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护士在促使符合医疗保险和医疗补助服务中心质量指标方面的影响:早期管理综合方案,严重脓毒症/脓毒性休克(SEP-1)

Nurse Influence in Meeting Compliance With the Centers for Medicare and Medicaid Services Quality Measure: Early Management Bundle, Severe Sepsis/Septic Shock (SEP-1).

作者信息

Jorgensen Ann L

机构信息

Ann L. Jorgensen, MS, APN, PCCN, CVN, CPHQ, is a quality improvement coordinator at Advocate Aurora South Suburban Hospital, Hazel Crest Illinois. Her knowledge of sepsis includes medical record abstraction and experience as a Clinical Nurse Specialist in progressive care.

出版信息

Dimens Crit Care Nurs. 2019 Mar/Apr;38(2):70-82. doi: 10.1097/DCC.0000000000000340.

Abstract

Increased mortality has been identified as the sepsis cascade progresses from sepsis to severe sepsis to septic shock. Estimates reflect sepsis death rates ranging from 10% to 20%, severe sepsis death rates of 20% to 50%, and septic shock fatality rates of 40% to 80%. The high rates of morbidity, mortality, and Medicare costs prompted the Centers for Medicare and Medicaid Services to implement bundled care and public reporting of the Early Management Bundle, Severe Sepsis/Septic Shock (SEP-1) quality measure in 2015. Sepsis care bundles were identified to be beneficial since the 1990s as the bundle facilitates efficient, effective, and timely delivery of care to support quality improvement. The SEP-1 measure can be challenging and requires the nurse's active participation. Nurses need increased knowledge of the sepsis cascade and treatments as defined in the SEP-1 quality measure. Increased knowledge and application of bundle elements are lifesaving and can influence postdischarge outcomes. This article discusses the nurse's role in meeting the specific elements of each bundle and strategies to improve bundle compliance.

摘要

随着脓毒症从脓毒症发展为严重脓毒症再到脓毒性休克,死亡率不断上升。据估计,脓毒症死亡率在10%至20%之间,严重脓毒症死亡率在20%至50%之间,脓毒性休克死亡率在40%至80%之间。高发病率、高死亡率以及高昂的医疗保险费用促使医疗保险和医疗补助服务中心在2015年实施了捆绑式护理,并公开报告早期管理捆绑式护理、严重脓毒症/脓毒性休克(SEP-1)质量指标。自20世纪90年代以来,脓毒症护理捆绑式护理被认为是有益的,因为它有助于高效、有效且及时地提供护理,以支持质量改进。SEP-1指标可能具有挑战性,需要护士的积极参与。护士需要更多地了解脓毒症级联反应以及SEP-1质量指标中定义的治疗方法。增加对捆绑式护理要素的了解和应用可以挽救生命,并能影响出院后的结果。本文讨论了护士在满足每个捆绑式护理具体要素方面的作用以及提高捆绑式护理依从性的策略。

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