Surviving Sepsis Campaign: Project Methods and Analysis

INTRODUCTION AND OVERVIEW

The proposed research study intends to examine the value of a sepsis prevention program within a hospital setting. Specifically, the research proposes to measure the effectiveness of the Surviving Sepsis Campaign’s (SSC) guidelines and bundles. Created by the Critical Care Society, the SSC has found that bundles and guidelines are effective combinations that aggressively treat sepsis before it can progress. Based on prior research, the best practices regarding the SSC are education and data collection. Nurses are crucial components of SSC's future success because of their front line roles in hospital care. 

As nurses deliver continuous care, they also monitor their patients and take note of any symptomatic changes. When nurses detect the first signs of sepsis, they can take action and implement the bundle care in order to halt sepsis’s progress. Therefore, education and awareness concerning initial sepsis symptoms are vital. The ultimate goal of this research is to provide education that will encourage nurses to collect data and use the SSC’s bundles and guidelines in order to identify sepsis in its early stages and decrease its overall mortality rates. 

Participants

In order to explore the implementation of SSC guidelines and bundles, it will be necessary to recruit study participants. Sepsis commonly occurs in the emergency department (ED) and the intensive care unit (ICU), so the participants within the study will be critical care nurses who work within the setting of a teaching hospital. The nurses’ experiences with sepsis will vary from those who have never worked a case to those who were very familiar with the condition. The nurse participants will also have widespread understandings of sepsis treatment. The number of participants in the study will be 25 nurses who have completed a BSN program in nursing. All participants need to have the same level of education, so master educated nurses will not be included in this particular study. The study participants will have responded to a survey that identified their interest in the SSC.

PROBLEM AND SOLUTION

Problem Outline

If left untreated, sepsis quickly progresses into severe sepsis or septic shock. Septic shock is often lethal because the infection affects the body’s vital organs, and they eventually shut down. Sepsis often occurs with another condition and it is typically found in the emergency department (ED) and the intensive care unit (ICU) because some patients often wait until they are seriously ill before they seek medical treatment. However, early diagnosis and aggressive treatment decrease sepsis’s progress. 

While sepsis commonly occurs in the ED and the ICU, this syndrome is a cause of concern for any nurse as the condition can occur across multiple nursing fields, and it does not discriminate. Sepsis can occur in young and old patients regardless of their race, age, or gender. At the same time, patients who have a weak immune system, such as infants or the elderly, are at an increased risk of contracting sepsis. While researchers have been unable to discover the cause of sepsis, abundant evidence suggests that severe sepsis and septic shock are “characterized by components of hypovolemic, cardiogenic, and distributive shock” (Levinson et al., 2011, Methods of Reducing Morality para. 1). Unfortunately, early detection of sepsis is difficult because its symptoms are so subtle. However, in order to decrease sepsis-related fatalities, the SSC guidelines created a definitive guide to early detection. In conjunction with early diagnosis, Kleinpell (2013) explained SSC care bundles are groups of treatments which effectively reduce sepsis’s development.

Problem Statement

The SSC website provided screening tools to aid in diagnosis and bundles of care that treat the various stages of sepsis, but the main issue is implementing the SSC protocol and using the provided tools, guidelines, and bundles within each care setting as early as possible in order to decrease sepsis-related fatalities. 

Possible Causes

There are a variety of factors that may inhibit SSC implementation. Firstly, nurses are crucial figures in early detection and treatment, but their hospitals may use a different protocol regarding sepsis treatment. In addition, nurses may misunderstand or fail to notice sepsis’s early symptoms because they are so subtle. Moreover, nurses may feel a level of discomfort at initiating treatment by notifying the physician. In addition, some nurses may feel compelled to hold on to former practices when treating sepsis because they are unaware that the SSC constantly updates its guidelines. The desire to decrease sepsis is apparent, but the awareness behind it is not. Lastly, many hospitals are under-resourced, so they may not have the necessary funds in order to implement educational programs regarding early detection and treatment of sepsis. 

Essentially, while the SSC’s guidelines and bundles have significant research that demonstrates its success, it is often difficult to “translate evidence into practice” (Levinson et al., p. 1, 2011). Therefore, in order to provide a solution, medical facilities will have to devise appropriate educational programs so clinicians understand that SSC implementation is crucial.

Proposed Solution

This study’s proposed outcome regards the application of simulation training in order to teach nurses to identify sepsis in its early stages and to embrace the SSC’s guidelines and bundles. Aitken et al.'s (2011) revealed the SSC based clinical care nurses as their audience when they created their content because of their ability to diagnose early stages.  Because nurses provide constant care to their patients during their hospital stays, they must monitor their patients and take note of any changes for the better or the worse. At the first sign of a patient’s symptoms of sepsis, nurses can take action and implement the bundle care in order to halt sepsis’s progress to its advanced lethal stages.  Levinson et al. (2011) emphasized SSC’s resuscitation and post-resuscitation/management bundles contributed to decreased mortality. Therefore, if hospital protocols used SSC guidelines and bundles in their standard protocol, they would decrease the number of patients who end up with severe sepsis and septic shock.

In addition, nurses have the ability to collect significant data. Kleinpell et al. (2013) asserted early treatment and recognition decreases advancement to severe sepsis and septic shock; therefore, when patients exhibit signs of sepsis, nurses can collect their data and add to the growing body of research regarding early signs and possible prevention. Moreover, data such as septic patients’ initial reasons for seeking treatment, the rate of speed that sepsis progresses, and patients’ outcomes will also add to the SSC’s research database. 

In the case that sepsis’s initial symptoms went unnoticed until the patient developed severe sepsis or septic shock, the nurses would provide details such as the patients’ outcome and SSC guidelines efficacy. Ultimately, nurses can add their facilities’ data into the SSC’s database in order to lead to viable solutions and centralized research regarding the cause of sepsis and the best way to prevent or treat it. Research suggests that sepsis cases will increase, so nurses play a critical role in its primary diagnosis, but it seems as though there is a lack of awareness in the nursing community. In order to implement the SSC within hospital communities, nurses will need to commit to the SSC and pass on this information to their colleagues. After the initial survey, clinical simulations and classroom lectures will allow participants to understand initial symptoms and practice teamwork. However, it is important to determine which teaching method is more effective. 

RESEARCH QUESTIONS

This capstone will rely on a series of research questions in order to provide a focus for this research project. The research questions established for this study are detailed in the following points:

1. Is there a need to create community awareness programs regarding the Surviving Sepsis Campaign? 

2. Will clinical simulations teach nurses to identify sepsis early symptoms?

3. Are the Surviving Sepsis campaign guidelines and bundles effective in diminishing sepsis rates?

4. What are the best ways to incorporate data collection and Surviving Sepsis Campaign bundles and guidelines as standard hospital protocol? 

These research questions will guide the overall research process. This research process is a focused one that moves from overall to explicit.

RESEARCH QUESTION ANALYSIS

Data to be Collected

This capstone will employ a quantitative and qualitative research methodology. The quantitative data will determine interest and potential participants. Simulations are worthwhile, yet expensive, so quantitative data will demonstrate the need and focus for SSC simulation educational programs. Nurses within the teaching hospital will have an invitation to participate in a survey via email. The information gathered from the survey will be examined within the context of an ongoing educational program. The qualitative research method that will be employed is a randomized control trial in which the researcher will compare a sepsis medical simulation course against instructive lectures to determine the most effective teaching method for recognition of early sepsis. Clinical simulation appears to be the gold standard when teaching nurses to use critical thinking skills while on the job. Specifically, Tipler et al. (2010) stressed comprehensive training regarding sepsis diagnosis allowed multidisciplinary teams to effectively reduce time because they quickly recognized signs of sepsis and decreased the amount of time it took to diagnose and to order, process, and administer antibiotics. 

Instrumentation and Methods

The first instrument used to collect data will be an email survey. Using questions based on SSC’s (2013) website, the questions are designed to gauge current awareness regarding sepsis. 

(Survey questions omitted for preview. Available via download)

The survey will be circulated to the nurses working in the teaching hospital via email. It is necessary to local participants who have a variety of backgrounds regarding sepsis. Ultimately, those who reply to less than half correctly will be invited to take part in the randomized control trial. The second instrument will consist of resources from the SSC website such as the SSC screening tool and guidelines. The following example comes from the SSC website and is used as a screening tool: 

(Screening tool omitted for preview. Available via download)

Because the simulation manikin will have preset conditions, participants will be able to actively diagnose and treat various levels of sepsis. However, the participant will be randomly selected to take part in the medical simulation, or they will take part in a traditional lecture in which they will complete an exam. It is important that the participants in the clinical simulation use critical thinking and teamwork in order to effectively diagnose the manikin. This will possible further the evidence that suggests treating sepsis requires a multidisciplinary approach. The screening tool is an example of a guideline to help nurses in the clinical simulation understands the importance of early detection and aggressive treatment. Therefore, by comparing a classroom and clinical setting will provide evidence that simulations may be an appropriate method when teaching new and experienced nurses that early diagnosis and treatment effectively decrease sepsis fatalities. 

Data Analysis Methods

In order to satisfy the findings for the research questions, the results would need to account for factors such as learning styles and experience with sepsis cases. Essentially, an exploratory data analysis would be effective because it would allow the researcher to base data on direct observation. Because it the research will take place in a teaching hospital, discussed earlier, the amount of information taken in based on the traditional classroom setting and simulation setting will provide evidence that often doing and practicing results in the best learning experiences. Because the participants will be assigned randomly, there will be a lack of bias from the researcher. Thus, accounting for these factors will strengthen the reliability of the research questions’ results. Post and pre-tests will provide evidence of learning in both cases. 

References

Aitken, L. M., Williams, G., Harvey, M., Blot, S., Kleinpell, R., Labeau, S., ... Ahrens, T. (2011). Nursing considerations to complement the Surviving Sepsis Campaign guidelines. Critical Care Medicine, 39(7), 1800-1818. doi: 10.1097/CCM.0b013e31821867cc

Critical Care Society. (2013). Surviving sepsis screening tool [PDF]. Surviving Sepsis Campaign.

Kleinpell, R., Aitken, L., & Achorr, C. A. (2013). Implications of the new international sepsis guidelines for nursing care. American Journal Of Critical Care, 22(3), 212-222. doi: 10.4037/ajcc2013158

Levinson, A. T., Casserly, B. P., & Levy, M. M. (2011). Reducing morality in severe sepsis and septic shock. Seminars in Respiratory and Critical Care Medicine, 32(2).

Nguyen, H. M., Schiavoni, A., Scott, K. D., & Tanios, M. A. (2012). Implementation of sepsis management guideline in a community-based teaching hospital -- can education be potentially beneficially for septic patients? The International Journal of Clinical Practice, 66(7), 705-710. doi: 10.1111/j.1742-1241.2012.02939.x

Society of Critical Care Medicine, & European Society of Intensive Care Medicine.. (n.d.). About the surviving sepsis campaign. Surviving Sepsis Campaign. Retrieved May 23, 2013, from http://www.survivingsepsis.org/About-SSC/Pages/default.aspx

Tromp, M., Hulscher, M., Bleeker-Rovers, C. P., Peters, L., Van den Berg, D. T., Borm, G. F., ... Pickkers, P. (2010). The role of nurses in the recognition and treatment of patients with sepsis in the emergency department: A prospective before-and-after intervention study. International Journal of Nursing Studies, 47(12), 1464-1473.