Development of Sepsis Guideline in Khunhan Hospital, Sisaket Province

Abstract

This action research aimed to develop a health care service guideline for patients with sepsis follow the results of guideline at Khunhan hospital. Participants were 76 health personnel including, physician, nurses and pharmacist, and 477 patients with sepsis. The research was conducted during 1 October 2015–31 March 2018 with 3 cycles which each cycle had 4 phases: covering planning, action, observation, and reflection. The research outcomes were included, 1) diagnosis rate with fast and accurate within 1 hour, 2) blood test rate, hemoculture, for 2 specimens before giving antibiotic, 3) giving antibiotic rate within 1 hour after diagnosis, 4) septic shock rate of the patients receiving enough fluid 1,500 ml. within 1 hour, and 5) mortality rate of patients with sepsis. Research instruments were 1) care process flow, 2) clinical practice guideline for sepsis, and 3) Search Out Severity score (SOS score). Data were collected by using patient medical records and analyzed by frequency and percentage. The results revealed that the first cycle began with reviewing the patient’s death with their health care service process provided. This stage led to see the problems in terms of delay detection, delay diagnosis, delay and inappropriate using of antibiotics, and delay shock-resuscitation. Therefore, the indicators and goals were set and evaluated, but there were no indicators passed. Regarding these operations, the clinical practice guideline for sepsis and competency of the related providers weredeveloped and implemented leading to see much better of the indicators’ results, but there were still no indicators passed. The reflection of this result was shown as the SOS score was difficult to use and inconsistency in use leading to the second cycle. This cycle started with developing the SOS score to be more appropriate and convenient to use and integrated to nursing supervision. From the observation stage in this cycle, there were 2 indicators included the diagnosis rate with fast and accurate within 1 hour and the septic shock rate of the patients receiving enough fluid 1,500 ml. within 1 hour, which did not pass bringing to the third cycle. This cycle was the organizing and monitoring the patients to receive antibiotic as a target set by providing blood test adjustment hemoculture, and giving antibiotic to the patients at the Emergency Room. By observing the indicators in this cycle, all indicators reached through the target set involving, 1) diagnosis rate with fast and accurate within 1 hour, 2) blood test rate, hemoculture, for 2 specimens before giving antibiotic, 3) giving antibiotic rate within 1 hour after diagnosis increasing from 75.8% to 100%, 4) septic shock rate of the patients receiving enough fluid 1,500 ml. within 1 hour increasing from 68.5% to 100%, and 5) mortality rate of patients with sepsis decreasing from 3.1% to 1.3% after implementing the research. In conclusion, this developed health care sepsis service guideline can help achieve the goal or target set leading to decrease the mortality rate of the patients. Therefore, this service guideline should be continuously operated.