Summary of Clinical Issue

This article covers a Summary of Clinical Issue.

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Use the \”Literature Evaluation Table\” to complete this assignment.

Select a nursing practice problem of interest to use as the focus of your research. Start with the patient population and identify a clinical problem or issue that arises from the patient population. In 200–250 words, provide a summary of the clinical issue.

Following the PICOT format, write a PICOT question in your selected nursing practice problem area of interest. The PICOT question should be applicable to your proposed capstone project (the project students must complete during their final course in the RN-BSN program of study).

Solution

Summary of Clinical Issue

One of the leading challenges that continue to bedevil healthcare systems worldwide in the 3rd decade of the 21st century is sepsis management. In medical terms, sepsis is defined as blood poisoning, a prevalent condition that is a common source of debilitation and fatal. Despite its long history in healthcare, the clinical parameters to concisely define sepsis are still debatable. The current proposed quality improvement project takes the term to refer to the systematic response that emanates from a microbial infection accompanied by some degree of organ malfunction (Paoli et al., 2018). According to these researchers, more than 970 000 cases of sepsis patients are admitted in the US hospitals and continue to increase by an average of 8.7% every year.

Their study noted that sepsis accounts for more than half of all hospital deaths, with mortality rates increasing dramatically with increasing disease severity. For example, sepsis mortality stands at 10- 20% for severe sepsis at 20- 40% and 40-80% in septic shock cases. Likewise, the average length of hospital stay in 2013 was reported to follow a similar pattern where it was 4.5 days for sepsis, 6.5 days for severe sepsis and 16.5 days for septic shock. Moreover, the cost of managing sepsis in the US hospitals was ranked at the top among admissions for all disease states.

Healthcare practitioners acknowledge that sepsis as a whole-body inflammatory response to an infection is a systemic overreaction widespread in modern times. Its incidence is more common than myocardial infarction and kills more patients than any form of cancer (World Sepsis Day, 2015). Left untreated or poorly managed, sepsis progresses to significant acute organ dysfunction medically categorized as severe sepsis, which may trigger a cascade of the mechanism leading to septic shock, multiple organ failure, and eventual death.

Be that as it may, one way of decreasing the condition’s high mortality rate and improved patient outcomes is early recognition, prompt diagnosis, and timely initiation of aggressive treatment through sepsis care optimization. Sepsis is a non- discriminate condition that affects people regardless of their age, race, or gender, but its effects are more devastating among the populations that are either underprivileged or disadvantaged. To facilitate innovative strategies and measures that would ensure accurate diagnostic methods and appropriate inpatient sepsis care that improves treatment and outcomes, this researcher formulated a PICOT based question as proposed by Melnyk and Fineout-Overholt in 2011.

PICOT Question:

‘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) over a period of 90 days (Time-T).’

CriteriaArticle 1Article 2Article 3
APA-Formatted Article Citation with PermalinkBurdick, 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. URL: https://informatics.bmj.com/content/27/1/e100109    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. URL: https://www.researchgate.net/publication/312211884_The_impact_of_evidence_based_sepsis_guidelines_on_emergency_department_clinical_practice_a_pre-post_medical_record_audit  Teles, F., Rodrigues, W. G., Alves, M. G. T. C., Albuquerque, C. F. T., Bastos, S. M. O., Mota, M. F. A., … & Silva, F. J. L. (2017). Impact of a sepsis bundle in wards of a tertiary hospital. Journal of intensive care5(1), 45. URL: https://jintensivecare.biomedcentral.com/track/pdf/10.1186/s40560-017-0231-2.pdf  
How Does the Article Relate to the PICOT Question?The study acknowledges that severe sepsis and septic shock are a leading cause fatalities in the US where early prediction of sepsis can lower adverse patient outcomes. The researchers sought to determine the effect of a machine learning algorithm for severe sepsis prediction which partly answers the outcome of the proposed PICOT question.The findings are relevant to the proposed PICOT question in that they establish the effect of pre – and post implementation of a sepsis guideline on triage assessment, ED management and on time to antibiotic thus improving sepsis care time to antibiotic.Its results demonstrate the impact of a sepsis bundle in hospital settings which would help the researcher decide which sepsis bundle to use for improved patient outcomes in a sepsis diagnosis.
Quantitative, Qualitative (How do you know?)Quantitative research study. It is a prospective clinical outcome evaluation.Quantitative Study. It is a one- year pre- and post-prospective randomized medical record audit.Quantitative study because it is a retrospective study.
Purpose StatementTo evaluate the impact of a machine learning algorithm for severe sepsis  prediction on in- hospital mortality, hospital length of stay and one month readmission.To explore the number of patients presenting with sepsis before and after Guideline implementation; the impact of sepsis guidelines on triage assessment, Emergency Department Management and the impact of guideline implementation on time to antibiotic. The number of patients presenting with sepsis before and after Guideline implementation; the impact of sepsis guidelines on triage assessment, Emergency Department Management and the impact of guideline implementation on time to antibiotic. To explore the number of patients presenting with sepsis before and after Guideline implementation; the impact of sepsis guidelines on triage assessment, Emergency Department Management and the impact of guideline implementation on time to antibiotic. To explore the number of patients presenting with sepsis before and after the implementation of a sepsis guideline on triage assessment, ED management and on time to antibiotic thus improving sepsis care time to antibiotic.To assess the impact of a sepsis protocol on the outcomes of patients in the wards of a tertiary hospital.
Research QuestionWhat is the effect a machine learning algorithm for severe sepsis prediction on in-hospital mortality, hospital length of stay and 30-day readmission?What is the impact of a sepsis guideline on triage assessment, ED management and on time to antibiotic thus improving sepsis care time to antibiotic?What is the impact of a sepsis protocol on the outcomes of patients in wards of a tertiary hospital?
OutcomeThere were reductions of in- hospital mortality, hospital length of stay and 30-day readmissions were observed in real-world clinical use of the machine learning-based algorithm. There was statistically significant 230 minute reduction in time to antibiotics after the implementation of the sepsis guidelines.There was 44% lower mortality when individuals who received a 3hour bundle compared to those who did not receive the bundle. The use of the 3h sepsis care bundle was directly linked to lower mortality rate.
Setting (Where did the study take place?)Multicenter diverse hospital settings of the performance of MLA for severe sepsis prediction from nine hospitals in some regions in the US.In one  metropolitan Australian Tertiary referral center ED.Osvaldo Brandao Vilela Unit at Santa Casa de Misericordia de Maceió Hospital, Brazil.
SampleData of 75 147 patient encounters between 2017 and 2018 abstracted from the HER systems.157 patients randomly selected for both pre – and post- groups.167 medical charts out of the 209 selected met the inclusion criteria.
MethodProspectively collected – real- world patient data from then EHR systems of the facilities had their clinical outcomes evaluated.A pre- post retrospective study randomized medical audit of adult patients diagnosed with sepsis.An observational retrospective study.
Key Findings of the StudyThe selected hospitals recorded decrease where the the in- hospital mortality  fell by 39.5%, the hospital length of stay fell by 32.3% and the one month readmission rate fell by 22.7% after using the MLA in clinical outcomes analysisAfter the implementation of a sepsis guideline tool, there a 230 minute reduction in time to antibiotics once the guidelines were implemented. The post group ( n=165) received  more urgent triage categories. There was also a 758  minute reduction in mean time to second litre of intravenous fluids and improved collection of baseline lactate.Implementation of sepsis protocol led to 44% lower mortality in individuals who received a 3hour bundle compared to those who did not receive the bundle. The use of the 3h sepsis care bundle was directly linked to lower mortality rate.
Recommendations of the ResearcherHospitals use predictive algorithm to improve sepsis related outcomes in live clinical settings.Sepsis guidelines positively impact on clinician decision making and behavior that supports best practice leading to better patient outcomes and should therefore be implemented in the ED to improve early assessment and triage.To reduce sepsis mortality rate, have shorter hospital length of stay and reduced ICU admission attributed to sepsis a sepsis protocol with systematic care in the wards should be implemented.
Summary of Clinical Issue
CriteriaArticle 4Article 5Article 6
APA-Formatted Article Citation with PermalinkRhodes, Andrew, Laura E. Evans, Waleed Alhazzani, Mitchell M. Levy, Massimo Antonelli, Ricard Ferrer, Anand Kumar et al. “Surviving sepsis campaign: international guidelines for management of sepsis and septic shock: 2016.” Intensive care medicine 43, no. 3 (2017): 304-377.URL: https://www.researchgate.net/publication/312503654_Surviving_Sepsis_Campaign_International_Guidelines_for_Management_of_Sepsis_and_Septic_Shock  Tarrant, C., O’Donnell, B., Martin, G., Bion, J., Hunter, A., & Rooney, K. D. (2016). A complex endeavour: an ethnographic study of the implementation of the Sepsis Six clinical care bundle. Implementation Science11(1), 149. URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5112724/  König, C., Matt, B., Kortgen, A., Turnbull, A. E., & Hartog, C. S. (2019). What matters most to sepsis survivors: a qualitative analysis to identify specific health-related quality of life domains. Quality of Life Research28(3), 637-647. URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6414230/
How Does the Article Relate to the PICOT Question?Its findings establish strategies of surviving sepsis and septic shock and therefore the guidelines can be incorporated in the proposed project.Its findings serve to demonstrate the efficacy of implementing the Sepsis Six clinical care bundle some of which the researcher may incorporate in the proposed intervention.Its findings illuminate the factors that matter most to ensure sepsis patients survive and have better patient outcomes thus decreasing the hospital length of stay.
Quantitative, Qualitative (How do you know?)Qualitative study. It is a consensus committee where nominal groups were assembled.Qualitative study. It is an ethnographic study.Qualitative study. A literature search was performed as the basis of an interview guide and subsequent qualitative analysis.
Purpose StatementTo provide an update to Surviving Sepsis Campaign Guidelines for Management of Sepsis and Shock, 2012.To examine frontline clinical practices in the implementation of the Sepsis Six.To identify the importance of health –related quality of life(HRQL)domains for the selected population
Research QuestionIn what ways can the Surviving Sepsis Campaign Guidelines for Management of Sepsis and Shock, 2012 be updated?In what ways can the Sepsis Six be implemented in frontline clinical practices?  What ate the important HRQL domains for sepsis survivors?
OutcomeThe Surviving Sepsis Guideline Panel came up with 93 statements on early management and resuscitation of patients’ sepsis or septic shock 18 of which were considered for best practice.Implementation strategies to promote reliable use of the Sepsis Six include education, engaging and motivating staff, and providing prompts for behavior, along with efforts to ensure that equipment required was readily availableEleven domains were identified as the key to helping sepsis survivors.
Setting (Where did the study take place?)In the US.In the UK, Scotland.In a Germany University hospital
SampleConsensus committee had 55 international experts reprenting 25 international organizations met.43 members of staff from six hospitals were interviewed.67 consecutive registry patients were invited where 15 of the interviews were analyzed.
MethodThe panel had five sections namely hemodynamics, infection, adjunctive therapies, metabolic, and ventilation. Population, intervention, comparison, and outcomes (PICO) questions were reviewed and updated as needed, and evidence profiles were generated.An ethnographic study was conducted.A literature search was performed to inform interview guide where 15 of the open ended interviewed and purposefully sampled.
Key Findings of the StudyThe Surviving Sepsis Guideline panel provided 93 statements on early management and resuscitation of patients with sepsis or septic shock. 32 of these statements strong recommendations, 39 were weak recommendations, and 18 were best‑practice statements.Six strategies were identified as implementation strategies focusing on education, engaging and motivating staff, and providing prompts for behavior, along with efforts to ensure that equipment required was readily available. This was realized using a sequence of six steps.Eleven domains were identified. These were Psychological impairment, Fatigue, Physical impairment, Coping with daily life, Return to normal living, Ability to walk, Cognitive impairment, Self-perception, Control over one’s life, Family support and Delivery of health care. Sepsis survivors want a “normal life”, to walk again, to regain control without cognitive impairment. Family support is essential to overcome sepsis aftermaths.
Recommendations of the ResearcherThere is need to use best evidence based recommendations for acute management of sepsis and septic shock as way of improving outcomes for critically ill patients.There is need to supplement the uptake of Sepsis Six through understanding of the sepsis bundle  in order to improve reliability through coordination of workflow.Since sepsis survivors want a normal life, the patients’ family members have a significant role to play so as to help the sepsis survivor overcome the condition’s aftermath. Offering the required assistance would help the sepsis survivor to walk again, and regain control devoid of cognitive impairment.
Summary of Clinical Issue

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Summary of Clinical Issue
Summary of Clinical Issue

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. URL: https://informatics.bmj.com/content/27/1/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 specific health-related quality of life domains. Quality of Life Research28(3), 637-647. URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6414230/

Paoli, C. J., Reynolds, M. A., Sinha, M., Gitlin, M., & Crouser, E. (2018). Epidemiology and costs of sepsis in the United States—an analysis based on timing of diagnosis and severity level. Critical care medicine46(12), 1889.

Rhodes, Andrew, Laura E. Evans, Waleed Alhazzani, Mitchell M. Levy, Massimo Antonelli, Ricard Ferrer, Anand Kumar et al. “Surviving sepsis campaign: international guidelines for management of sepsis and septic shock: 2016.” Intensive care medicine 43, no. 3 (2017): 304-377.URL: https://www.researchgate.net/publication/312503654_Surviving_Sepsis_Campaign_International_Guidelines_for_Management_of_Sepsis_and_Septic_Shock

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. URL: https://www.researchgate.net/publication/312211884_The_impact_of_evidence_based_sepsis_guidelines_on_emergency_department_clinical_practice_a_pre-post_medical_record_audit

Tarrant, C., O’Donnell, B., Martin, G., Bion, J., Hunter, A., & Rooney, K. D. (2016). A complex endeavour: an ethnographic study of the implementation of the Sepsis Six clinical care bundle. Implementation Science11(1), 149. URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5112724/

Teles, F., Rodrigues, W. G., Alves, M. G. T. C., Albuquerque, C. F. T., Bastos, S. M. O., Mota, M. F. A., … & Silva, F. J. L. (2017). Impact of a sepsis bundle in wards of a tertiary hospital. Journal of intensive care5(1), 45. URL: https://jintensivecare.biomedcentral.com/track/pdf/10.1186/s40560-017-0231-2.pdf

World Sepsis Day. (2015). Fact Sheet Sepsis. Retrieved from http://www.world-sepsisday.org/?MET=SHOWCONTAINER&vCONTAINERID=11

Question

Use the \”Literature Evaluation Table\” to complete this assignment.

  1. Select a nursing practice problem of interest to use as the focus of your research. Start with the patient population and identify a clinical problem or issue that arises from the patient population. In 200–250 words, provide a summary of the clinical issue.
  2. Following the PICOT format, write a PICOT question in your selected nursing practice problem area of interest. The PICOT question should be applicable to your proposed capstone project (the project students must complete during their final course in the RN-BSN program of study).
  3. The PICOT question will provide a framework for your capstone project.
  4. Conduct a literature search to locate six research articles focused on your selected nursing practice problem of interest. This literature search should include three quantitative and three qualitative peer-reviewed research articles to support your nursing practice problem.

Note: To assist in your search, remove the words qualitative and quantitative and include words that narrow or broaden your main topic. For example: Search for diabetes and pediatric and dialysis. To determine what research design was used in the articles the search produced, review the abstract and the methods section of the article. The author will provide a description of data collection using qualitative or quantitative methods. Systematic Reviews, Literature Reviews, and Metanalysis articles are good resources and provide a strong level of evidence but are not considered primary research articles.  Therefore, they should not be included in this assignment.

While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines

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