Proposed Evidence-Based Practice Change on Early Sepsis Care Optimization

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Prepare this assignment as a 1,500-1,750 word paper

In the Topic 2 and Topic 3 assignments, you completed a qualitative and quantitative research critique on two articles for each type of study (4 articles total). Use the feedback you received from your instructor on these assignments to finalize the critical analysis of each study by making appropriate revisions.

The completed analysis should connect to your identified practice problem of interest that is the basis for your PICOT question.

Solution

Proposed Evidence-Based Practice Change on Early Sepsis Care Optimization

Introduction

Sepsis is a result of the body’s reaction to an infection. In healthy people, the body’s protective system, commonly known as the immune system, fights infection, but in some cases, help is required in the form of antibiotics, fluids, and other forms of therapeutic interventions to prevent sepsis from degenerating into a severe condition. In such a scenario, treatment becomes a prerogative to resolve the infection and to avoid organ dysfunction. Medically speaking, sepsis refers to blood poisoning, which is not only a common and debilitating health status of an individual but is equally a deadly condition that can be fatal. The word sepsis originates from ancient Greek describing rotten flesh, decay, as well as putrefaction.

As a whole-body inflammatory response when a patient suffers from an infection, sepsis is a severe and widespread systemic overreaction, with its incidence being more common than a heart attack. It ends in fatality numbers higher than those caused by any form of cancer alone (World Sepsis Day, 2015). If untreated or inadequately addressed, it can quickly progress to a significant acute organ dysfunction known as a severe shock, whose complications trigger a cascade of mechanisms resulting in septic shock, multiple organ failure, and eventually death. Septic shock is usually linked to gram-negative bacteria through other pathogens, are they protozoans, viruses, fungi, or even other bacteria is believed to emanate from endotoxins action or other products of the infecting agent. Once in the vascular system, these toxins cause large volumes of blood to be sequestered in the blood vessels, leading to histamine release, cytokines, and several other mediators.

The patient then exhibits clinical characteristics like chills, raised cardiac output, amongst other symptoms, and is under-recognized as sepsis symptoms mean its mortality remains high. Be that as it may, a positive outcome in sepsis patients largely depends on early recognition, prompt diagnosis, and timely execution of aggressive treatments. Consequently, this essay aims to present a finalized critical analysis of the literature that supports the proposed intervention of early sepsis care optimization herein known as Novel Sepsis Protocol to reduce the hospital length of stay (LOS) during and after the implementation period.

Background of the Studies

While the authors of the retrieved articles adopted different perspectives on how to address sepsis condition, they all had a consensus on its impact on the patient and the healthcare system. Notable among these effects is increased healthcare costs, which, according to Burdick et al. (2020), consumed 6% of the national hospital bill in 2013 alone within the USA. Likewise, Romero et al. (2017) acknowledged that sepsis remains a leading cause of death in healthcare facilities, with countries adopting sepsis’s early identification as a preventive measure despite being preventable. The two quantitative study’s findings have their significance in nursing as the subsequent conclusions, besides answering the researchers’ questions, means if other hospitals implement the measures used, then sepsis morbidity and mortality would go down, a significant indicator being the reduced number of days the admitted stay in hospital. Romero et al.’s (2017) purpose were similar to Burdick’s et al. (2020). Both had their point of convergence in the objective that an evidence-based sepsis guideline and a sepsis prediction algorithm would decrease the patient’s hospital length of stay amongst other positive outcomes.

How the Two Articles Support the Nurse Practice Issue of

Early Sepsis Care Optimization

The proposed PICOT Question that acts as a guide to my research study states ‘In adult patients diagnosed with sepsis (Population-P) does the implementation of a novel sepsis protocol (NSP) through machine learning-based sepsis prediction in the ED (Intervention-I) compared to conventional approaches lead to decreased hospital length of stay (Outcome- O) for 90 days (Time-T).’

            The study conducted by Burdick et al. (2020) directly responds to the proposed PICOT question in that the sepsis prediction algorithm directly affects the patient’s LOS, readmission, and mortality. That means, incorporating the intervention measured used would affect that NPS would also result in decreased LOS. Similarly, Romero et al.’s (2017) pre-post medical record audit determined that the sepsis guidelines positively affect early assessment, recognition, and management of sepsis patients. As evidence-based guidelines whose effectiveness has been demonstrated, the NPS intervention should also borrow from these guidelines. The two interventions compare to the NPS intervention in that the sepsis care algorithm and sepsis guidelines have an outcome that touches on the patient’s LOS. The comparison group in the proposed study are those patients who undergo conventional standards of sepsis care versus those of NPS guided maintenance and compare with the pre-intervention in the sepsis prediction algorithm or the pre- sepsis guidelines in the study conducted by Romero et al. (2017).

Method of Study

Like the proposed study, both Burdick et al. (2020) and Romero (2017) used a quantitative methodology approach but with different research designs. In the USA survey, real-world patient data were abstracted from the EHRs systems of Epic and prospectively collected in the nine hospitals selected for the study. This research design entailed a clinical outcomes analysis of the facilities that had implemented the machine learning algorithm for sepsis prediction and detection. The investigators then evaluated the data collected to establish what impact the algorithm had on patient outcomes of inpatient mortality, hospital LOS and one-month readmission. The study conducted in Australia saw researchers use a pre-post retrospective study of the 157 randomized medical audits that met the inclusion criteria.

In contrast, my research uses a quasi-experimental type as the research design. The selection of a research design is determined by several factors ranging from the kind of research question, the practical and ethical aspects. Regardless of the study design selected, each has its advantages and limitations. For example, using a prospective study design enables the researcher to collect exposure data that comparatively complete, but its downside is that the approach requires a long time for the investigators as they wait for the disease or event to happen. A retrospective study’s choice may be informed because it is a less expensive methodology to set up and consume much time. Contrariwise, its main drawback is that retrospective studies are generally conducted on a small scale and possess the inherent risk of collecting low levels of evidence, suffer more recall bias, and misclassification bias.

Results of Study

According to Burdick et al. (2020), the participating hospitals identified an average decrease of about 40% in total sepsis patients’ death. The LOS decreased by 32%, even as the one-month readmission rates fell by approximately 23%. These findings effectively demonstrated that MLA implementation’s efficacy would improve patient outcomes of the most notable being the outcome anticipated in the proposed study, as evidenced by decreased LOS. A critical analysis and comparison of the pre-post sepsis guideline implementation revealed that up to 230 minutes decreased towards antibiotic treatment initiation. In contrast, a 758-minute decrease was noted before the second liter of intravenous fluids was administered.

Specifically, the meantime to the second liter of IVF for the pre and post-group was 1128 minutes (with SD at 2669) and 370 minutes (with SD of 393), respectively. Just like the quantitative studies reviewed demonstrated that optimization of early sepsis care would lead to better patient and health outcomes, their counterparts who used qualitative research echoed similar sentiments backed by similar findings. A case in point is that of Tarrant et al. (2016), who found that adopting measures that ensured adherence to Sepsis Six should further be widened in scope to embrace other multiple and interdependent tasks like schedule prioritization.

Moreover, Konig et al. (2018) also highlighted some 11 domains underpinning the need for patients to control their lives backed by their families’ support. These measures would help the sepsis patient lead a normal life again. All four studies’ significance in nursing reminds the trained nurse of the importance of early sepsis recognition as this is the only way to ensure timely treatment and management of the condition to avoid progression to severe sepsis and septic shock whose complications are in and of themselves life-threatening.

Ethical Considerations

While the Intercollegiate Center for Nursing Education (ICNE) state five general principles of guidelines for ethical conduct in carrying out nursing research, the limited scope necessitates that only two will be discussed, respect for persons, respect for community, beneficence, justice, and contextual caring all have their importance in research. As an ethical principle, one respect for persons requires that the researcher not engage in any activity that would unnecessarily put the participants in harm’s way. If harm or discomfort in the study is inescapable, then there should be a solid justification, and more often than not, this should be the lesser of two evils. The researcher is also expected to expound on how the physical, psychological, or social/ economic harm is reduced.

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Proposed Evidence-Based Practice Change on Early Sepsis Care Optimization
Proposed Evidence-Based Practice Change on Early Sepsis Care Optimization

Ethical principle 2 focuses on informed consent, whose main ingredient is that the participants fully understand why they are taking part in the study within the research purpose, methods, expected outcomes, and likely risks. This principle of informed consent is that the; participants do so voluntarily, are not under duress, and still have the residue power to drop out of the study at any time. For whatever reason, they may opt to drop out of the study. Like in the proposed research, the investigators in the four articles reviewed sought approval from the Institution Review Board (IRB) and actively ensured that informed consent was maintained throughout the study’s duration. Additionally,

Outcomes Comparison

The proposed study’s primary outcome is that the successful implementation of NSP would decrease the number of days that inpatients remain admitted in the hospital selected as the project site. Secondary outcomes include reduced inpatient mortality attributed to sepsis and better patient outcomes, and enhanced patience and family satisfaction. As observed in the introductory section, better patient outcomes in sepsis patients are pegged on early recognition and prompt initialization of sepsis pharmacological interventions.

References

Burdick, H., Pino, E., Gabel-Comeau, D., McCoy, A., Gu, C., Roberts, J., … & Das, R. (2020). Effect of a sepsis prediction algorithm on patient mortality, length of stay, and readmission: a prospective multicentre clinical outcomes evaluation of real-world patient data from US hospitals. BMJ Health & Care Informatics27(1), e100109.

König, C., Matt, B., Kortgen, A., Turnbull, A. E., & Hartog, C. S. (2019). What matters most to sepsis survivors: a qualitative analysis to identify the specific health-related quality of life domains? Quality of Life Research28(3), 637-647.

Romero, B., Fry, M., & Roche, M. (2017). The impact of evidence‐based sepsis guidelines on emergency department clinical practice: a pre‐post medical record audit. Journal of clinical nursing26(21-22), 3588-3596.

Tarrant, C., O’Donnell, B., Martin, G., Bion, J., Hunter, A., & Rooney, K. D. (2016). A complex endeavor: an ethnographic study of the implementation of the Sepsis Six clinical care bundle. Implementation Science11(1), 149.

Question

Prepare this assignment as a 1,500-1,750 word paper

In the Topic 2 and Topic 3 assignments, you completed a qualitative and quantitative research critique on two articles for each type of study (4 articles total). Use the feedback you received from your instructor on these assignments to finalize the critical analysis of each study by making appropriate revisions.

The completed analysis should connect to your identified practice problem of interest that is the basis for your PICOT question.

Refer to \”Research Critiques and PICOT Guidelines – Final Draft.\” Questions under each heading should be addressed as a narrative in the structure of a formal paper.

Proposed Evidence-Based Practice Change

Discuss the link between the PICOT question, the research articles, and the nursing practice problem you identified. Include relevant details and supporting explanation and use that information to propose evidence-based practice changes.

General Requirements

Prepare this assignment according to the APA guidelines

Related FAQs

1. Can Early Screening interventions improve sepsis care in the emergency department?

A quality improvement project to improve early sepsis care in the emergency department The new protocol demonstrates that early screening interventions can lead to expedited delivery of care to patients with sepsis in the ED and could serve as a model for other facilities.

2. Can standardizing sepsis care reduce care variation?

Standardizing sepsis care reduces variation. The committee developed a sepsis power plan, a set of protocols and order sets accessed by one click within the EMR, to reduce care variation. The evidence-based bundled care interventions initiate nursing, lab, and pharmacy workflows, facilitating early treatment interventions

3. How can we improve outcomes with sepsis?

This involves the early identification of at-risk patients and prompt treatment with antibiotics, hemodynamic optimization, and appropriate supportive care. This has contributed significantly to the overall improved outcomes with sepsis.

4. How has sepsis changed over the years?

A revolutionary change in the way we manage sepsis has been the adoption of early goal-directed therapy. This involves the early identification of at-risk patients and prompt treatment with antibiotics, hemodynamic optimization, and appropriate supportive care.

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