How a Sepsis Protocol Is Changing Care Delivery for ED Nurses

This new sepsis protocol is saving time and saving lives, according to this CNO.

CNOs everywhere need to be concerned about sepsis.

According to the CDC, 1.7 million American adults develop sepsis annually and at least 350,000 adults with sepsis die during hospitalization or are discharged to hospice. Nurses play a critical role in preventing sepsis, through early detection, infection control, and patient education.

It's the CNO's responsibility to ensure that nurses are fully equipped to deal with sepsis. Nicole Telhiard, chief nursing officer at Our Lady of the Lake Health, implemented a new, nurse-led sepsis advisory in the emergency department (ED), alongside physician leaders, to help with tedious sepsis BPA alerts in the health system’s EPIC platform. Through a collaborative effort, the team came up with two key questions in the EHR, which serve as an alternative to the BPA alerts in clinical documentation.

"These two key questions allow the nurse to use their expertise and their input," Telhiard said.

The first question is: Is the patient presenting with an altered mental status? The second question is: Do you and all of your expertise feel like the patient is presenting with suspected infection?

"After answering those questions, it then goes through some of those other cycles of clinical data that we were using to really formulate and help us initiate our sepsis protocol," Telhiard said.

Addressing pain points

According to Telhiard, the biggest pain point that this new protocol aims to address is unnecessary testing. In the past, nurses would have to draw blood cultures when patients arrived in the ED with sepsis. The wait times for physician orders plus the time it took for the actual blood draw and then the waiting times for the results proved to be unnecessary.

"It took a lot of time on the nurses' part to draw a sterile blood culture and do it well, and these are quality processes that we were measuring, is the cleanliness and sterility of our blood culture collection process by nurses," Telhiard said.

Once the nurses began taking a more active, engaged role in sepsis detection and prevention as part of the protocol, Telhiard explained that it saves the nurses time by reducing the number of cultures drawn and helps them refocus on other patients in the ED, and the ones who definitely have sepsis and need treatment. The protocol has also made data collection quicker and more efficient, due to the implementation of the IntelliSep rapid sepsis diagnostic test that can deliver test results in approximately eight minutes.

"We now have [better and quicker] data at our fingertips to know these patients are septic, these may have other infections but not sepsis, or have other things that we then need to work through with our physician colleagues in the emergency room," Telhiard said.

The protocol has been extremely beneficial for the nurses as well, according to Telhiard.

"Not waiting and delaying for other comprehensive panels and cultures that take time has really been a tremendous help for the nurses," Telhiard said. "Having them be a key part of the interprofessional team has really helped improve the morale in the department and improve the time that they have to spend on other patient care duties and work more collaboratively with our team."

Looking at outcomes

According to Telhiard, there have been several positive outcomes following the implementation of the sepsis protocol and the IntelliSep tool. Length of stay has decreased, along with revisits, and the health system has seen a 39% rate reduction in sepsis mortality. 

"We're accurately testing and screening people appropriately, so we've seen great success with patients not having to revisit the emergency department," Telhiard said. "We have a much more accurate perspective of what's going on with them on that first ED visit versus repeating multiple visits within a seven- or 10-day period."

Additionally, the health system is working on an early mobility protocol for when patients are admitted to the med surg or critical care units. Learning how the nurses use the sepsis protocols and some best practices learned from the early mobility protocol helps ensure that patients on the units move around earlier and get out of their beds and sit in their chairs to eat, Telhiard explained.

"It's helped the full perspective of nursing care and interprofessional care at Our Lady of the Lake by transitioning the clinical protocols from just an emergency room focus to a process used across the full spectrum of healthcare," Telhiard said.

For other CNOs who want to implement a similar strategy, Telhiard emphasized the importance of including frontline staff and working with multidisciplinary teams.

"I mentioned some of our key leaders that were part of this process, but I can quickly visualize the charge nurses and nurse supervisors in the ED that wanted to have an input into this work," Telhiard said. "Including frontline staff, shared governance, which many CNOs value, that work is very important to this process."

Telhiard also recommended following up by spending time with frontline leaders and charge nurses, listening to their voices, and letting them be part of the decision-making process. Lastly, CNOs should focus on removing barriers.

"Our medical executive committee has been very supportive of collaborating with the nursing team, having those protocols reviewed, and oversight of those protocols on an annual basis so that we are all working from the same page," Telhiard said.