Clinical Simulation: Caring for a Critically Ill Patient with Sepsis

Purpose: The purpose of this simulation research was to assess whether experienced critical care nurses could better apply currently recommended therapeutic interventions for patients with sepsis by using a horizons trends clinical decision support tool, rather than just standard monitoring screen shots alone. Methods: Simulation research participants (N=29) were first required to attend a didactic training session focusing on recognition and evidence-based treatment for critically ill patients with sepsis. Participants were then directed to apply these treatments in a simulated sepsis experience. Participants were brought into the simulation lab in a large booth at the National Teaching Institute Critical Care Nursing Conference, New Orleans, May 2005. A METI HPS (human patient simulator) was connected to a Philips Medical Systems Intellivue MP 90 and a Nellcor-Puritan-Bennett ventilator in a simulated critical care environment. Participants were given the patient history, and completed the rest of their assessment using the HPS and Intellivue patient monitoring. Data were collected to compare the use of bedside monitor displays with and without horizon screen trends in the care of patients with sepsis. Group 1 completed the sepsis scenario using a standard screen display, and group 2 had the addition of horizon trends on the display. Results: Table 1 highlights the differences between the 2 groups. The point that marked the onset of sepsis was when each of the physiologic parameters met the current evidence-based screening criteria The mean time to get to every therapeutic decision point was shorter in Group 2 than in Group 1.Table 1: Group Comparisons for Initiation of Appropriate Sepsis TreatmentsConclusions: While the number of participants was too low to reach statistical significance, results of this pilot study support the hypothesis that the use of horizons screen trends assisted the clinicians in making more rapid clinical decisions.