Overview
The scholarly activity I participated in was a one-time assessment of the sepsis intervention techniques by the critical care committee. Specifically, I was enjoined to a team of four inter-disciplinary professionals tasked with evaluating the efficiency of the 'Sepsis Six' clinical care bundle. The institution's quality management required a review of its efficiency and suggestions about its prospects, such as replacement. I was poised to benefit from understanding the key modalities such as Behaviour Change Technique (BCT) and Theoretical Domains Framework (TDF) in managing sepsis.
Problem
The hospital had recently witnessed an increasing mortality rate of up to 10% in patients with Modified Early Warning Scores (MEWS) of 8-11. A couple of reasons were probabilistically suggested, including possible methodological issues in behavioural modalities such as BCT and potential monitoring problems. The evaluation exercise was then slotted for two months, after which a report would be submitted to help the management make sense of the situation. The information would also contribute to the Global Sepsis Alliance's current studies, the International Medicine Journal, and the Journal of Clinical Endocrinology & Metabolism. As a key player in healthcare delivery, a nurse would benefit from the assessment by engaging, hands-on, in developing expertise by administering diagnoses and interventions to sepsis patients in intensive care units alongside other professionals.
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Solution
The team undertook an evidence-based care model to address the problem of escalating mortality rates. Having done a proper synthesis of TDF and BCT, the team obtained the following recommendations:
A need for coordinated effort between medical teams and emergency teams working with the Electronic Health Record (EHR) monitoring systems.
The need to introduce 'sepsis boxes and trolleys' in the Early detection (ED) units in to facilitate more rapid response to critical incidences.
We noticed incomplete compliance with all the six elements, particularly with precision in administering empiric intravenous antibiotics and measuring serum lactates. There was a need to enhance strict adherence.
The need to fine-tune EHR systems – The team recommended adopting Sequential Organ Failure Assessment (qSOFA) instead of Systemic Inflammatory Response Syndrome (SIRS) and MEWS.
Opportunities
The field of sepsis remedy – particularly the effectiveness of 'Septic Six" – is full of opportunity. There is a wide gap in research about vasoactive drugs' influence on serial serum lactate readings (Kumar et al., 2015). Further research drawing meaningful links to the two would be gladly appreciated.
Roberts et al. (2017) also observe a shortage in data linking early goal-directed therapy (EGDT) with mortality rate, as well as accurate data on deaths directly attributed to EHR failure.
There high cost of the research was a limiting factor. That expresses an opportunity in scholarly that could reduce the financial labour in evaluating sepsis treatment modalities.
Also, the team established that EHR alert systems had sensitivity issues. In recommending a transition from SIRS to SOFA, the paper signals opportunity for further studies to find a stable and reliable ticket and alert system.
Being part of the scholarly activity was an enriching experience. It was equally challenging and fulfilling working out complex readings to the Computerized Physician Order Entry (CPOE) systems and evaluating complex metrics in MEWS algorithms. Above all, I acquired familiarity with electronic medical systems and reliably assessed most of the data from Sigma Six against patient outcomes. The experience of working on a multi-disciplinary team also comes as a surplus.
Program competencies
Intra-professional collaboration: I worked alongside multi-disciplinary professionals consisting of general surgeons, nurses, and clinical practitioners. With that, I gained the confidence to seek solutions to problems that require professional collaboration.
The role of technology in improving health care outcomes: I interacted with EHR systems. I gained courage and optimist in leveraging technology to enhance efficiency in healthcare a setting.
Health disparities: Like in many other occasions, we worked on a problem by which health outcomes did not reflect the expected theoretical results of the treatment approach. Ultimately, we worked out the disparity successfully by thoughtfully disassembling the problem and identifying the problematic parameters.
References
Kumar, P., Jordan, M., Caesar, J., & Miller, S. (2015). Improving The Management of Sepsis in a District General Hospital by Implementing The 'Sepsis Six' Recommendations. BMJ Open Quality , 4(1).
Roberts, N., Hooper, G., Lorencatto, F., Storr, W., & Spivey, M. (2017). Barriers and Facilitators Towards Implementing the Sepsis Six Care Bundle (BLISS-1): A Mixed Methods Investigation Using the Theoretical Domains Framework. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine , 25(1), 96.
