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THE EFFECTS OF SEPSIS MANAGEMENT PROTOCOLS ON TIME TO ANTIBIOTIC ADMINISTRATION IN THE EMERGENCY DEPARTMENT
Title
THE EFFECTS OF SEPSIS MANAGEMENT PROTOCOLS ON TIME TO ANTIBIOTIC ADMINISTRATION IN THE EMERGENCY DEPARTMENT.
Creator
Lorch, Margaret K, Bourgault, Annette, University of Central Florida
Abstract / Description
Sepsis is one of the leading causes of death in U.S. hospitals, resulting from organ dysfunction caused by an inappropriate inflammatory reaction to an infection. Timely treatment with empiric antibiotics in the emergency department is crucial to facilitate positive patient outcomes. The Surviving Sepsis Campaign (SSC) recommends initiating empiric antibiotic therapy within one hour of presentation to the emergency department. Some emergency departments have implemented sepsis management...
Show moreSepsis is one of the leading causes of death in U.S. hospitals, resulting from organ dysfunction caused by an inappropriate inflammatory reaction to an infection. Timely treatment with empiric antibiotics in the emergency department is crucial to facilitate positive patient outcomes. The Surviving Sepsis Campaign (SSC) recommends initiating empiric antibiotic therapy within one hour of presentation to the emergency department. Some emergency departments have implemented sepsis management protocols to guide care and ensure timely treatment. The purpose of this study is to determine the effect of a formal sepsis protocol in the emergency department on the time to antibiotic administration. A literature review was conducted using CINAHL, Cochrane Database, Health Source: Nursing/Academic Edition, and MEDLINE. Results from one systematic review, eight quasi-experimental studies, and four quality improvement projects suggested that implementation of a sepsis management protocol in an emergency department may decrease the time to antibiotic administration. ([less than] 10 = spell out) Eleven of the 13 articles reported decreased time to antibiotic administration by as much as 8-193 minutes compared to pre-protocol. One study met the SSC goal of 1 hour and reported a median administration time of 17 minutes. Time to antibiotics was influenced by protocols based on published sepsis guidelines, inclusion of antibiotic guidelines, nurse-initiated treatment, and education for emergency clinicians regarding sepsis management. Emergency departments should implement sepsis protocols adapted to their local institution to decrease time to antibiotic administration and reduce mortality of sepsis patients. Further research on how sepsis protocols affect antibiotic administration time is needed.
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Date Issued
2018
Identifier
CFH2000341, ucf:45734
Format
Document (PDF)
PURL
http://purl.flvc.org/ucf/fd/CFH2000341
PRONE POSITIONING IN ACUTE RESPIRATORY DISTRESS SYNDROME PATIENTS
Title
PRONE POSITIONING IN ACUTE RESPIRATORY DISTRESS SYNDROME PATIENTS.
Creator
Thornton, Sarah Rose H, Sole, Mary Lou, Bourgault, Annette, University of Central Florida
Abstract / Description
Introduction: Acute respiratory distress syndrome (ARDS), seen in critically ill patients, is a disease process that affects the lungs and directly impacts a patient's oxygenation. Despite treatment, patients often die of ARDS secondary to systemic complications. Prone positioning has been introduced as a treatment to improve the outcomes of ARDS patients. This thesis summarized and critiqued recent literature on the outcomes of prone positioning in ARDS patients. Methodology: An initial...
Show moreIntroduction: Acute respiratory distress syndrome (ARDS), seen in critically ill patients, is a disease process that affects the lungs and directly impacts a patient's oxygenation. Despite treatment, patients often die of ARDS secondary to systemic complications. Prone positioning has been introduced as a treatment to improve the outcomes of ARDS patients. This thesis summarized and critiqued recent literature on the outcomes of prone positioning in ARDS patients. Methodology: An initial literature search was conducted using CINAHL Plus with Text, Medline, Cochrane Database of Systematic Reviews, and US National Library of Medicine National Institutes of Health. Multiple search terms were used. Inclusion criteria consisted of peer reviewed research articles, academic journal articles, and evidence-based research or practices published within the last ten years. All studies included adult subjects and were published in the English language. Studies that did not address patient outcomes such as mortality, length of stay, or hemodynamic oxygenation were excluded from the review. Results: The review of literature contains one meta-analysis and two studies. Data indicated that prone positioning was statistically significant in reducing mortality when performed in sessions of 12 hours or longer (p=0.05). Hemodynamic oxygenation improved significantly after at least 48 hours of implementing prone positioning. There was no trend in the length of stay or duration in mechanical ventilation whether supine or prone positioning was used. Complications such as endotracheal tube dislodgement, incidence of ventilator-associated pneumonia, and pressure ulcers were reported in both supine and prone position with an increased risk of pressure ulcers and endotracheal tube obstruction in the prone position groups. Conclusions: Findings support a benefit in patient outcomes in patients placed in prone position with ARDS. Mortality was reduced when prone sessions lasted longer than 12 hours possibly due to the improvement in patient oxygenation 48 hours after initiation of prone positioning intervention. Further research is needed to solidify these findings and establish guidelines and optimal procedural methods to maximize patient outcomes and lower the incidence of patient complications.
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Date Issued
2018
Identifier
CFH2000337, ucf:45861
Format
Document (PDF)
PURL
http://purl.flvc.org/ucf/fd/CFH2000337