Abstract
BackgroundThe ‘Sepsis 6’, a care bundle of basic, but vital, measures (e.g. intravenous fluid, antibiotics) has been implemented to improve sepsis treatment. However, uptake has been variable. Tools from behavioral sciences, such as the Theoretical Domains Framework (TDF) may be used to understand and address such implementation issues. This study used a behavioral science approach to identify barriers and facilitators towards Sepsis Six implementation at a case study hospital.MethodsSemi-structured interviews based on the TDF were conducted with a sample group of consultants, junior doctors and nurses from Emergency Department, Medical and Surgical Admissions, to explore barriers/facilitators to Sepsis Six performance. Transcripts were analyzed following the combined principles of content and framework analysis. Emerging themes informed a questionnaire to explore generalizability and importance across a sample of 261 stakeholders. Median importance and agreement ratings for each theme were calculated overall and for each role and clinical area. These were used to identify important barriers and important facilitators as targets for performance improvement.ResultsNo new belief statements were discovered and data saturation was deemed achieved after 10 interviews. 1699 utterances were coded into 64 belief statements, then collated into a 51-item questionnaire. 113 questionnaire responses were obtained (44.3% response rate). Important barriers included insufficient audit and feedback, poor teamwork and communication, concerns about using the Sepsis Six in certain patients, insufficient training, and resource concerns. Facilitators included confidence in knowledge and skills, beliefs in overall benefits of the bundle, beliefs that identification and management of septic patients fell within everyone’s role, and that regular use of the bundle made it easier to remember. Some beliefs were applicable for the entire group, others were specific to particular staff groups.Discussion and ConclusionsA range of barriers and facilitators towards Sepsis Six performance across different staff groups were systematically identified using a theoretically-informed approach. This can inform development of targeted performance improvement interventions.
Highlights
The ‘Sepsis 6’, a care bundle of basic, but vital, measures has been implemented to improve sepsis treatment
Semi-structured interviews Participant characteristics No new belief statements were identified after analysis of the initial ten participant interviews; thematic data saturation was deemed achieved and no further interviews were conducted or analyzed (Data saturation table in Additional file 3)
Three participants came from Medical Admissions Unit (MAU), three from surgical admissions units (SAU) and four from Emergency Department (ED)
Summary
The ‘Sepsis 6’, a care bundle of basic, but vital, measures (e.g. intravenous fluid, antibiotics) has been implemented to improve sepsis treatment. Tools from behavioral sciences, such as the Theoretical Domains Framework (TDF) may be used to understand and address such implementation issues. Antibiotic administration in septic patients has been adopted as a national standard against which UK hospitals are measured, with performance linked to financial reward or punishment [2]. Modern care standards, with early antibiotics and fluid resuscitation, show significant mortality benefit compared to previous research [3,4,5,6,7]. Many patients still die from sepsis around the world each year, with international care standards rarely achieved in full [8,9,10]. One strategy adopted to improve this is using a simplified care bundle, the ‘Sepsis 6’ (Table 1), which demonstrates increased compliance and an association with reduced mortality compared to full Surviving Sepsis Campaign care bundles [11]
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