Implementation of Interprofessional Education and Physician Order Set Improves Compliance with Early Recognition and Treatment of Maternal Sepsis

Abstract

Septic shock is rare in pregnancy; however, sepsis remains an important contributor to maternal mortality. The perinatal patient can appear deceptively well before rapidly deteriorating to septic shock. There is a need for protocols regarding early recognition and management of maternal sepsis. The Surviving Sepsis Campaign developed guidelines to provide guidance for the clinician caring for patients with severe sepsis or septic shock. The purpose of this doctoral project was to evaluate compliance with early goal directed therapy before, during, and following the implementation of a standardized physician order set and interprofessional education for nurses and physicians in the perinatal setting. The systemic inflammatory response criteria were adjusted for consideration of the physiological effects of pregnancy to accurately screen for sepsis. A retrospective study included 97 patients screening positive for sepsis from April 2014 to January 2015. The indicators for early goal-directed therapy included drawing of lactate and blood cultures, administration of 30ml/kg crystalloid intravenous fluid bolus, additionally the administration of a broad-spectrum antibiotic to determine the effects of sepsis protocol. When comparing pre and post intervention in patients with sepsis, statistical significance was achieved for draw lactate (p=. 029), administering a broad-spectrum antibiotic (p=. 006), and drawing a repeat lactate (p=. 034). In patients with severe sepsis and septic shock, statistical significance was achieved for administering a broad-spectrum antibiotic (p=. 010). The importance of education and a perinatal sepsis protocol using a multidisciplinary approach can improve compliance with the sepsis bundles. Lori Susan Olvera April 2015 IMPLEMENTATION OF INTERPROFESSIONAL EDUCATION AND PHYSICIAN ORDER SET IMPROVES COMPLIANCE WITH EARLY RECOGNITION AND TREATMENT OF MATERNAL SEPSIS by Lori Susan Olvera A project submitted in partial fulfillment of the requirements for the degree of Doctorate of Nursing Practice in the School of Nursing at California State University, Fresno April 2015 NOTE: THIS PAGE IS OPTIONAL, AND REQUIRES PAYMENT OF AN EXTRA $55 FEE. DELETE THIS PAGE IF YOU’RE NOT REGISTERING YOUR COPYRIGHT © 2015 Lori Susan Olvera APPROVED For the Department of Nursing: We, the undersigned, certify that the Doctorate of Nursing Practice project of the following student meets the required standards of scholarship, format, and style of the university and the student's graduate degree program for the awarding of the Doctorate of Nursing Practice degree. Lori Olvera DNP-c, RN, RNC Lori Susan Olvera Danette Dutra Nursing, CSU Fresno Beth Stephens-Hennessy Administration Sutter Memorial Hospital Laura Senn Administration Sutter Memorial Hospital For the University Graduate Committee: Dean, Division of Graduate Studies AUTHORIZATION FOR REPRODUCTION OF DOCTORATE OF NURSING PRACTICE PROJECT I grant permission for the reproduction of this Doctorate of Nursing Practice project in part or in its entirety without further authorization from me, on the condition that the person or agency requesting reproduction absorbs the cost and provides proper acknowledgment of authorship. Permission to reproduce this Doctorate of Nursing Practice project in part or in its entirety must be obtained from me. Signature of project author: lori olvera