1. Dawn Drahnak, DNP, RN, CCNS, CCRN, Courtney Boast, BS
Effects of Clinical Reminders for Severe Sepsis on Patient Outcomes and Nurse Action
Dawn Drahnak, DNP, RN, CCNS, CCRN, Courtney Boast, BS
Abstract
Introduction
Methods & Materials
Results & Conclusions
Sepsis is a leading cause of death in the United States (US) (750,000) with significant financial burden associated with treating sepsis ($20 billion annually in US).
A strong body of evidence correlates prompt diagnosis, antimicrobial therapy, risk stratification, and hemodynamic stabilization to significant reductions in sepsis-related mortality.
Despite this evidence, healthcare organizations continue to struggle to identify, treat, and document sepsis in a timely manner. Healthcare organizations recognize this struggle first hand and continues to demonstrate suboptimal compliance with
SEP-1 guidelines which may have a negative impact on patient outcomes.
This project seeks to audit EHR records of patients with severe sepsis and evaluate the effect of the best practice alerts (BPAs) on patient outcomes and nurse actions.
Specific Aims:
1) Reduce the number of clinical reminders (Best Practice Alerts – BPAs) for sepsis in the inpatient adult population (> 18 years) through clinical reminder customization.
2) Improve patient safety through implementation of meaningful clinical reminders and in turn decrease clinical reminder fatigue in nurses.
3) Determine if nurses’ action to clinical reminders for sepsis was appropriate and if it affected patient outcome (failure to rescue or delay in implementation of the sepsis bundle) – Electronic Health Record (EHR) review of patients’ EHRs that triggered clinical reminders for sepsis.
Hypotheses:
A revision for the clinical reminder/Best Practice Alert (BPA) for sepsis will:
A. Decrease the frequency of nuisance clinical reminders/BPA,
B. Decrease nurse “alarm fatigue” thereby positively changing nurse action to clinical reminder/BPA,
C. Positively affect patient outcome by decreasing either/both failure to rescue or/and time to sepsis bundle implementation
Preliminary Data (Implementation Phase in Process)
Setting
Acute and Critical Care Units
Participants
Patient accounts that trigger BPA for Sepsis
Acute and Critical Care Nurses and Clinicians
Potential benefit
Minimize nuisance BPAs (clinical reminders)
Improve Patient (w/ Severe Sepsis/Septic Shock Diagnosis) Outcomes
To what extent do you feel frequent irrelevant clinical reminders/BPAs for sepsis lead to reduced attention or response (fatigue) to clinical reminders/BPAs when they occur?
Of all the clinical reminders/BPAs (for sepsis) you have encountered in patient records, estimate the percent that are false or irrelevant (the patient does not require clinical intervention).
Pre/post data extraction (audit) of the impact of the study interventions (editing the BPA, updating nurse and physician on latest sepsis guidelines)
Pre/post Nursing survey: The survey tool was created by the principal investigator and reviewed by content experts
Duration & Timeline (Approx. 1 year)
(1.5 months) Define: Identify the project scope and goals
(2 months) Measure: Pre (existing) conditions
(1.5 months) Analyze: Pre data and determine gaps between current performance
and goal, prioritize opportunities for improvement, develop interventions for improvement create
implementation plan for the interventions
(1.5 months) Improve: Implementation of interventions for improvement and stabilization
(0.5 month) Control: Develop and implement ongoing monitoring plan (prevent reverting back to “old way”)
Pre-Study Total BPAs for Severe Sepsis