الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 84 |  |  |
| | | from | 84 | | |
Abstract
Sepsis affects more than 30 million people annually, and it results in 6 to 11 million
fatalities, according to estimates. The middle east and north Africa are thought to see between
780,000 and 970,000 cases of sepsis each year. Hospitalized sepsis patients account for onefourth
of all fatalities. Death rates for the most lethal ailments are almost 50%.
Sepsis is a global cause of morbidity, mortality, and healthcare expenses; therefore,
effective and precise therapy reduces sepsis consequences. Early diagnosis, early
antimicrobial treatment, and early hemodynamic resuscitation remain the cornerstones of
sepsis care. According to recent recommendations, the initial therapy and life-saving
measures should be initiated within an hour after the suspicion of sepsis. Serious morbidity
and mortality are linked to septic shock and severe sepsis.
Early goal-directed treatment (EGDT) as a set of evidence-based interventions that have
been shown to be more effective when used together than when used individually in therapy.
EGDT has significantly enhanced patient outcomes, as evidenced by a 16% decrease in
mortality.
Nurses contribute in early goal-directed therapy and sepsis management by being critical in
the early detection and treatment of sepsis. To prevent the progression of sepsis, they can carefully
monitor and assess patients’ health conditions and promptly administer nursing care. Nurses are
essential in the early detection, rapid diagnosis, and prompt treatment of patients with sepsis in
order to lower mortality and increase patient survival. In addition, nurses’ clinical evaluation skills
during triage and their involvement in sepsis research may aid in early identification, precise
severity prediction, and speedy sepsis therapy.
Barriers relating to patients, nursing, organizations, and healthcare teams have been
identified by the studied emergency care nurses that affected on the choice of whether to
begin EGDT.
All nurses of both gender (60) who are assigned in the direct care of the newly
admitted patients with sepsis at the previously mentioned units were included in study.
One tool was used in the current study:
Barriers of implementing early goal directed therapy among critically ill patients with sepsis
questionnaire: This tool consisted of four parts.
This tool included five parts:
Part one: Sociodemographic Data and work-related data
This part included age, gender, level of education, years of experience, and marital
status, implementation of early goal directed therapy.
Part two: Patient-related barriers:
This part included time of admission, diagnosis, severity of disease, complexity and
atypical presentation of early symptoms of sepsis, poverty of patient, conscious level of the
patient, comorbidity conditions which are complicating initial management such as human
immunodeficiency virus (HIV) or malnutrition, variability in environmental factors, or
genetic features of host response, presence of relatives at the time of admission, education level of the patients and family, these items rated on a dichotomous scale of (yes or no) and
the score assigned for each item as follow: Yes (for correct answer) and equal one, while no
(for incorrect answer) and equal zero.
Part three: Nurses related barriers:
It was used to assess nurse related barriers as Lack of awareness and familiarity about
EGDT protocol, lack of knowledge about sepsis, in sufficient knowledge about importance of
early goal directed therapy, lack of clinical skills, there are no clinical guidelines for implementing
EGDT, delay recognition of sepsis and septic shock, failure of communication between the staff
(Handoff failure), the burden of caring several patients (increase nurses’ workload), lack of
continuous supervision, mentorship, and support by senior manager, lack of training program,
shortage of the staff, lack of expertise in assessment of tissue perfusion indicators, delay in
obtaining samples from the patient for sepsis workup, delay in sending sample to the lab, delay in
starting management, lack of authority regarding initiation of fluid or vasopressors, lack of
motivations. These items rated on a dichotomous scale of (yes or no) and the score assigned for
each item as follow: yes (for correct answer) and equal one, while no (for incorrect answer) and
equal zero.
Part four: Organization related barriers:
It was included organization culture does not promote implementation of EGDT, time
consumed in admission procedures, lack of expertise, prolonged laboratory turnaround times, lack
of laboratory supplies as lactate level devices, lack of medications as vasopressor medications and
fluid, lack of supplies for taking blood culture under aseptic technique, lack of cardiac monitor
devices, infusion pump, lack of training sessions related to applying sepsis management, policy
related barriers in implementing EGDT, lack of collaboration and communications between
different departments, lack of agreement with clinical protocol on EGDT, presence of logistics
barriers (as places, administration affairs& papers), day of admission (working days and
holidays), lack of continuous monitoring and lack of supervision, prolonged turnaround time in
implementing EGDT, time consumed in patient transfers and admission, prolonged laboratory
turnaround times, limited pharmacy resources, these items rated on a dichotomous scale of (yes or
no) and the score assigned for each item a follow: Yes (for correct answer) and equal one, while
no (for incorrect answer) and equal zero.
Part V: Health care team related barriers:
It was used to assess barriers related to health care team other than the studied nurse’s
(physician, technician, consultant and other) whose action contributed to the encountered barriers.
This part included shortage of staff members, difficult in recognition of the patient condition, delay
in diagnosis, delay in prescription of medications, delay in insertion of central venous catheter,
Response time to patient (delay in placement of central venous catheter), Resistance to change to the
new guidelines of EGDT (doesn’t participate in training programs. each item on this tool was rated
on a dichotomous scale of (yes or no) and the score was assigned for each item as follow: Yes (for
correct answer) and equal one, while no (for incorrect answer) and equal zero.
The main findings of the current study were that:
Regarding EGDT implementation barriers among studied emergency care nurses, it was
clear that the majority of EGDT implementation barriers were Health care team related
barriers in nature, followed by patient related barriers and nurses related barriers in nature.
Barriers related to health team such as shortage of health care team, delay in diagnosis is a barrier to them, lack of multidisciplinary collaboration, resistance to change to the new
guidelines of EGDT (doesn’t participate in training programs and delay prescription, ordering
and delivery of fluids, medications, and vasopressors.
Furthermore, patient related barriers such as the presence of relatives at the time
of admission, age of the patients (greater than 60 years)diagnosis and comorbidity, severity
of the illness (SOFA score) and immunity status of the patient, moreover, nurses related barriers
such as Shortage of the staff, the burden of caring for several patients (Increase nurses’
workload),delay recognition of sepsis and septic shock, lack of training program, lack of
motivations, lack of awareness and familiarity with EGDT protocol, delay in obtaining samples
from the patient for sepsis workup. Finally organization related barriers such as lack of
collaboration and communication between different departments, prolonged laboratory
turnaround times, presence of logistics barriers (as places, administration affairs& papers),time
consumed in admission procedures, lack of expertise of the multidisciplinary team.
Finally, it can be recommended that:
The following recommendations on educational level are made based on the study’s
findings: Include early goal-directed therapy in undergraduate curriculum, teach emergency care
nurses about early goal-directed therapy in continuing education courses to update their
knowledge of new evidence-based practice, encourage nurses to attend early goal-directed therapy
workshops to clarify their role in nursing care, and on an administrative level, include: Implement
quality improvement techniques to improve the use of early goal directed therapy, lower the risk
of complications from sepsis, and guarantee that the materials required for EGDT implementation
are easily accessible.
Further studies are needed for developing educational programs to educate healthcare
providers about sepsis and EGDT, applying this study on a large popularity sample to validate
the results, developing nursing led protocols that empower nursing staff to implement EGDT
based on predetermined criteria, electronic reminder that a catheter is still in place. Regarding
clinical practice includes: availability of continuous supervision all over 24 hours to monitor
implementation of EGDT. Finally regular staff meeting, training and conference should be
conducted to discuss barriers of EGDT implementation, their categorization and their control.