An observational study of the effects of a clinical nurse specialist quality improvement project for clinical reminders for sepsis on patient outcomes and nurse actions

Dawn Marie Drahnak


Background: Clinicalreminders (CRs) are designed to cue the healthcare team to provideevidence-based guidelines and care. Inappropriate, delayed, or lack of responseto CRs for sepsis may result in excessive reminders contributing to alarmfatigue and failure to rescue.
Methods: QualitativeInitiative/Analysis, Retrospective Medical Review, Questionnaire/Survey.Pre/post data pull (audit) of the impact of the study interventions (editingthe CRs, updating nurse and physician on latest sepsis guidelines).Post-intervention survey of nurses/clinicians regarding their response to CRs.Specific aims: (I) improve sepsis bundle compliance using Sepsis CMS CoreMeasure (SEP-1) criteria; (II) increase efficiency of CR/best practice alerts(BPAs) by decreasing frequency of inappropriate CR/BPAs via refinement ofresponse algorithm; (III) provide nurse/clinician update of Surviving SepsisCampaign (SSC): International Guidelines for Management of Sepsis and SepticShock: 2016.
Results:Theinstitution’s inpatient hospital quality measures dashboard: sepsis: earlymanagement bundle, severe sepsis/septic shock: sampled. Centers for Medicare& Medicaid Services (CMS). Pre-project adherence (July 2017) =3%;post-project adherence (December 2017) =48% positive trending to nearinstitutional goal with a 45% improvement with adherence to the sepsis bundle(institutional target ≥50%). Inpatient optimalcare reported via The Balanced Scorecard—hospital core measure: inpatientoptimal care score: sepsis (SEP-1) demonstrated a 94.85% increase in YTD 18 Actual41.7% compared to YTD 17 Actual 21.4% (data source—Quantros). #CR/BPA pre- andpost-intervention—base sepsis detection/SIRS criteria for registered nurse (RN)(sepsis CR/BPA) July 2017—13,391 (pre-intervention) compared to January2018—16,612 (post-intervention) (February 2018—11,081) and July 2018—8,622 (6months later). The nursing survey revealed nursing documentation practice canaffect timing of CRs and potentially delay recognition of sepsis/septic shock.Protocols for sepsis being in place does not equate to adherence to policy.
Conclusions:Reminderfatigue is a not completely unavoidable with increasingly complex patients. CRdesign, education for use, and continued auditing can decrease alarm fatigueand improve patient outcomes.