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

References

• Singer M, Deutschman CS, Seymour CW, et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA. 2016;315(8):801–810. doi:10.1001/jama.2016.0287
   PubMed Web of Science ®Google Scholar
• Rudd KE, Johnson SC, Agesa KM, et al. Global, regional, and national sepsis incidence and mortality, 1990–2017: analysis for the Global Burden of Disease Study. Lancet. 2020;395(10219):200–211. doi:10.1016/s0140-6736(19)32989-7
   PubMed Web of Science ®Google Scholar
• Vincent JL. The challenge of early identification of the hospital patient at risk of septic complications. Ann Transl Med. 2017;5(3):56. doi:10.21037/atm.2017.01.49
   PubMed Web of Science ®Google Scholar
• Bone RC, Balk RA, Cerra FB, et al. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest. 1992;101(6):1644–1655. doi:10.1378/chest.101.6.1644
   PubMed Web of Science ®Google Scholar
• Levy MM, Fink MP, Marshall JC, et al. 2001 SCCM/ESICM/ACCP/ATS/SIS international sepsis definitions conference. Crit Care Med. 2003;31(4):1250–1256. doi:10.1097/01.Ccm.0000050454.01978.3b
   PubMed Web of Science ®Google Scholar
• Knoop ST, Skrede S, Langeland N, Flaatten HK, Brakenridge S. Epidemiology and impact on all-cause mortality of sepsis in Norwegian hospitals: a national retrospective study. PLoS One. 2017;12(11):e0187990. doi:10.1371/journal.pone.0187990
   PubMed Web of Science ®Google Scholar
• Kumar A, Roberts D, Wood KE, et al. Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Crit Care Med. 2006;34(6):1589–1596. doi:10.1097/01.Ccm.0000217961.75225.E9
   PubMed Web of Science ®Google Scholar
• Rhodes A, Evans LE, Alhazzani W, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock: 2016. Intensive Care Med. 2017;43(3):304–377. doi:10.1007/s00134-017-4683-6
   PubMed Web of Science ®Google Scholar
• Schorr C, Odden A, Evans L, et al. Implementation of a multicenter performance improvement program for early detection and treatment of severe sepsis in general medical-surgical wards. J Hosp Med. 2016;11(Suppl 1):S32–S39. doi:10.1002/jhm.2656
   PubMedGoogle Scholar
• Kleinpell R. Promoting early identification of sepsis in hospitalized patients with nurse-led protocols. Crit Care. 2017;21(1):10. doi:10.1186/s13054-016-1590-0
   PubMedGoogle Scholar
• Gyang E, Shieh L, Forsey L, Maggio P. A nurse-driven screening tool for the early identification of sepsis in an intermediate care unit setting. J Hosp Med. 2015;10(2):97–103. doi:10.1002/jhm.2291
   PubMed Web of Science ®Google Scholar
• Aitken LM, Williams G, Harvey M, et al. Nursing considerations to complement the surviving sepsis Campaign guidelines. Crit Care Med. 2011;39(7):1800–1818. doi:10.1097/CCM.0b013e31821867cc
   PubMed Web of Science ®Google Scholar
• Tromp M, Hulscher M, Bleeker-Rovers CP, et al. The role of nurses in the recognition and treatment of patients with sepsis in the emergency department: a prospective before-and-after intervention study. Int J Nurs Stud. 2010;47(12):1464–1473. doi:10.1016/j.ijnurstu.2010.04.007
   PubMed Web of Science ®Google Scholar
• Funk D, Sebat F, Kumar A. A systems approach to the early recognition and rapid administration of best practice therapy in sepsis and septic shock. Curr Opin Crit Care. 2009;15(4):301–307. doi:10.1097/MCC.0b013e32832e3825
   PubMed Web of Science ®Google Scholar
• Varpula M, Karlsson S, Parviainen I, Ruokonen E, Pettilä V. Community-acquired septic shock: early management and outcome in a nationwide study in Finland. Acta Anaesthesiol Scand. 2007;51(10):1320–1326. doi:10.1111/j.1399-6576.2007.01439.x
   PubMed Web of Science ®Google Scholar
• Dellinger RP, Levy MM, Rhodes A, et al. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012. Crit Care Med. 2013;41(2):580–637. doi:10.1097/CCM.0b013e31827e83af
   PubMed Web of Science ®Google Scholar
• Levy MM, Rhodes A, Phillips GS, et al. Surviving sepsis Campaign: association between performance metrics and outcomes in a 7.5-year study. Intensive Care Med. 2014;40(11):1623–1633. doi:10.1007/s00134-014-3496-0
   PubMed Web of Science ®Google Scholar
• Jones SL, Ashton CM, Kiehne L, et al. Reductions in sepsis mortality and costs after design and implementation of a nurse-based early recognition and response program. Jt Comm J Qual Patient Saf. 2015;41(11):483–491. doi:10.1016/s1553-7250(15)41063-3
   PubMedGoogle Scholar
• Torsvik M, Gustad LT, Mehl A, et al. Early identification of sepsis in hospital inpatients by ward nurses increases 30-day survival. Crit Care. 2016;20(1):244. doi:10.1186/s13054-016-1423-1
   PubMedGoogle Scholar
• Donohue LA, Endacott R. Track, trigger and teamwork: communication of deterioration in acute medical and surgical wards. Intensive Crit Care Nurs. 2010;26(1):10–17. doi:10.1016/j.iccn.2009.10.006
   PubMedGoogle Scholar
• Martin JS, Ummenhofer W, Manser T, Spirig R. Interprofessional collaboration among nurses and physicians: making a difference in patient outcome. Swiss Med Wkly. 2010;140:w13062. doi:10.4414/smw.2010.13062
   PubMed Web of Science ®Google Scholar
• House S, Havens D. Nurses’ and physicians’ perceptions of nurse-physician collaboration: a systematic review. J Nurs Adm. 2017;47(3):165–171. doi:10.1097/nna.0000000000000460
   PubMed Web of Science ®Google Scholar
• Brier J, Carolyn M, Haverly M, et al. Knowing ‘something is not right’ is beyond intuition: development of a clinical algorithm to enhance surveillance and assist nurses to organise and communicate clinical findings. J Clin Nurs. 2015;24(5–6):832–843. doi:10.1111/jocn.12670
   PubMed Web of Science ®Google Scholar
• Wood C, Chaboyer W, Carr P. How do nurses use early warning scoring systems to detect and act on patient deterioration to ensure patient safety? A scoping review. Int J Nurs Stud. 2019;94:166–178. doi:10.1016/j.ijnurstu.2019.03.012
   PubMed Web of Science ®Google Scholar
• Smith DJ, Aitken LM. Use of a single parameter track and trigger chart and the perceived barriers and facilitators to escalation of a deteriorating ward patient: a mixed methods study. J Clin Nurs. 2016;25(1–2):175–185. doi:10.1111/jocn.13104
   PubMed Web of Science ®Google Scholar
• Rogan A, Lockett J, Peckler B, Robinson B, Raymond N. Exploring nursing and medical perceptions of sepsis management in a New Zealand emergency department: a qualitative study. Emerg Med Australas. 2022;34(3):417–427. doi:10.1111/1742-6723.13911
   PubMed Web of Science ®Google Scholar
• Kitto S, Marshall SD, McMillan SE, et al. Rapid response systems and collective (in)competence: an exploratory analysis of intraprofessional and interprofessional activation factors. J Interprof Care. 2015;29(4):340–346. doi:10.3109/13561820.2014.984021
   PubMed Web of Science ®Google Scholar
• Giorgi A. The phenomenological movement and research in the human sciences. Nurs Sci Q. 2005;18(1):75–82. doi:10.1177/0894318404272112
   PubMed Web of Science ®Google Scholar
• Malterud K. Systematic text condensation: a strategy for qualitative analysis. Scand J Public Health. 2012;40(8):795–805. doi:10.1177/1403494812465030
   PubMed Web of Science ®Google Scholar
• Antonacci G, Lennox L, Barlow J, Evans L, Reed J. Process mapping in healthcare: a systematic review. BMC Health Serv Res. 2021;21(1):342. doi:10.1186/s12913-021-06254-1
   PubMed Web of Science ®Google Scholar
• Royal College of Physicians. National Early Warning Score (NEWS) 2: standardising the assessment of acute-illness severity in the NHS. Updated report of a working party. London: RCP; 2017.
   Google Scholar
• Askim Å, Moser F, Gustad LT, et al. Poor performance of quick-SOFA (qSOFA) score in predicting severe sepsis and mortality - a prospective study of patients admitted with infection to the emergency department. Scand J Trauma Resusc Emerg Med. 2017;25(1):56. doi:10.1186/s13049-017-0399-4
   PubMedGoogle Scholar
• Polit D, Beck C. Sampling in qualitative research. In: Nursing Research. 9 ed. Lippincott Williams & Wilkins; 2012:515–532.
   Google Scholar
• Malterud K. Shared understanding of the qualitative research process. Guidelines for the medical researcher. Fam Pract. 1993;10(2):201–206. doi:10.1093/fampra/10.2.201
   PubMed Web of Science ®Google Scholar
• Malterud K. Qualitative research: standards, challenges, and guidelines. Lancet. 2001;358(9280):483–488. doi:10.1016/s0140-6736(01)05627-6
   PubMed Web of Science ®Google Scholar
• Massey D, Aitken LM, Chaboyer W. What factors influence suboptimal ward care in the acutely ill ward patient? Intensive Crit Care Nurs. 2009;25(4):169–180. doi:10.1016/j.iccn.2009.03.005
   PubMedGoogle Scholar
• Robson W, Beavis S, Spittle N. An audit of ward nurses’ knowledge of sepsis. Nurs Crit Care. 2007;12(2):86–92. doi:10.1111/j.1478-5153.2007.00210.x
   PubMedGoogle Scholar
• Minton J, Clayton J, Sandoe J, Mc Gann H, Wilcox M. Improving early management of bloodstream infection: a quality improvement project. BMJ. 2008;336(7641):440–443. doi:10.1136/bmj.39454.634502.80
   PubMedGoogle Scholar
• Turi SK, Von Ah D. Implementation of early goal-directed therapy for septic patients in the emergency department: a review of the literature. J Emerg Nurs. 2013;39(1):13–19. doi:10.1016/j.jen.2011.06.006
   PubMed Web of Science ®Google Scholar
• Murray E, Treweek S, Pope C, et al. Normalisation process theory: a framework for developing, evaluating and implementing complex interventions. BMC Med. 2010;8(1):63. doi:10.1186/1741-7015-8-63
   PubMed Web of Science ®Google Scholar
• McEvoy R, Ballini L, Maltoni S, O’Donnell CA, Mair FS, Macfarlane A. A qualitative systematic review of studies using the normalization process theory to research implementation processes. Implement Sci. 2014;9(1):2. doi:10.1186/1748-5908-9-2
   PubMedGoogle Scholar
• May C, Sibley A, Hunt K. The nursing work of hospital-based clinical practice guideline implementation: an explanatory systematic review using normalisation process theory. Int J Nurs Stud. 2014;51(2):289–299. doi:10.1016/j.ijnurstu.2013.06.019
   PubMed Web of Science ®Google Scholar
• Daniels R, Nutbeam T, McNamara G, Galvin C. The sepsis six and the severe sepsis resuscitation bundle: a prospective observational cohort study. Emerg Med J. 2011;28(6):507–512. doi:10.1136/emj.2010.095067
   PubMed Web of Science ®Google Scholar
• Bleakley G, Cole M. Recognition and management of sepsis: the nurse’s role. Br J Nurs. 2020;29(21):1248–1251. doi:10.12968/bjon.2020.29.21.1248
   PubMedGoogle Scholar
• Kangas C, Iverson L, Pierce D. Sepsis screening: combining early warning scores and SIRS criteria. Clin Nurs Res. 2021;30(1):42–49. doi:10.1177/1054773818823334
   PubMed Web of Science ®Google Scholar
• Karlsen EE, Rønsåsbjørg NA, Skrede S, Mosevoll KA. [Scoring systems for early detection of sepsis on the ward]. Skåringsverktøy for tidlig oppdagelse av sepsis på sengepost. Tidsskr Nor Laegeforen. 2023;143(2). Norwegian. doi:10.4045/tidsskr.21.0905
   Google Scholar
• Plambech MZ, Lurie AI, Ipsen HL. Initial, successful implementation of sepsis guidelines in an emergency department. Dan Med J. 2012;59(12):1.
   Web of Science ®Google Scholar
• Ferrer R, Artigas A, Levy MM, et al. Improvement in process of care and outcome after a multicenter severe sepsis educational program in Spain. JAMA. 2008;299(19):2294–2303. doi:10.1001/jama.299.19.2294
   PubMed Web of Science ®Google Scholar
• Steinmo SH, Michie S, Fuller C, Stanley S, Stapleton C, Stone SP. Bridging the gap between pragmatic intervention design and theory: using behavioural science tools to modify an existing quality improvement programme to implement “Sepsis Six”. Implement Sci. 2016;11:14. doi:10.1186/s13012-016-0376-8
   PubMed Web of Science ®Google Scholar
• World Health Organization. Improving the Quality of Health Services: Tools and Resources. Turning Recommendations into Practice. World Health Organization; 2018.
   Google Scholar
• Odell M, Victor C, Oliver D. Nurses’ role in detecting deterioration in ward patients: systematic literature review. J Adv Nurs. 2009;65(10):1992–2006. doi:10.1111/j.1365-2648.2009.05109.x
   PubMed Web of Science ®Google Scholar
• Preece MH, Hill A, Horswill MS, Watson MO. Supporting the detection of patient deterioration: observation chart design affects the recognition of abnormal vital signs. Resuscitation. 2012;83(9):1111–1118. doi:10.1016/j.resuscitation.2012.02.009
   PubMed Web of Science ®Google Scholar
• Christofidis MJ, Hill A, Horswill MS, Watson MO. A human factors approach to observation chart design can trump health professionals’ prior chart experience. Resuscitation. 2013;84(5):657–665. doi:10.1016/j.resuscitation.2012.09.023
   PubMed Web of Science ®Google Scholar
• Lydon S, Byrne D, Offiah G, Gleeson L, O’Connor P. A mixed-methods investigation of health professionals’ perceptions of a physiological track and trigger system. BMJ Qual Saf. 2016;25(9):688–695. doi:10.1136/bmjqs-2015-004261
   PubMed Web of Science ®Google Scholar
• Ludikhuize J, de Jonge E, Goossens A. Measuring adherence among nurses one year after training in applying the modified early warning score and situation-background-assessment-recommendation instruments. Resuscitation. 2011;82(11):1428–1433. doi:10.1016/j.resuscitation.2011.05.026
   PubMed Web of Science ®Google Scholar
• Benner P. Expertise in Nursing Practice: Caring, Clinical Judgment and Ethics. 2 ed. Springer Publishing Company; 2009.
   Google Scholar
• O’Neill SM, Clyne B, Bell M, et al. Why do healthcare professionals fail to escalate as per the early warning system (EWS) protocol? A qualitative evidence synthesis of the barriers and facilitators of escalation. BMC Emerg Med. 2021;21(1):15. doi:10.1186/s12873-021-00403-9
   PubMed Web of Science ®Google Scholar
• Muller-Juge V, Cullati S, Blondon KS, et al. Interprofessional collaboration between residents and nurses in general internal medicine: a qualitative study on behaviours enhancing teamwork quality. PLoS One. 2014;9(4):e96160. doi:10.1371/journal.pone.0096160
   PubMed Web of Science ®Google Scholar
• Douw G, Schoonhoven L, Holwerda T, et al. Nurses’ worry or concern and early recognition of deteriorating patients on general wards in acute care hospitals: a systematic review. Crit Care. 2015;19(1):230. doi:10.1186/s13054-015-0950-5
   PubMedGoogle Scholar
• Cox H, James J, Hunt J. The experiences of trained nurses caring for critically ill patients within a general ward setting. Intensive Crit Care Nurs. 2006;22(5):283–293. doi:10.1016/j.iccn.2006.02.003
   PubMedGoogle Scholar
• Williams DJ, Newman A, Jones C, Woodard B. Nurses’ perceptions of how rapid response teams affect the nurse, team, and system. J Nurs Care Qual. 2011;26(3):265–272. doi:10.1097/NCQ.0b013e318209f135
   PubMed Web of Science ®Google Scholar
• Welch J, Dean J, Hartin J. Using NEWS2: an essential component of reliable clinical assessment. Clin Med. 2022;22(6):509–513. doi:10.7861/clinmed.2022-0435
   PubMed Web of Science ®Google Scholar