Kumar Prashant, Jordan Mark, Caesar Jenny, Miller Sarah
South Canterbury DHB, New Zealand.
BMJ Qual Improv Rep. 2015 Sep 9;4(1). doi: 10.1136/bmjquality.u207871.w4032. eCollection 2015.
Sepsis is a common condition with a major global impact on healthcare resources and expenditure. The Surviving Sepsis Campaign has been vigorous in promoting internationally recognised pathways to improve the management of septic patients and decrease mortality. However, translating recommendations into practice is a challenging and complex task that requires a multi-faceted approach with sustained engagement from local stakeholders. Whilst working at a district general hospital in New Zealand, we were concerned by the seemingly inconsistent management of septic patients, often leading to long delays in the initiation of life-saving measures such as antibiotic, fluid, and oxygen administration. In our hospital there were no clear systems, protocols or guidelines in place for identifying and managing septic patients. We therefore launched the Sepsis Six resuscitation bundle of care in our hospital in an attempt to raise awareness amongst staff and improve the management of septic patients. We introduced a number of simple low-cost interventions that included educational sessions for junior doctors and nursing staff, as well as posters and modifications to phlebotomy trolleys that acted as visual reminders to implement the Sepsis Six bundle. Overall, we found there to a be a steady improvement in the delivery of the Sepsis Six bundle in septic patients with 63% of patients receiving appropriate care within one hour, compared to 29% prior to our interventions. However this did not translate to an improvement in patient mortality. This project forms part of an on going process to instigate a fundamental culture change among local healthcare professionals regarding the management of sepsis. Whilst we have demonstrated improved implementation of the Sepsis Six bundle, the key challenge remains to ensure that momentum of this project continues and forms a platform for sustainable clinical improvement in the long term.
脓毒症是一种常见病症，对全球医疗资源和支出产生重大影响。拯救脓毒症运动一直在积极推广国际认可的途径，以改善脓毒症患者的管理并降低死亡率。然而，将建议转化为实践是一项具有挑战性和复杂性的任务，需要采取多方面的方法，并持续让当地利益相关者参与其中。在新西兰一家地区综合医院工作时，我们对脓毒症患者看似不一致的管理感到担忧，这常常导致在启动抗生素、补液和输氧等救命措施方面出现长时间延误。在我们医院，没有明确的系统、方案或指南来识别和管理脓毒症患者。因此，我们在医院推出了脓毒症六步复苏护理包，试图提高工作人员的意识并改善脓毒症患者的管理。我们引入了一些简单且低成本的干预措施，包括为初级医生和护理人员举办教育课程，以及在采血推车上张贴海报并进行改进，以此作为实施脓毒症六步护理包的视觉提醒。总体而言，我们发现脓毒症患者接受脓毒症六步护理包的情况有稳步改善，63%的患者在一小时内得到了适当护理，而在我们干预之前这一比例为29%。然而，这并没有转化为患者死亡率的改善。该项目是正在进行的一个过程的一部分，旨在促使当地医疗专业人员在脓毒症管理方面实现根本性的文化变革。虽然我们已经证明脓毒症六步护理包的实施有所改善，但关键挑战仍然是确保该项目的势头持续下去，并形成一个长期实现可持续临床改善的平台。
