Nurses’ and Physicians’ Experiences After Implementation of a Quality Improvement Project to Improve Sepsis Awareness in Hospitals

Figures & data

Table 1 Schematic Overview Over the Interventions in the Stop Sepsis Nurse Project

Intervention	Critical Content of the Intervention
Development of tools for screening, observation, alert, and treatment flow chart. Developed with the users and improved in iterative cycles.	Systemic Inflammatory Response Syndrome and Organ Failure (SOF)-triage, including red flag criteria New observation chart developed with nurses and doctors Treatment flow chart described according to results in SOF-triage Stressing importance of objective communication
Training sessions (4 hours) for all nurses and nursing students at the hospital	Pathophysiology of Systemic Inflammatory Response Syndrome (SIRS), sepsis and organ failure Systematic observation of vital parameters and signs of organ failure How to use the SOF-triage and observation chart Discussing case reports on events in the course of observing and treatment of previous patients Importance of prompt intravenous fluids and appropriate antibiotics Learning objective communication about the patient’s status based on observation of vital signs
Six extra hours training for expert nurses	Background for the project Interpretation of blood gas analysis Use of the SOF-triage and flow-chart
Information sessions for physicians:	Presentation of SOF-triage chart and the algorithm in the alert and treatment flow chart
Development of clinical pathway:	Standardized care pathway for patients with SIRS/Sepsis Developed standardised laboratory orders for microbial and organ failure detection.

Table 2 Informants Baseline Characteristics, n=18

Characteristics	Measurements as Indicated
Nurses, n (%)	13 (72.2)
Women, n (%)	14 (77.7)
Age, range (mean)	31–59 (45.2)
Years of work experience nurses, range, (mean)	6–32 (18.0)
Years of work experience physicians, range (mean)	5–29 (12.4)
Job position in % working time, nurses	50–100%
Job position in % working time physicians, range	100–100%

Table 3 Schematic Example of the Stepwise Analysing Process Using Systematic Text Condensation

Step 1: Preliminary Theme	Step 2: Meaning Unit	Step 3: Condensed Meaning	Step 4: Final Sub-Groups and Themes
		Codes	Sub-Groups	Final Theme
The tools for screening and observation	“It suddenly came two new charts, and in the start it was a bit unfamiliar […] but it is the observation tool that is most useful for me” “you might use it [the observation chart] for an opposite purpose too; you can wait to start [antibiotics] and follow the development with a supportive treatment like intravenous fluid and oxygen and such. And you have confidence in being informed if deterioration happens that says you have to start with antibiotics»”	Nurses and physicians find the observation chart most useful, but have a different view on how to use it	Using the charts: Nurses use of SIRS and Organ Failure triage (SOF-triage) and observation chart. Physicians view of the charts	Enhanced clinical assessment and judgement