Developing a nursing care system for sepsis patients at Accident and Emergency department, Loei hospital

Abstract

The Research and Development study aimed at developing the nursing system for sepsis patients at Accident and Emergency department Loei Hospital. The participants were 26 registered nurses working in the emergency department. The 117 patients were admitted in the emergency department. The duration of the study was from March to October 2019. Data analysis used descriptive data in quantitative data by percentages and qualitative data using content analysis. The study used 2 cycle, each cycle consists of 4 steps; 1) data situation and planning, 2) Do, 3) Check and 4) Act. 

The findings were in the first cycle, the analysis conducted by 59 cases. The finding included screening sepsis from 2 out 3 symptoms by 83%, reporting Lactic in blood by 68%, fluid administration by 80%, antibiotic administration within 1 hour after ordering from doctors by 78%, surveillance prevention by SOS score 52% leading to late or ineffective referral system (SBP<90 mm.Hg by 31% and MAP<65 mm.Hg by 17%). The finding from the reflection of nurses found that old clinical guideline is not suitable for the context of the department, not adequate support to use clinical guidelines and more workload. Thus, the study supported to use of the clinical guideline of sepsis including remodeled old clinical guideline to being a fast track for sepsis patients, and improving nursing assignment, consulting the medical team for admitting. The second cycle, the researcher conducted a learning forum among doctors and nurses, plan assignments with communicating the criteria for admitting to doctors and nurses in the department. The study found reporting lactic blood levels increased from 68 to 76%. The administration of sufficient fluid increased from 80 to 90%. The administration of antibiotics within 1 hour after the treatment order increased from 78 to 91%. The surveillance according to the criteria increased by 52 to 61%. The SBP was<90 mm.Hg decreased from 31 to 12% and the MAP value was less than 65 mm.Hg decreased from 17 to 5%. Therefore, the nurse had a working system creates a policy of sepsis management and they were confidence and satisfaction. Besides, nurses can observe patients with signs of infection following guidelines and fast care so that nurses can aware of sepsis patients. The guideline helps nurses monitor and care for patients with closely, safety and appropriate referral system.