The Use of an Educational Tool to Improve Adjustment to the Sepsis Protocol and the Clinical Impact

Abstract

Introduction: Sepsis is a major global health problem and is responsible for the deaths of thousands of people each year. It is the second leading cause of death in intensive care units, after coronary heart disease. Due to the high mortality rate, sepsis needs to be addressed through evidence-based practice, institutionalized protocols, well-developed clinical strategies, and continuing education. This study analyzed the clinical impact of adherence to an education tool for sepsis control measures at the Adventist Hospital of Belém in Brazil. Methodology:A prospective, quasi-experimental study was carried out from March to December 2015. The study included 152 patients diagnosed as having selection criteria with suspected sepsis. The patients diagnosed in the emergency department of the hospital were divided into a control group (n=30) and a case group (n=122) based on the period in which an educational tool was applied, for adherence to the hospital sepsis protocol. Results:The best adherence measure, after the tool application, was antimicrobial therapy. There was a reduction in the hospitalization time of the surviving patients from 19.7 days to 7.7 days and the mortality rate decreased from 63.3% to 30.6%. Conclusion:Although adherence to resuscitation packages was low, the education tool increased the insight of professionals in the identification of septic patients, resulting in a diagnosis and early treatment that corresponded with a reduction in hospitalization time and a decrease in mortality. The implementation of the educational tool and feedback letter was performed in August 2015. Patients admitted from March to July 2015, the period prior to the use of the tool, were eligible for participation in the control group, while patients admitted from August to December 2015 were eligible for participation in the case group. All adult patients greater than 18 years of age and diagnosed with sepsis, severe sepsis, and septic shock, admitted from the emergency department or transferred to the ICU within the first 24 hours of the diagnosis, were included in the study. The criteria for defining sepsis were based on the Sepsis Survival campaign (CSS) criteria. Obstetric patients, patients with sepsis referred from other institutions, and patients with organic dysfunctions not considered secondary to a chronic disease were excluded. KeywordsThe compilation of clinical and demographic data was conducted through the patients' clinical histories, using the form designed by the Institute Latin American Sepsis (ILAS) 9 and adapted by hospital quality management in conjunction with the Hospital Infection Control Committee (CCIH). From the time that the patient with suspected sepsis was admitted to the hospital, the CCIH team was activated and the data was collected using the pre-designed form. The evaluation was based on compliance with the updated CSS resuscitation package from 2012. The package also includes requirements that must be met within the first three and six hours, which are comprised of diagnosti...