbom M, Hallgren A, Berg S, Hanberger H. Delay of appropriate antibiotic treatment is associated with high mortality in patients with communityonset sepsis in a Swedish setting 2018; https://doi. org/10.1007/s10096-019-03529-8
52. Yousefi H, Nahidian M, Sabouhi F. Reviewing the effects of an educational program about sepsis care on knowledge, attitude, and practice of nurse in intensive care units. Iranian Journal of Nursing and Midwifery Research 2012;17(2):S91.
หมายเหตุ: รายการหลักฐานเชิงประจักษ์ที่ใช้ในการพัฒนารูปแบบการดูแลผู้ป่วยภาวะติดเชื้อในกระแสโลหิตด้วยระบบทางด่วน (34 เรื่อง) คือ เอกสารอ้างอิงหมายเลข 13, 16-48