Code Sepsis: Development of a Sepsis Protocol for the Obstetric Patient

Purpose for the program:

In 2003, the Surviving Sepsis Campaign partnered with the Institute for Healthcare Improvement (IHI), which led to Surviving Sepsis Campaign Bundles for quality improvement techniques to treat sepsis and decrease mortality. While great strides have been made in early recognition and intervention for sepsis in the general population, there has been little focus on the obstetric population and their unique considerations.  The Labor & Delivery (L&D) nurses at Baylor University Medical Center (BUMC) identified an improvement opportunity in the area of promoting the health and safety of the obstetric patients.  A screening tool, protocol and sepsis bundle was developed and implemented for the obstetric population aiding in early detection and reducing sepsis mortality. 

Proposed change:

A process was developed to facilitate early recognition and prompt intervention for sepsis in the obstetric patient.  Implementation steps included: establishing a screening tool and protocol for sepsis in L&D, incorporating a sepsis bundle and education and training for all staff. 

Implementation, outcomes and evaluation:

BUMC has implemented sepsis bundles in the emergency department and the ICUs, however Women and Children’s recognized that sepsis presentation in the obstetric population was unique, and would require bundles specifically designed for their population.  The nurses in L&D, as front-line caregivers that perform initial assessments, are a critical part of the healthcare team, responsible for early identification and intervention to treat the patient in a timely fashion. Using the IOWA model, coupled with benchmarking and a current literature review, a multidisciplinary team collaborated to establish a protocol and a sepsis screening tool specific to the obstetric patient.  Pre- and post-surveys were created to identify knowledge deficits surrounding sepsis and educational in-services were presented to staff.  Post-educational surveys showed improvements in early identification and recognition to promptly treat sepsis in the hospital setting. 

Implications for nursing practice:

In many cases, sepsis-related deaths and additional severe co-morbidities are preventable through swift detection and treatment. The first 24 hours in sepsis treatment are critical, as mortality increases with each passing hour sepsis goes unrecognized and untreated. Implementation of standardized sepsis education, initiation of a sepsis screening tool and a sepsis protocol can improve the care we provide to our patients.  Incorporating a standardized, multidisciplinary approach will ensure our patients receive best care to promote optimal outcomes. 

Keywords:

Sepsis, screening tool, protocol,