T heresa Weinschrot
Julita Soliszko
LEXIS
KHUSHBOO
Sepsis
Aiza Butt, Hector Cortes, Theresa Weinschrott
Purdue University Northwest
Meghan McGonigal-Kenney, PHD, RN
NUR 45200 Quality and Safety for Professional Nursing Practice
September 4, 2022
Background of the problem
Definition:
Sepsis is an inflammatory response to infection that can lead to organ failure. When the inflammatory response becomes generalized it can cause tissue hypoxia ultimately leading to dysfunction of organs and death (Gyawali et al.,2019).
According to Taeb et al. (2017), “Sepsis is associated with high morbidity and mortality, with estimates of more than $20 billion in annual U.S. healthcare expenditures.The incidence of severe sepsis in the United States is estimated to be about 300 cases per 100,000 population” (p. 296).
PICO Question:
In emergency department patients, can using the sepsis bundle help identify sepsis earlier when compared to the current sepsis protocol on this unit in order to decrease mortality rate?
Problem: Sepsis rates have risen over 20% in the past year in our facility.
Goal: Improving the speed and accuracy of sepsis detection to decrease sepsis rates and lower mortality.
Search Strategy:
The search strategy involves using PICO question and PICO template, using broad search terms initially, and then narrowed down to specific terms, scholarly article nursing databases, evidence based studies, national statistics, unit based data metrics.
Analysis of Current Condition
Sepsis rates at our facility have risen over 20% during the past year. We decided that the best way to reduce our sepsis rate was to place a sepsis alert system into our emergency department. Our current process is as follows. A patient comes into the ED (either by foot or by ambulance). We perform a basic assessment and triage the person. If the patient’s temperature is 101 or less, we place them in a regular ED room and screen them for COVID. They are seen by the physician in the order in which they arrived and based on their acuity. The doctor will then order labs to be drawn. Usually, we draw a chemistry profile (12 labs), a complete blood count, a sputum, and a urinalysis. The results take about 1-2 hours to come back. Unless we are looking for the lab results, we do not see them.
If the WBC comes back over 12, we start them on a broad-spectrum antibiotic until we know what specific antibiotic will work. This usually takes about 24-48 hours to determine. By that time the patient is usually in a ho
SURGICAL SITE INFECTION PREVENTION
Shannon Pienkowski
Julita Soliszko
Sally Tecpanecatl
BACKGROUND
A hospital is working on reducing surgical cite infections (SSI) for knee and hip replacement patients. The SSI rate for knee replacements last year was 11.2% and the SSI rate for hip replacements was 16.3%. They want to reduce the numbers to zero.
The process is as follows: The patient is scheduled for surgery, they are required to attend a 2-hour educational session pre-operatively, they are informed the night before of the time to be at the hospital and to take a shower on the day of surgery but no not scrub at the surgical site.
On the day of: the patient is placed onto a pre-op bed, given information about the surgery, is visited by the surgeon and the anesthesiologist, and asked to sign a consent form.
Surgical Site Infection Prevention
BACKGROUND CONT.
During surgery, the surgeon cleanses the site and creates a sterile field. After closing the site, a dressing is placed on the surgical site and the patient is later informed not to change the dressing for one week.
The patient is given a new dressing to replace the old one.
The patient is allowed to shower but has to keep the surgical site dry by using plastic wrap and tape.
All patients are sent home with instructions about what to watch for and when to call the physician or come to the emergency room (e.g., temperature over 100 degrees, redness or soreness at the site, cold leg).
Surgical Site Infection Prevention
3
DOES THE USE OF A SURGICAL SITE INFECTION BUNDLE HELP PREVENT OR REDUCE SURGICAL SITE INFECTIONS IN PATIENTS RECEIVING TOTAL HIP OR KNEE REPLACEMENTS?
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4
PICO question
ANALYSIS OF PROBLEM
On the PNWOSC unit there are many surgical site infections compared to other units.
SSI RATES
Surgical Site Infection Prevention
6
FISHBONE DIAGRAM
7
Surgical Site Infection Prevention
ACTION PLAN TO PREVENT SSI
Surgical Site Infection Prevention
8
Sepsis
Lexi Gibrick, Anna Wojtowicz, Brayan Aguirre
Background of problem:
Sepsis is a medical emergency that describes the body’s systemic immunological response to an infectious process that can lead to end-stage organ dysfunction and death
Sepsis is the 3rd leading cause of death in the United States
More than 30 million people are affected by sepsis every year worldwide
Early detection of sepsis with timely, appropriate interventions increases the likelihood of survival for patients with sepsis
PICO: For adult patients in the Emergency Department, do sepsis alerts and screening tools, as compared to no early detection tools, reduce the mortality rates of patients?
Background of problem
Who is at high risk?
Adults 65 and older
Chronic health conditions
Weakened immune system
Sepsis survivors
Recent hospitalization
Signs and symptoms
High heart rate
Fever and/or shivering
Shortness of breath
Confusion
Pain
Feeling of impending doom
Analysis of Problem:
Sepsis Data
| Month | Our Unit | Comparison Unit – 1 | Comparison Unit – 2 |
| January | 1 | 1 | 0 |
| February | 1 | 1 | 0 |
| March | 4 | 3 | 1 |
| April | 7 | 0 | 0 |
| May | 5 | 0 | 2 |
| June | 12 | 1 | 0 |
| July | 13 | 0 | 0 |
| August | 16 | 0 | 1 |
| September | 18 | 0 | 0 |
| October | 8 | 0 | 0 |
| November | 9 | 3 | 7 |
| December | 10 | 1 | 0 |
Our Unit:
Mean – 8.67
Median – 8.5
Range – 17
Comparison Unit – 1:
Mean – 0.83
Median – 0.5
Range – 3
Comparison Unit – 2:
Mean – 0.92
Median – 0
Range – 7
Number of Cases
Analysis of problem
Current practice at our facility:
If the patient’s temp is 101 or less, they are placed in regular ER rooms and tested for Covid-19
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Patient arrives into our ED (via walk in/ ambulance)
Basic assessment and tri
Falls Prevention
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Tay Dove-Zoladz, Khushbu Patel, Laurie Hayes
Purdue University Northwest
College of Nursing
NUR 45200
Hi, This presentation is done by Tay, Khushbu, and Laurie. And our topic is falls prevention.
BACKGROUND
What are falls?
An unplanned descent to the floor with or without injury to the patient.
According to the agency for healthcare research and quality also known as AHRQ, defines falls as an unplanned descent to the floor with or without injury to the patient.
WHO states that falls are the second leading cause of unintentional injury deaths worldwide. In our case study,The interventions for fall prevention that were in place were not enough and the staff was not compliant with the implementation. This lead to an increase number of fall rates in the past year.
Depth & Breadth
700,000-1,000,000 falls annually
250,000 lead to fractures
11,000 deaths
$50 billion spent -non fatal fall injuries
$754 million- fatal falls
In general, experiencing falls after a surgery or in the hospital can be detrimental. WHO states that falls are linked to higher mortality rates, longer hospital stays, and increased healthcare costs.
AHRQ reports there are 700,000 to 1,000,000 hospital falls each year
Out of those falls, 250,000 falls lead to injuries and about 11,000 deaths occur. About 15% of falls cause bone fractures and injuries to the brain.
After these falls, there can be severe consequences faced by the patients and hospitals. In the past year, $50 billion was spent on nonfatal FALLS and $754 million on fatal falls. What is more important is that most fall cases are preventable and measures can be taken to prevent them from occurring. We will be talking more about this later in the slides.
Causes
Can be multifactorial
Consequences
Can be for both patients and organization
Higher mortality rates
Longer hospital stays
Increased healthcare costs
Financial burdens
Legal consequences
Injuries (physical and emotional trauma)
To understand why the falls, occur and to prevent them, it is crucial to identify the potential causes. There can be many factors that can lead to falls. After these falls occur, the consequences that the patients and the organization hav
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