Background Sepsis is a leading cause of death, but evidence suggests that early recognition and prompt intervention can save lives. In 2005 Houston Methodist Hospital prioritized sepsis detection and management in its ICU. In late 2007, because of marginal effects on sepsis death rates, the focus shifted to designing a program that would be readily used by nurses and ensure early recognition of patients showing signs suspicious for sepsis, as well as the institution of prompt, evidence-based interventions to diagnose and treat it. Methods The intervention had four components: organizational commitment and data-based leadership; development and integration of an early sepsis screening tool into the electronic health record; creation of screening and response protocols; and education and training of nurses. Twice-daily screening of patients on targeted units was conducted by bedside nurses; nurse practitioners initiated definitive treatment as indicated. Evaluation focused on extent of implementation, trends in inpatient mortality, and, for Medicare beneficiaries, a before-after (2008–2011) comparison of outcomes and costs. A federal grant in 2012 enabled expansion of the program. Results By year 3 (2011) 33% of inpatients were screened (56,190 screens in 9,718 unique patients), up from 10% in year 1 (2009). Inpatient sepsis-associated death rates decreased from 29.7% in the preimplementation period (2006–2008) to 21.1% after implementation (2009–2014). Death rates and hospital costs for Medicare beneficiaries decreased from preimplementation levels without a compensatory increase in discharges to postacute care. Conclusion This program has been associated with lower inpatient death rates and costs. Further testing of the robustness and exportability of the program is under way.

Duration of Initiative 48 months and currently ongoing. Setting The Houston Methodist Hospital System and affiliated hospitals (3 facilities with 2 hospital-run skilled nursing facilities in and around Houston), St. Joseph’s Regional Health Center (1 acute care hospital and 2 skilled nursing facilities in Bryan, Texas), Hospital Corporation of America (2 acute care facilities in Houston, 1 acute care facility in McAllen, Texas [Rio Grande Valley]), Kindred Healthcare (2 long term acute care facilities in Houston), Select Medical Specialty Hospitals (2 long term acute care facilities in Houston). Whom This Should Concern Hospital administrators, quality and safety officers, performance improvement and patient safety professionals, clinic managers, infection control and prevention staff, and other physicians, nurses, and clinical staff.

Creating a culture of nursing excellence requires strategic planning, transformational leadership, and effective change management. The American Nurses Credentialing Center (ANCC) provides 2 programs that recognize nursing practice. The Pathway to Excellence Program R recognizes health care organizations that provide nurses with positive and safe practice environments. The ANCC Magnet Recognition Program R , the highest level of recognition for nursing, recognizes health care organizations that demonstrate excellence in nursing and quality patient outcomes. Both of these programs promulgate the valuable contributions of nurses to influence the practice environment and ultimately enhance patient outcomes. ANCC recognition, as either a Pathway to Excellence R or a Magnet R recognized facility, is a significant achievement for both the nursing enterprise and the organization.The transition from achieving Pathway to Excellence R recognition to Magnet R recognition requires organizational change management through transformational leadership and employee engagement at multiple levels. This article addresses one community hospital's strategy to advance a culture of nursing excellence through integration of the Pathway to Excellence R 12 Practice Standards and enculturation of the Magnet R Model to achieve Magnet R recognition. The ADKAR R Model of change management was applied throughout this journey in a systematic approach that created awareness, desire, knowledge, ability, and reinforcement. Key strategies were implemented to engage employees and resources were provided to advance the culture of nursing excellence within the health care organization.

Background: As more complex patients are hospitalized, the need for highly skilled and competent nurses to recognize clinical deterioration becomes more apparent. The literature supports the use of simulation-based education to enhance the recognition of clinical deterioration. The purpose of this evidence-based practice project was to utilize simulation as an educational modality to improve the knowledge of registered nurses in the recognition of clinical deterioration among their patients.Methods: This evidence-based practice project was conducted from May through June 2013 in a 900-bed facility. Participation was voluntary and included 15 medical-surgical, procedural, and post-anesthesia care unit registered nurses. Simulation-based education was utilized for assessing the recognition, management, and reporting of clinical deterioration by nurses while supporting learning in a safe environment. Each participant managed two simulated patients in deteriorating states. Baseline performance was obtained during the initial simulation scenario by utilizing RAPIDS, a validated tool that evaluates assessment, management, and clinical deterioration reporting. A post-simulation debriefing and education session occurred that included a review of all required critical action elements. Debriefing was followed by a second post-intervention simulated clinical deterioration scenario. Results:The results indicated statistically significant improvement in mean assessment and management scores when the post-intervention results were compared with baseline [t ( 14) =2.04, p = .03]. Post-intervention reporting scores were also improved, although this change was not statistically significant.Conclusions: Simulation-based education may be an effective strategy for impacting a nurse's ability to recognize clinical deterioration and thereby allow for timely intervention.