Intensive Care Unit, University of Connecticut Health Center, Farmington, Connecticut, USA
School of Nursing, University of Connecticut, Storrs, Connecticut, USA.
BMJ Open Qual. 2022 Dec;11(4). doi: 10.1136/bmjoq-2022-001930.
In 2015, the Centers for Medicare and Medicaid Services developed a national quality bundle for the management of patients with severe sepsis and septic shock (SEP-1). Despite performance improvement measures, compliance remains low. This needs assessment is the first stage of a quality improvement initiative to improve SEP-1 compliance. Using a conceptual outcomes framework, this needs assessment analyses SEP-1 compliance data, knowledge, and competence to identify gaps in care and educational opportunities.
The needs assessment began with a review of national and statewide SEP-1 compliance data to identify a need for improvement. The needs assessment proceeded with a retrospective chart review to evaluate process measures and identify which providers would most likely benefit from educational interventions. A focus group provided perspective on the chart review findings.
During the period of 1 April 2017-31 March 2018, national SEP-1 compliance was 51% and compliance at the studied institution was 19%. The chart review included 51 patients (66.7% severe sepsis, 33.3% septic shock). Frequently missed SEP-1 measures included administration of intravenous fluids (0% severe sepsis, 58.8% septic shock), repeat lactate levels (52.6% severe sepsis, 60% septic shock), documentation of volume and tissue perfusion assessment (58.8%), vasopressor administration (73.3%) and administration of broad-spectrum antibiotics (76.5%, severe sepsis). Focus group perceptions identified themes related to gaps in declarative and dispositional knowledge.
This educational needs assessment highlights gaps in SEP-1 clinician performance, competence and knowledge. A multifaceted education programme is the next step for this performance improvement project. Education should include a series of meetings, activities, and workshops that include declarative knowledge, procedural knowledge and dispositional knowledge. Simulation activities can provide an opportunity for providers to demonstrate competence. Point-of-care prompts and performance measurement and feedback of patient care data can support clinician performance. This needs assessment underscores the need for a multifaceted approach to clinician education and performance to improve SEP-1 compliance.
2015 年，医疗保险和医疗补助服务中心（Centers for Medicare and Medicaid Services）制定了一项针对严重脓毒症和脓毒性休克（SEP-1）患者管理的国家质量捆绑包。尽管采取了绩效改进措施，但合规性仍然较低。本需求评估是一项旨在提高 SEP-1 合规性的质量改进计划的第一阶段。本需求评估使用概念性结果框架，分析 SEP-1 合规性数据、知识和能力，以确定护理中的差距和教育机会。
需求评估首先审查了国家和全州 SEP-1 合规性数据，以确定改进的必要性。需求评估接着进行了回顾性图表审查，以评估过程措施，并确定哪些提供者最有可能受益于教育干预。焦点小组对图表审查结果提供了看法。
在 2017 年 4 月 1 日至 2018 年 3 月 31 日期间，全国 SEP-1 的合规率为 51%，而研究机构的合规率为 19%。图表审查包括 51 名患者（66.7%为严重脓毒症，33.3%为脓毒性休克）。经常错过的 SEP-1 措施包括静脉输液（0%严重脓毒症，58.8%脓毒性休克）、重复乳酸水平（52.6%严重脓毒症，60%脓毒性休克）、记录容量和组织灌注评估（58.8%）、血管加压素管理（73.3%）和广谱抗生素管理（76.5%，严重脓毒症）。焦点小组的看法确定了与声明性和处置性知识差距相关的主题。
本教育需求评估突出了 SEP-1 临床医生表现、能力和知识方面的差距。多方面的教育计划是该绩效改进项目的下一步。教育应包括一系列会议、活动和研讨会，包括声明性知识、程序性知识和处置性知识。模拟活动可以为提供者提供展示能力的机会。床边提示以及患者护理数据的绩效测量和反馈可以支持临床医生的表现。本需求评估强调需要采取多方面的临床医生教育和绩效方法来提高 SEP-1 的合规性。
