使用脓毒症途径加速熟练护理设施中脓毒症的检测和干预。
Accelerating Detection and Intervention for Sepsis in Skilled Nursing Facilities Using a Sepsis Pathway.
机构信息
COVID Operations, United Health Care, Valencia, California (Dr Ahmed); Santa Clarita Nursing Facility, Newhall, California (Ms Macapili); Department of Otolaryngology-Head & Neck Surgery, University of Michigan Medical School, Ann Arbor, and Global Tracheostomy Collaborative, Raleigh, North Carolina (Dr Brenner); and Department of Nursing Faculty, and Outcomes After Critical Illness and Surgery Research Group, Johns Hopkins University, Baltimore, Maryland (Dr Pandian).
出版信息
J Nurs Care Qual. 2024;39(1):67-75. doi: 10.1097/NCQ.0000000000000729. Epub 2023 Jun 22.
BACKGROUND
Early detection of sepsis decreases mortality in hospitals, but recognition of sepsis is often delayed in skilled nursing facilities (SNFs).
LOCAL PROBLEM
A local SNF in the northeastern United States sought to use a standardized sepsis pathway to prevent hospital readmissions due to sepsis.
METHODS
A pre-/postimplementation design was used for this project. Outcome measures included sepsis detection and treatment, length of stay in the SNF, sepsis-related hospital transfer rate, mortality rate, and predictors of clinical outcomes.
INTERVENTIONS
A SNF sepsis pathway was developed based on current sepsis detection tools. The pathway incorporated a sepsis screening tool and a sepsis bundle. Implementation of the pathway involved education of nurses and certified nursing assistants on the pathway.
RESULTS
A total of 178 patients were included in data analysis (81 preimplementation and 97 implementation). Sepsis recognition increased from 56% to 86% ( P < .001), and sepsis-related hospital transfers decreased from 68% to 44% ( P = .07). Laboratory testing for lactate, white blood cell count, and blood cultures increased, and sepsis intervention rates significantly improved ( P < .001).
CONCLUSIONS
Implementing a modified SNF sepsis pathway accelerated identification of sepsis and improved clinical outcomes.
背景
早期发现败血症可降低医院的死亡率，但在熟练护理机构（SNF）中，败血症的识别往往会延迟。
当地问题
美国东北部的一家当地 SNF 试图使用标准化的败血症途径来防止因败血症导致的医院再次入院。
方法
该项目采用了预/后实施设计。结果测量包括败血症的检测和治疗、在 SNF 的住院时间、与败血症相关的医院转率、死亡率以及临床结果的预测因素。
干预措施
根据当前的败血症检测工具，制定了 SNF 败血症途径。该途径包括败血症筛查工具和败血症捆绑包。该途径的实施涉及对护士和注册护士助理进行途径培训。
结果
共有 178 名患者纳入数据分析（81 名实施前和 97 名实施后）。败血症的识别率从 56%增加到 86%（P<0.001），与败血症相关的医院转率从 68%下降到 44%（P=0.07）。乳酸、白细胞计数和血液培养的实验室检测增加，败血症干预率显著提高（P<0.001）。
结论
实施改良的 SNF 败血症途径可加速败血症的识别并改善临床结果。
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