Background: Every patient in the health care environment is at risk for the development of sepsis. Sepsis is one of the leading causes of death in the United States and the number one cause of death in intensive care units. The mortality rate for severe sepsis is extremely high, anywhere between 20% and 60% dependent on severity. Foreground: Patients can be under or misdiagnosed when clinicians don’t recognize sepsis due to generalized symptoms and/or co-morbidities. The literature identifies this phenomenon as “failure to rescue” (FTR). It reflects the quality of monitoring and the effectiveness of actions taken once early complications are recognized. Clinicians often accept preventable causes as an unfortunate part of illness. Evidence-Based Practice Framework: The project purpose was to design and implement a transformational, organizational system change derived from evidence based practice (EBP) that would improve the identification and earlier treatment of patients that exhibit sepsis symptomatology. Specifically, in hospitalized adult patients, what effect the utilization of a standardized sepsis screening tool by nurses has on identifying septic patients earlier, communicating results sooner, and implementing interventions more rapidly in a community hospital. Methods: There are three methodologies of sepsis: early recognition, early intervention, and early goal directed therapy. A sepsis failure to rescue conceptual map was developed to explore cause and affect relationships with sepsis methodology. The concept represents the dynamics that can lead to FTR and how nursing can intervene collaboratively to save lives. Based on the IHI Surviving Sepsis Campaign, all nurses received education about sepsis symptomatology, how to complete the sepsis screening form in the EMR, the EC and inpatient protocols and the Sepsis Early Bundle with a major focus on the EBP rationale behind each interventions. Outcome measures include mortality rate, hosptial length of stay (HLOS), intensive care unit length of stay (ICU LOS), charges, and cost direct and indirect. Findings: There was a decrease in sepsis mortality and ICU LOS over a three month timeframe. Mortality decreased by 26.4% from 18.2% to 13.4%, with 11.3% mortality during the third month. When annualized it has the potential of saving 24 patient lives. ICU LOS decreased by 1.4 days or 37%. HLOS and average costs per case were not significantly affected. However, the average cost savings equals $600,300. Conclusion/Recommendations: With the increased incidence, high mortality rate, subtle onset, and rapid progression sepsis needs to identified and treated as early as possible. Further recommendations should focus on disease identification, by specialty and presentation symptomatology. More inquiry about Nursing’s scope of influence should be explored. Clinicians should strive for a zero mortality rate from sepsis. If sepsis is seen as preventable, clinicians will take a more aggressive and active role in improving the quality of care provided. It would also change the approach to sepsis from reactionary to preventative.
