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- Title
- THE EFFECTS OF SEPSIS MANAGEMENT PROTOCOLS ON TIME TO ANTIBIOTIC ADMINISTRATION IN THE EMERGENCY DEPARTMENT.
- Creator
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Lorch, Margaret K, Bourgault, Annette, University of Central Florida
- Abstract / Description
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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.
Show less - Date Issued
- 2018
- Identifier
- CFH2000341, ucf:45734
- Format
- Document (PDF)
- PURL
- http://purl.flvc.org/ucf/fd/CFH2000341
- Title
- SEPSIS KNOWLEDGE IN UNDERGRADUATE NURSING STUDENTS.
- Creator
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Tilton, Kelsey E., Guido-Sanz, Francisco, University of Central Florida
- Abstract / Description
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Background: Sepsis is the most common cause of death in critically ill patients in settings other than cardiovascular intensive care units (ICUs). Research shows that early detection is the best way to prevent sepsis progression and improve patient outcomes. Nurses can play a critical role in the treatment of sepsis using their knowledge and resources to detect the presence of sepsis at the earliest possible point in the progression of the syndrome. Baccalaureate nursing students were...
Show moreBackground: Sepsis is the most common cause of death in critically ill patients in settings other than cardiovascular intensive care units (ICUs). Research shows that early detection is the best way to prevent sepsis progression and improve patient outcomes. Nurses can play a critical role in the treatment of sepsis using their knowledge and resources to detect the presence of sepsis at the earliest possible point in the progression of the syndrome. Baccalaureate nursing students were surveyed to assess students' beliefs and knowledge of sepsis and to examine the gaps in students' abilities to identify sepsis. Methodology: An instrument, consisting of 46 items, was developed and administered as a survey. The survey contained demographic questions, belief statements, knowledge questions on sepsis, and an unfolding case study designed to gauge students' understanding and recognition of sepsis. Data were analyzed for descriptive statistics. Participants were undergraduate nursing students recruited from baccalaureate programs across three campuses at the University of Central Florida. Results: The sample consisted of 40 participants. Over 75% (n=31) of participants were females, 42.5% (n=17) were over 27 years old, and 45% (n=18) had five to six years of previous college experience. Only 22% (n=11) of participants selected the three best measures to screen for sepsis at the bedside and 60% (n=24) identified the correct definition of sepsis. In the knowledge application section, 40% (n=16) of participants identified the correct patient in the beginning of the case study (i.e., most likely for developing sepsis or showing signs and symptoms of sepsis). Discussion: Most students reported that they were relatively comfortable with their abilities to identify sepsis in the clinical setting. However, there were some clear gaps in students' understanding of sepsis, particularly related to general knowledge about sepsis and recommended bedside screening measures. Education on sepsis is key to provide timely care to septic patients and to provide them with the best care possible. Conclusion: This study identified gaps in baccalaureate nursing students' understanding of sepsis. Addressing these knowledge deficits could provide students with the ability to identify sepsis earlier and improve patient outcomes in their future practice.
Show less - Date Issued
- 2019
- Identifier
- CFH2000574, ucf:45694
- Format
- Document (PDF)
- PURL
- http://purl.flvc.org/ucf/fd/CFH2000574
- Title
- Pre and Post Implementation Evaluation of an Emergency Department Severe Sepsis Alert and Practice Protocol.
- Creator
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Williams, Darleen, Andrews, Diane, Sole, Mary Lou, Parrish, Gary, University of Central Florida
- Abstract / Description
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ABSTRACTSevere sepsis kills an estimated 1,400 people worldwide every day. This often fatal infectious process accounts for an estimated 215,000 deaths in the United States (US) annually. The main goal of this project was to evaluate the impact of the Emergency Department Severe Sepsis Alert and Practice Protocol (EDSSAPP) post implementation, on time to first antibiotic administration, length of stay, and mortality in patients admitted via the ORMC ED with severe sepsis.This study evaluated...
Show moreABSTRACTSevere sepsis kills an estimated 1,400 people worldwide every day. This often fatal infectious process accounts for an estimated 215,000 deaths in the United States (US) annually. The main goal of this project was to evaluate the impact of the Emergency Department Severe Sepsis Alert and Practice Protocol (EDSSAPP) post implementation, on time to first antibiotic administration, length of stay, and mortality in patients admitted via the ORMC ED with severe sepsis.This study evaluated the time to first antibiotic administration, total ED and hospital length of stay (LOS) and mortality of severe sepsis patients either with a severe sepsis alert (SSA) activated or no alert activated that were admitted to the hospital through the ED. A retrospective review of the electronic medical record (EMR) was conducted to gather the required data across three time cohorts: base line/time zero (T0), six months prior to the implementation of EDSSAPP; Time one (T1) the first six months following initial EDSSAPP implementation; and Time two (T2), six months following reinstatement of the corporate sepsis committee. The most significant finding of this study was the increased number of Severe Sepsis Alerts activated in time cohort T2 (n=113) compared to T1 (n=19). Another important finding was the decreased mortality in T2 (16.4%) compared to T0 (22.7%) and T1 (33%). Overall, the number of ED patients with severe sepsis who received antibiotics within the EDSSAPP required 60 minutes did not consistently improve across the three time cohorts, T0 (81.8%), T1 (71.7%) and T2 (80.6%).The hospital LOS of stay was increased by almost 1.5 days between those patients with a severe sepsis alert activated in T1 (9.00 days) compared to time T2 (10.48 days). There was no significant decrease in the ED LOS across time cohorts and between groups of patients who had a SSA activated versus no alert activated. However, there was a 1 hour and 28 minute decrease in ED LOS in patients who had a severe sepsis alert activated in T1 compared to T0. In addition, there was a 1 hour and 52 minutes decrease in ED LOS between patients who had a SSA activated compared to those who had no alert activated in T2.While EDSSAPP data does not demonstrate the statistically significant results that was expected, the challenges related to adherence by providers to EDSSAPP is as it is seen in the literature. Increased awareness via consistent communication of on-going audit results to ED personnel will heighten their awareness for severe sepsis and EDSSAPP. Improved collaborative efforts with the interdisciplinary team are needed to refocus everyone's efforts to increase early recognition that is followed by appropriate treatment interventions and documentation is essential. Lastly, the development of a formal process to follow up with individual providers as close to real time as possible following a SSA that includes accountability for care provided and related documentation would also contribute to both awareness and adherence.
Show less - Date Issued
- 2015
- Identifier
- CFE0005739, ucf:50075
- Format
- Document (PDF)
- PURL
- http://purl.flvc.org/ucf/fd/CFE0005739
- Title
- PROTOCOL BASED SCREENING TOOLS TO IDENTIFY SEPSIS PATIENTS TRANSPORTED BY EMERGENCY MEDICAL SERVICES.
- Creator
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Moser, Isaiah, Talbert, Steven, University of Central Florida
- Abstract / Description
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Sepsis is a complicated disorder in which an infection has reached the bloodstream and caused a cascade of events that in time will lead to death. Interventions aimed at identifying sepsis early in its progression are imperative to stopping the process. The purpose of this study is to examine the current state of the literature regarding sepsis screening tools utilized by emergency medical services. A literature review exploring the various tools in place was conducted to see their value in...
Show moreSepsis is a complicated disorder in which an infection has reached the bloodstream and caused a cascade of events that in time will lead to death. Interventions aimed at identifying sepsis early in its progression are imperative to stopping the process. The purpose of this study is to examine the current state of the literature regarding sepsis screening tools utilized by emergency medical services. A literature review exploring the various tools in place was conducted to see their value in predicting sepsis and secondary what the initiation of a sepsis alert has on the patients' outcome. Results found included that sepsis screening tools when in place decrease time to identification, decrease time to antibiotics, increase amount of fluid administration, and overall reduce hospital stay and mortality rate. With these findings educational training for EMS providers and the introduction of generalized protocols are of the upmost importance. Further research is needed to be done to create a consistent tool to be used by all EMS agencies that has a validated predictive value of sepsis.
Show less - Date Issued
- 2017
- Identifier
- CFH2000155, ucf:46061
- Format
- Document (PDF)
- PURL
- http://purl.flvc.org/ucf/fd/CFH2000155
- Title
- BARRIERS AFFECTING COMPLIANCE WITH THE IMPLEMENTATION OF EARLY GOAL DIRECTED THERAPY IN THE EMERGENCY DEPARTMENT.
- Creator
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Castro, Ivan, Blackwell, Christopher, University of Central Florida
- Abstract / Description
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Early Goal Directed Therapy (EGDT) has been thoroughly researched and clinically supported to be effective at lowering morbidity and mortality associated with severe sepsis and septic shock. Due to the strengths of its efficacy, it has been integrated as an essential component of the Surviving Sepsis Campaign. However, very few studies have explored the barriers that affect compliance of the protocol in actual practice. The purpose of this study was to synthesize current research findings...
Show moreEarly Goal Directed Therapy (EGDT) has been thoroughly researched and clinically supported to be effective at lowering morbidity and mortality associated with severe sepsis and septic shock. Due to the strengths of its efficacy, it has been integrated as an essential component of the Surviving Sepsis Campaign. However, very few studies have explored the barriers that affect compliance of the protocol in actual practice. The purpose of this study was to synthesize current research findings regarding nursing barriers associated with EGDT. This research was limited to studies performed in the United States between 2003-2012, with patients at least 18 years old, and with data obtained from studies conducted within emergency departments (EDs) only. These findings may serve to help increase the compliance rate with the protocol among nurses in the ED. Findings indicated that compliance rates were mostly affected by two major barriers: 1) Lack of knowledge regarding the presentation and management of sepsis and septic shock, and 2)Lack of resources in the ED to perform the protocol to its full potential. Limitations of the review noted were that most research studies used were in major academic hospitals which limited the generalizability of the findings to other hospital settings. Nursing education should emphasize early recognition and aggressive treatment of sepsis. Future research should focus on addressing the most efficient ways to educate nurses on sepsis presentation and management and the ways these can be implemented in practice.
Show less - Date Issued
- 2013
- Identifier
- CFH0004420, ucf:45095
- Format
- Document (PDF)
- PURL
- http://purl.flvc.org/ucf/fd/CFH0004420
- Title
- Physical-Virtual Patient Simulators: Bringing Tangible Humanity to Simulated Patients.
- Creator
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Daher, Salam, Welch, Gregory, Gonzalez, Laura, Cendan, Juan, Proctor, Michael, University of Central Florida
- Abstract / Description
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In lieu of real patients, healthcare educators frequently use simulated patients. Simulated patients can be realized in physical form, such as mannequins and trained human actors, or virtual form, such as via computer graphics presented on two-dimensional screens or head-mounted displays. Each of these alone has its strengths and weaknesses. I introduce a new class of physical-virtual patient (PVP) simulators that combine strengths of both forms by combining the flexibility and richness of...
Show moreIn lieu of real patients, healthcare educators frequently use simulated patients. Simulated patients can be realized in physical form, such as mannequins and trained human actors, or virtual form, such as via computer graphics presented on two-dimensional screens or head-mounted displays. Each of these alone has its strengths and weaknesses. I introduce a new class of physical-virtual patient (PVP) simulators that combine strengths of both forms by combining the flexibility and richness of virtual patients with tangible characteristics of a human-shaped physical form that can also exhibit a range of multi-sensory cues, including visual cues (e.g., capillary refill and facial expressions), auditory cues (e.g., verbal responses and heart sounds), and tactile cues (e.g., localized temperature and pulse). This novel combination of integrated capabilities can improve patient simulation outcomes. In my Ph.D. work I focus on three primary areas of related research. First, I describe the realization of the technology for PVPs and results from two user-studies to evaluate the importance of dynamic visuals and human-shaped physical form in terms of perception, behavior, cognition, emotions, and learning.Second, I present a general method to numerically evaluate the compatibility of any simulator-scenario pair in terms of importance and fidelity of cues. This method has the potential to make logistical, economic, and educational impacts on the choices of utilizing existing simulators.Finally, I describe a method for increasing human perception of simulated humans by exposing participants to the simulated human taking part in a short, engaging conversation prior to the simulation.
Show less - Date Issued
- 2018
- Identifier
- CFE0007750, ucf:52402
- Format
- Document (PDF)
- PURL
- http://purl.flvc.org/ucf/fd/CFE0007750
