Poster Presentation power point

Efficacy of the Implementation of Early Severe Sepsis Strategies on a Medical Surgical Unit Jorge Hirigoyen ARNP-BC

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Background ❖Worldwide there are approximately 18 million new cases of sepsis each year, with a mortality rate range estimated about 30% to 60%. ❖Sepsis is the 10th leading cause of death in the United States. ❖Organ failure occurred in 19.1 % of sepsis patients from 1979 to 1989 and 30.2% from 1990 to 2000. ❖Severe sepsis as the primary diagnosis increased from 326,000 in 2000 to 727,000 in 2008. ❖Severe sepsis as the secondary diagnosis increased from 621,000 in 2000 to 1,141,000 in 2008. ❖About 24 % of patients who develop severe sepsis or septic shock will do so in a Medical-Surgical unit. Significance to Nursing ❖Healthcare Practice: ❖ Nurses early sepsis recognition and management. ❖Healthcare Outcomes: ❖ Improve sepsis mortality and morbidity rates. ❖Healthcare Delivery: ❖ Improve awareness about the subject of sepsis in medical surgical units. ❖ Potential Core Measure. ❖Healthcare Policy: ❖ Generate policy changes beyond the local municipal government Theoretical Framework ❖Severe sepsis strikes about 750,000 Americans annually 28%-50% of these people die., more U.S. deaths than from prostate cancer, breast cancer and AIDS combined ❖Sepsis is on the rise due to: Aging population, increased longevity of people with chronic diseases, spread of antibioticresistant organisms, increase in invasive procedures, broader use of immunosuppressive and chemotherapeutic agents Phases Phase 1: Approval ❖Generate administration and management support for the project: Project proposal was presented to Unit Manager, Director and Hospital Nursing Council for approval. Project was also presented to Medical Executive Committee for approval. ❖Education was performed to all medical surgical nurses on the topic of sepsis in the pilot unit. All participating staff received a 30-45 minutes education program, including a PowerPoint presentation and education flyers regarding the study. Phase 2: Development of Bundle ❖ A sepsis bundle (Tool, Algorithm and Order Set) was developed for medical surgical units following the recommendations of the SSC 2012. ❖The sensitivity and specificity of a severe sepsis tool was calculated. Total number of admissions from pilot unit during a three month period was collected. Admitted patients with a discharge diagnosis of sepsis was attained. All patients that had at least one positive screening for severe sepsis was calculated. Those patients with a discharge diagnosis of sepsis but screened negative for sepsis was also calculated. The results yielded the sensitivity and specificity of the tool by utilizing a 2×2 designs and receiver operating curve. Phase 3: Implementation ❖Decrease hospital length of stay: retrospective data collection will be conducted on all patients who have screened positive for sepsis during a three month period prior from implementation with focus on hospital length of stay. The same method will be employ after the implementation of the new sepsis bundle. With again focus on hospital length of stay. An independent t-test will be utilized to obtain results and measure outcome. ❖Decrease septic patients transfer to higher level of care: retrospective study will be conducted on all patients who have screened positive for severe sepsis during a three month period with focus on transfers to higher level of care. The same method will be utilized after the implementation of the new algorithm and sepsis bundle. With focus on transfer to higher level of care on all patients that screen positive for severe sepsis. A chi-square will be utilized to obtain results and measure outcome. Phase 4: Data Analysis ❖Data Analysis and Presentation of Outcomes to Stakeholders. Phase 5: Evaluation ❖Evaluation of Project. Problem Statement The problem is that no sepsis bundles exists for the identification and treatment of septic patients on medical surgical units. Purpose The purpose of this pilot study is to develop and implement a severe sepsis bundle on a medical surgical unit to determine if there is a reduction in hospital length of stay and transfer to higher level of care. Methodology ❖Quasi Experimental, non-randomized one group pre test-posttest design. ❖ Retrospective review of the data ❖ Pre-Implementation ❖ Education ❖ Implementation ❖ Post-Implementation Algorithm Results ❖It is the intent that the implementation of a severe sepsis bundle on a medical surgical unit will decrease the hospital length of stay and transfer of septic patients to higher level of care. ❖Implementation of this project will allow for further exploration of sepsis work in medical surgical wards. Results of the capstone project are pending References Anderson, R. & Schmidt, R. (2010). Clinical biomarkers in sepsis. Front Bioscience (Elite Edition), 2(5), 504-520. Carter, C. (2007). Implementing the severe sepsis care bundles outside the ICU by outreach. Nursing Critical Care, 12(5), 225-230. Gyang, E., Shieh, L., Forsey, L., & Maggio, P. (2011). A simple screening tool for the early identification of sepsis in a non-icu setting. Poster session presented at: Surgical infection society. 31st Annual Conference of the Surgical Infection Society. May 11-14, Palm Beach, Fl. Hall, M. J., Williams, S. J., DeFrances, C, J., & Golosinskiy, A. (2011). Inpatient care for septicemia or sepsis: A challenge for patients and hospitals. Centers for Disease Control and Prevention National Center for Health Statistics, 62, Retrieved from: http://www.cdc.gov/nchs/data/databriefs/db62.pdf. Sankar, V. & Webster, N. R. (2013). Clinical application of sepsis biomarkers. Journal of Anesthesia, 27, 269-283. Sample Size: Power Analysis Objectives ❖Generate administration and management support for the project ❖Educate medical surgical nurses on the topic of sepsis ❖Develop and implement a severe sepsis bundle (Tool, Algorithm, Order Set) for medical surgical units ❖Evaluate the sensitivity and specificity of a severe sepsis screening tool ❖Decrease septic patients hospital length of stay. ❖Decrease septic patients transfer to higher level of care. RESEARCH POSTER PRESENTATION DESIGN © 2012 www.PosterPresentations.com ❖Power Analysis ❖ Sepsis Hospital Length of Stay ❖ Level of significance (α error probability), power (1-β error probability) and effect size. ❖ Cohen’s recommendation ❖ α value was set at 0.05 ❖ β value was set at 0.95. ❖ Anticipated effect size (Cohen’s d) was set as medium effect, 6% of the variance: d=0.5 ❖ n=256 ❖ Transfers to Higher level of Care ❖ Cramer’s V table chi-square ❖ α value was set at 0.05 ❖ power set at 0.80 ❖ V statistics set at 0.30 ❖ n=174 Singer, M. (2013). Biomarkers in sepsis. Current Opinion in Pulmonary Medicine, 19(00), 1-5. Tazbir, J. (2012). Early recognition and treatment of sepsis in the medical-surgical setting. Medical Surgical Nursing, 21(4), 205-208. Tromp, M., Tijan, D. H. T., van Zanten, A. R. H., Gielen-Wiffels, S. E. M., Goekoop, G. J. D., Van den Boogaad, M., Wallenborg, C. M., Biemond-Moeniralam, H. S., & Pickkers, P. (2011). The effects of implementation of the surviving sepsis campaign in the Netherlands. Netherlands Journal of Medicine, 69(6), 292-298. Poster Presentation Students this project will allow you to formulate and hypothetically develop your own research project. The purpose of this project is for the student to follow all of the different steps in a research project on an already published article and presented as a poster presentation. A poster session or poster presentation is the presentation of research information by an individual or representatives of research teams at a congress or conference with an academic or professional focus. The work is usually peer reviewed. Poster sessions are particularly prominent at scientific conferences such as medical congresses. Students will select a nursing research already published and following the article information you will create a poster presentation that include the below information: The outline of the poster should include the following tabs (minimum requirements) Abstract Outline: -Title of Project -Problem Statement: what is the problem that needs fixing? -Purpose of the Project -Research Question(s) -Hypothesis -Methodology (Qualitative vs. Quantitative) -Steps in implementing your project -Limitations Results (Pretend results) -Conclusion -References I have attached an example of a poster presentation for guidance. The due date for the poster presentation is WEEK 13. Please feel free to be artistic and provide graphs and data. You are welcome to use any poster template. Please submit it via turn it in. Criterion Completeness Outstanding 4 Complete in all respects; reflects all requirements Understanding Demonstrates excellent understanding of the topic(s) and issue(s) Analysis Presents an insightful and through analysis of the issue (s) identified Makes appropriate and powerful connections between the issue(s) identified and the concept(s) studied Evaluation Opinion Supports opinion with strong arguments and evidence; presents a balanced and critical view; interpretation is Very Good 3 Complete in most respects; reflects most requirements Demonstrates an accomplished understanding of the topic(s) and issue(s) Presents a thorough analysis of most of the issue(s) identified Makes appropriate connections between the issue(s) identified and the concept(s) studied Supports opinion with reasons and evidence; presents a fairly balanced view; interpretation is Good 2 Incomplete many respects; reflects few requirements Demonstrates an acceptable understanding of the topic(s) and issue(s) Presents a superficial analysis of some of the issue(s) identified Makes appropriate but somewhat vague connections between the issue(s) identified and the concept(s) studied Supports opinion with limited reasons and evidence; presents a somewhat one- Unacceptable 1 Incomplete in most respects; does not reflect requirements Demonstrates an inadequate understanding of the topic(s) and issue(s) Presents an incomplete analysis of the issue(s) identified. Makes little or no connection between the issue(s) identified and the concept(s) studied. Supports opinion with few reasons and little evidence; argument is onesided and not Score Recommendations both reasonable and objective Presents detailed, realistic, and appropriate recommendations clearly supported by the information presented and concepts studied Grammar and Spelling Minimal spelling and grammar errors APA guidelines Uses APA guidelines accurately and consistently to cite sources both reasonable and objective Presents specific, realistic and appropriate recommendation supported by the information presented and the concepts studied Some spelling and grammar errors sided argument objective. Presents realistic or appropriate recommendation supported by the information presented and the concepts studied Presents realistic or appropriate recommendation with little, if any, support from the information and the concepts studied. Noticeable spelling and grammar errors Uses APA guidelines with minor violations to cite sources Reflects incomplete knowledge of APA guidelines Unacceptable number of spelling and grammar errors Does not use APA guidelines Total
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