Nijmegen Institute for Infection, Inflammation, and Immunity (N4i), Radboud University Nijmegen Medical Centre, The Netherlands.
Int J Nurs Stud. 2010 Dec;47(12):1464-73. doi: 10.1016/j.ijnurstu.2010.04.007. Epub 2010 May 21.
In 2004, the Surviving Sepsis Campaign (SSC), a global initiative to reduce mortality from sepsis, was launched. Although the SSC supplies tools to measure and improve the quality of care for patients with sepsis, effective implementation remains troublesome and no recommendations concerning the role of nurses are given.
To determine the effects of a multifaceted implementation program including the introduction of a nurse-driven, care bundle based, sepsis protocol followed by training and performance feedback.
A prospective before-and-after intervention study conducted in the emergency department (ED) of a university hospital in the Netherlands.
Adult patients (≥16 years old) visiting the ED because of a known or suspected infection to whom two or more of the extended systemic inflammatory response syndrome (SIRS) criteria apply.
We measured compliance with six bundled SSC recommendations for early recognition and treatment of patients with sepsis: measure serum lactate within 6h, obtain two blood cultures before starting antibiotics, take a chest radiograph, take urine for urinalysis and culture, start antibiotics within 3h, and hospitalize or discharge the patient within 3h.
A total of 825 patients were included in the study. Compliance with the complete bundle significantly improved from 3.5% at baseline to 12.4% after our entire implementation program was put in place. The completion of four of six individual elements improved significantly, namely: measure serum lactate (improved from 23% to 80%), take a chest radiograph (from 67% to 83%), take urine for urinalysis and culture (from 49% to 67%), and start antibiotics within 3h (from 38% to 56%). The mean number of performed bundle elements improved significantly from 3.0 elements at baseline to 4.2 elements after intervention [1.2; 95% confidence interval=0.9-1.5].
Early recognition of sepsis in patients presenting to the ED and compliance with SSC recommendations significantly improved after the introduction of a predominantly nurse-driven, care bundle based, sepsis protocol followed by training and performance feedback.
2004 年，发起了旨在降低脓毒症死亡率的全球倡议——拯救脓毒症运动（SSC）。尽管 SSC 提供了衡量和提高脓毒症患者护理质量的工具，但有效的实施仍然存在问题，并且没有关于护士作用的建议。
确定一种多方面实施计划的效果，该计划包括引入以护士为驱动、以护理包为基础、遵循脓毒症方案，然后进行培训和绩效反馈。
在荷兰一所大学医院的急诊科进行的前瞻性前后干预研究。
因已知或疑似感染而就诊于急诊科的成年患者（≥16 岁），且患者符合两个或更多扩展的全身炎症反应综合征（SIRS）标准。
我们测量了对 SSC 早期识别和治疗脓毒症患者的六项护理包建议的依从性：在 6 小时内测量血清乳酸、在开始使用抗生素前采集两份血培养、拍摄胸片、采集尿液进行尿液分析和培养、在 3 小时内开始使用抗生素，以及在 3 小时内住院或出院。
共有 825 名患者纳入研究。在实施整个实施计划后，完整护理包的依从性从基线时的 3.5%显著提高到 12.4%。六个单独元素中的四个元素的完成情况显著改善，即：测量血清乳酸（从 23%提高到 80%）、拍摄胸片（从 67%提高到 83%）、采集尿液进行尿液分析和培养（从 49%提高到 67%），以及在 3 小时内开始使用抗生素（从 38%提高到 56%）。干预后，执行的护理包元素的平均数量从基线时的 3.0 个显著提高到 4.2 个[1.2；95%置信区间=0.9-1.5]。
在引入以护士为驱动、以护理包为基础、遵循脓毒症方案，然后进行培训和绩效反馈之后，急诊科就诊的脓毒症患者的早期识别和 SSC 建议的依从性显著提高。
