Plambech Morten Z, Lurie Andrew I, Ipsen Helle L
Department of Anaesthesia and Emergency Medicine, Nykøbing Falster Hospital, Denmark.
Dan Med J. 2012 Dec;59(12):A4545.
Early screening and treatment of sepsis can reduce mortality. Region Zealand established guidelines for the diagnosis and treatment of sepsis. We assess an interdisciplinary intervention for implementation of these guidelines at the Department of Emergency Medicine at Nykøbing Falster Hospital from July 2009 to August 2010.
Structured training was imparted to personnel during the first 18 weeks. Electronically accessible guidelines, posters with diagnostic and treatment algorithms, pocket references and checklists were made available to encourage adherence to the guidelines. Key nurses and doctors encouraged compliance. Journal audits (at baseline, 18 weeks and one year) were undertaken to measure adherence to six elements of the sepsis guidelines: lactate measurement, oxygen and fluid treatment, timely antibiotic treatment, blood culture and planning of treatment monitoring.
A total of 27 (baseline), 29 (18 weeks) and 48 (one year) patients were included for analysis. Adherence to 3-5 of the elements of the sepsis guidelines' six elements increased from 37% to 65% from baseline to the first follow-up at 18 weeks (p = 0.03). Adherence to 3-5 of the elements decreased from the first to the second follow-up at one year. Lactate measurement, blood culture and antibiotic administration increased from baseline to the one-year follow-up.
The intervention had a positive effect on the implementation of guidelines. This effect was reduced one year after the baseline audit, possibly due to a decline in the focus on the intervention and/or personnel turnover in the department.
脓毒症的早期筛查和治疗可降低死亡率。西兰地区制定了脓毒症的诊断和治疗指南。我们评估了2009年7月至2010年8月在法尔斯特医院急诊科实施这些指南的跨学科干预措施。
在最初的18周内对工作人员进行了结构化培训。提供了电子可获取的指南、带有诊断和治疗算法的海报、袖珍参考资料和检查表，以鼓励遵守指南。关键护士和医生督促大家遵守。进行了日志审核（在基线、18周和1年时），以衡量对脓毒症指南六个要素的遵守情况：乳酸测量、氧气和液体治疗、及时的抗生素治疗、血培养以及治疗监测计划。
共纳入27例（基线）、29例（18周）和48例（1年）患者进行分析。从基线到18周的首次随访，脓毒症指南六个要素中3至5个要素的遵守率从37%提高到65%（p = 0.03）。从18周的首次随访到1年的第二次随访，3至5个要素的遵守率有所下降。从基线到1年随访，乳酸测量、血培养和抗生素使用情况有所增加。
该干预措施对指南的实施产生了积极影响。在基线审核1年后，这种效果有所降低，可能是由于对干预措施的关注度下降和/或科室人员更替。
