Improving Nurses' Identification of Sepsis in the Hospitalized Elderly

This project aimed to determine whether an evidence-based educational intervention for staff registered nurses (RNs) would lead to an increase in the accuracy of the sepsis screenings performed by the RNs on elderly patients in the acute care for the elderly (ACE) unit of a hospital in Northern California. There has been an alarming increase in the number of inpatient hospitalizations due to sepsis in recent years (Gohil et al., 2016; Rhee & Klompas, 2017), and the elderly are more likely than their younger counterparts to both develop sepsis and die from complications associated with it (Shen, 2015). The early diagnosis and treatment of sepsis are particularly challenging among the elderly due to their atypical clinical presentations of infection (Nasa, Juneja, & Singh, 2012). Further, the lack of relevant education and training among staff RNs has been identified as a significant barrier to accurate sepsis screening, which also contributes to the delayed identification and treatment of sepsis (Van den Hengel, Visseren, Meima-Cramer, & Schuit, 2016). The Surviving Sepsis Campaign’s (SSC’s) sepsis screening tool is widely used in hospitals across the United States to detect the presence of sepsis. This screening tool was already in use at the participating hospital. However, it was not known whether an evidence-based educational intervention for staff RNs would increase the accuracy of the tool’s use. Sepsis screening data were collected from 34 RNs both before and after the evidence-based educational intervention had been conducted. The evidence-based educational intervention involved a PowerPoint presentation attended by the 34 participating RNs. The following topics were covered in the presentation: sepsis epidemiology, hospital sepsis data, sepsis pathophysiology, sepsis clinical manifestations in the elderly, and sepsis treatment and management. A sepsis case study was discussed following the presentation. The content of the presentation was drawn from current evidence-based literature and guidelines concerning sepsis (Levy, Evans, & Rhodes, 2018; Rhodes et al., 2017; SSC, n.d.). In order to assess whether there were significant differences in the RNs’ pre- and post-intervention sepsis screening accuracy scores, a dependent samples t-test was performed. The results showed that the intervention was effective in terms of increasing the accuracy of the sepsis screenings performed on elderly patients in the ACE unit, with a 22.06% increase in accuracy being observed (p = .007). Elderly patients who are accurately screened are more likely to be diagnosed and treated promptly, which increases their chance of survival and enhances their quality of life (Armen et al., 2016). The success of the educational intervention could potentially lead to an overall improvement in the outcomes of sepsis care in these patients, as well as offering the potential to improve overall compliance with the sepsis bundles established by the SSC. Future studies should focus on creating similar interventions intended to be implemented in other organizations. Further, developing an intervention that includes simulation as part of the sepsis education could provide a valuable learning experience for RNs, since it should allow them the opportunity to practice sepsis screening using real clinical scenarios. Lastly, creating a clear and evidence-based sepsis screening tool that is specifically geared toward the elderly population could also have the valuable potential to improve clinical outcomes for elderly patients with sepsis.