الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 180 |  |  |
| | | from | 180 | | |
Abstract
Sepsis is a time-sensitive condition, so timely, evidence-based emergency sepsis treatment saves lives. Early identification and response by nurses at the initial points of care thus facilitates a rapid increase in treatment, reducing patient decline and death. That can be done through implementation of sepsis clinical pathway which demonstrate positive clinical outcomes and become widely adopted by critical care team members.
Materials & Method
A Quasi-experimental research design was used to determine the outcomes of implementing a clinical pathway for critically ill patients with sepsis. The study was carried out at the ICUs of the Alexandria Main University Hospital (AMUH), namely: the reception and resuscitation unit.
A convenience sample of 80 newly admitted critically ill adult patients who were admitted to the previously mentioned units constituted the subjects for this study. The sample was equally assigned into two equal groups (40 patients in each): group “A” the control group were subjected to unit routine care and group “B”, the study group were subjected to the clinical pathway. The study sample size was calculated by power analysis using (Epi-Info program), Population size = 100, expected frequency=50%, acceptable error=5%, design effect=1, confidence coefficient=95% and power=80%.
One tool namely “Adult sepsis outcomes Assessment tool” was utilized to collect the data of this study. This tool was adapted by the researcher from Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016. This tool was used to determine the outcomes of implementing a clinical pathway for critically ill patients with sepsis. It consists of two parts: Part I named Patients’ demographic and clinical profile and Part II named Patient clinical variances.
Approval of ethics committee of the faculty of nursing was obtained. Permission to conduct the study was obtained from hospital responsible authority after explanation of aim of the study and delivery of an official letter from the Faculty of Nursing.
Results
Eighty patients were recruited in the current study. Regarding the sex, this table shows that 57.5% of the study group was males compared to 47.5% in the control group of patients. Additionally, 82.5 % of the study group had co-morbidities compared to 85.0% in the control group of patients.
Respiratory disorders represent the most encountered diagnosis among both groups. Furthermore, there was the most common encountered suspected source of sepsis in both groups was pneumonia. Also, 100.0% of study group aspirate blood culture compared to 0.0% in the control group of patients with highly statistical difference between the two groups (P= 0.001).
Regarding the most common encountered suspected source of sepsis in both groups was pneumonia and presented by infiltration, atelectasis, consolidation, pleural effusion, and congestion on chest X-ray. While the second encountered suspected source of sepsis in both groups was urinary tract infection. Moreover, 57.5% of the study group were proceeded from sepsis to septic shock, compared to 77.5% in the control group with statistical significance differences between the two groups (P= 0.003).
Likewise, the current study shows that the mean time of starting management in study group (30 min) is less than time of starting management of control group (141.6 min) with a statistically significant difference between both groups.
Moreover, the results of the current study show that the mean time to initial antibiotic administration of the study group (96 minutes) is improved significantly after clinical pathway implementation, while the control group is 255 minutes. Also, there were a statistically significant differences in Arterial lactate, lactate clearance, level of consciousness, UOP, MAP, and HI when comparing zero time and consecutive times for study and control group.
Conclusion
from the present study it could be concluded that the implementation of a clinical pathway for critically ill patients with sepsis resulted in improvements in the effectiveness and timeliness of sepsis management.
Recommendations
from the conclusion, the following recommendations are suggested:
Recommendation regarding clinical practice:
- Hospital based sepsis clinical pathway is preferred as patients’ health related performance can be continuously assessed.
- Screening of sepsis can be performed via a paper tool; a screening tool and an alert system can improve survival from sepsis and septic shock.
- Develop a multidisciplinary critical care team to be responsible for the development and sustaining the early goal directed therapies in the emergency department and the ICU especially clinical pathway.
Recommendations regarding education and training:
- Hospitals should seek to improve their treatment of sepsis by set up individual unit-level surveys to identify baseline knowledge and possible barriers.
- Implementing an educational program for nurses, physicians, residents, and fellows lead to increased knowledge on sepsis and strict protocol control will improve patient outcomes. Also, can change the behaviors and has a positive impact on the outcomes of critically ill patients.
- Highlighting and signifying the concept of the early goal directed therapies as a clinical pathway in managing critically ill patient’s health problems in the undergraduate’s courses.
- In-service training for intern nurses to minimize the gap between their limited skills/experience and expected performance.
Recommendations regarding administration:
- Policies should be established to keep a qualified, dependable, and focused team to assess, plan, implement, and evaluate process change; Surviving Sepsis teams must be the primary vehicle to drive the change in the institution.
- Systems that link prehospital and ED standards of care that can drastically improve outcomes should be created.
- Develop policies to simplify the charting and documentation system as regard surveillance and management of sepsis.
Recommendations regarding future research:
- Continued investigations and research are needed to identify factors contributing to diagnosis, treatment, and outcomes in patients with sepsis.
- Future studies are needed to determine whether the approaches used in this study may be translatable to other organizations and care settings across the continuum of sepsis management.
- Larger studies will be required to determine if emergency medical services sepsis alert protocols or antibiotic administration decrease overall inpatient mortality or improve upon other functional outcomes.