kNOw Sepsis: Creating a culture of early identification

During the COVID-19 pandemic an increase in sepsis mortality rate and length of stay (LOS) was observed. However, as the number of Covid-19 cases decreased, mortality and LOS remained elevated. The organization lacked a standardized process for early identification of sepsis. Surviving Sepsis Campaign guidelines recommend use of a screening tool for all hospitalized adults as this has been shown to improve patient outcomes. The purpose of this quality improvement (QI) project was to identify interventions to aid in early recognition and treatment of not present on admission (NPOA) sepsis and to assess the impact of those interventions. An interdisciplinary team led by clinical nurse specialists developed a sepsis screening tool for identification of NPOA sepsis. The tool was utilized by nurses to screen for sepsis in all inpatient adults, every shift. A nursing protocol was created to empower nurses to implement the initial steps of the sepsis bundle while activating a sepsis rapid response team. Ongoing Plan-Do-Study-Act (PDSA) cycles were completed for continuous QI. In the year following implementation of the screening tool, protocol, and sepsis rapid response team, an 11.1% reduction in NPOA severe sepsis/septic shock mortality was observed. Additionally, average LOS decreased by 0.33 days. The findings of this QI project suggest that implementation of a nurse-driven sepsis screening tool for inpatient adults may positively impact LOS and mortality. Empowering bedside nurses to use their clinical assessment skills in conjunction with critical thinking, the screening tool promotes a comprehensive and individualized assessment for each patient. The results of this QI project indicate that when nurses use standardized protocols to assess for signs of sepsis on a routine basis, development of sepsis is identified earlier, and more timely treatment is initiated. After implementation of a standardized screening process, a reduction in NPOA sepsis mortality and LOS was observed. Embedding a standardized screening process into nurses’ daily workflow resulted in a sustained culture of awareness.