Integration of Sepsis Alert Team

Posted: January 4th, 2023

Integration of Sepsis Alert Team

Student’s Name

Institutional Affiliation

Integration of Sepsis Alert Team

Fleischmann-Struzek et al. (2018) and Haque, Sartelli, McKimm, and Bakar (2018) paint a grim picture of the prevalence of hospital-acquired infections and sepsis in the world and individual countries. For instance, Fleischmann-Struzek et al. (2018) noted that sepsis caused over 6 million fatalities across the world, with 22% if patients that had been admitted in German hospitals in 2015 having at least one infection episode during their hospital stay. Similarly, Haque, et al. (2018) revealed that healthcare-associated infections afflicted nearly 1.7 million hospitalized Americans and cause fatalities in one in every seventeen of these patients. These statistics demonstrate the urgency of attending to sepsis urgently to prevent fatalities, thus justifying the setting up and integrating sepsis alert teams. 

Chrisman, Jordan, Davis, and Williams (2014) explain what evidence-based practice (EBP) is and its utility in research since its advent in clinical practice in 1992. They note that great strides had been accomplished, with the American Nursing Association (ANA) predicting that 90% of nursing practice would be derived from EBP research findings by 2020 (Chrisman et al., 2014). Further, they advise that EPB is applicable in quantitative and qualitative studies, which can be use singly or using a mixed-methods approach. Portney (2020) attends to the use of evidence-based practice in clinical research extensively by going through all the research mechanics that lead to a high quality study. As a research guide, Portney’s (2020) work is beneficial to a researcher who needs to choose a research approach among the many that are available based of the research aim, question and objectives, and justify the choice. Portney (2020) agrees that clinical research is especially driven the need to gather sufficient evidence of care that would improve the health of populations and lower the cost of healthcare. 

Murad, Asi, Alsawas, and Alahdab (2016) go further by explaining the evidence pyramid and how it can be improved by emphasizing the internal and external validities of the methodologies and statistics used. Murad et al. (2016) compared the traditional evidence pyramid with two revised versions; one showing a blurring and interceptions of the evidence divides and another that leaves out systematic reviews from the pyramid. They called for a reevaluation of the position given to evidence from meta-analyses and systematic reviews, and insist on the robustness of the methodologies to substantiate evidence quality. Consequently, in evaluating the evidence obtained for and from this study, the internal and external validity of the methodologies is pertinent to ensure high-quality and sufficient evidence to inform strong recommendations for nursing practice.    

De Groot, Van der Wouden, Van Hell, and Nieweg (2013) detailed the approaches used to translate theory into practice and how it is influenced by the differences between individuals and groups, when dealing with healthcare professionals and patients. They argued that evidence-based practice (EBP) went beyond making decisions related to individual patients to include the development of procedures and guidelines for groups of patients and healthcare professionals. However, they distinguished between the evidence-based practices for the two scenarios by noting that single caregivers were charged with implementing the EBP for individual patients while a team of healthcare providers handed the group EBP (De Groot et al., 2013). In this study, alert responses are a team effort rather than an individual undertaking. In this regard, the five steps used in making and implementing evidence-based practice decisions, are critical in advancing the routine of the healthcare practitioner. 

Positivism is one of the research philosophies used to undertake quantitative studies in nursing. Ryan (2018) notes that researchers using the positivistic worldview value objectivity in their studies as their epistemological underpinning of the truth. To this end, they accept or reject hypotheses based on the evidence gathered in quantitative study. Consequently, positivism provides a reality that is based on logical realism and empiricism (Ryan, 2018). The positivistic research philosophy is preferred for this study because it enables the researcher to seek out the patterns, relationships and trends between two of more measurable variables rather than the opinions of individuals.

McNeill and Bryden (2013) singled out the use of comparative studies that compare the effectiveness of different rapid response systems in different circumstances and geographies. In a systematic study that reviewed the literature on the relationship between emergency response teams and early warning systems, and patient survival in hospitals, McNeill and Bryden (2013, p. 1652) found that the studies that used single parameters presented low quality evidence compared to these that adopted a “whole system” approach and used the aggregate weighted scoring of multiple variables. In this study, a comparative study may present a higher quality of evidence for use in nursing practice if multiple variables are investigated. In the same vein, Stürmer, Wyss, Glynn, and Brookhart (2014) recommended the use of propensity scores to estimate the effects of an intervention across populations that have different characteristics.

With these prevailing research conditions, the Model for Nursing Effectiveness Research best anchors this study, theoretically, and promises to deliver high quality evidence that is usable in nursing practice. Lukewich, Tranmer, Kirkland, and Walsh (2019, p. 685) noted that the Nursing Role Effectiveness Model (NREM) that underpins the nursing effectiveness research is effective in assessing the contribution of nursing to the quality of care and patient outcomes in a multidimensional healthcare environment.  The Donabedian model of structure-process-outcome forms the basis of NREM, and includes several components specific to nursing, along with several variables that contribute to the robustness of nursing research. Considering that sepsis patients may have multiple underlying and associated issues that need to be considered by the alert teams, investigating the complex practice issues that would influence the effectiveness of such teams requires a robust theoretical foundation such as NREM.  

Research design

A mixed-methods design comprising qualitative and quantitative components is proposed for the study. The qualitative part will involve interviews to capture the sentiments of nurses and clinicians of the use of sepsis alert code teams, while the quantitative part will analyses different patient variables obtained from their medical health records. The quantitative part will be a comparative study that compares the outcomes of the sepsis alert code to a control that has not rapid sepsis response system.  

Sample

The sample will comprise of nurses, clinicians and patients. While 10 nurses and 5 clinicians will be interviewed, patient data held by the hospital will be used to provide quantitative information on various variables such as those with and without sepsis, interventions involving or nor not involving sepsis alert code team response, length of hospitals stay, recoveries and fatalities.

Proposed evidence-based intervention

The proposed intervention is the establishment of a sepsis alert code team. This team would be integrated into the alert code system and response protocol already being used to respond to Trauma and SEMI alert codes in the healthcare institutions. The sepsis alert code team is expected to respond to patients that digress into sepsis urgently enough to avert fatalities.  

References

Chrisman, J., Jordan, R., Davis, C., & Williams, W. (2014). Exploring evidence-based practice research. Nursing Made Incredibly Easy, 12(4), 8-12. doi:10.1097/01.nme.0000450295.93626.e7.

De Groot, M., Van der Wouden, J. M., Van Hell, E. A., & Nieweg, M. B. (2013). Evidence-based practice for individuals or groups: let’s make a difference. Perspectives on Medical Education, 2(4), 216-221. doi:10.1007/s40037-013-0071-2.

Fleischmann-Struzek, C., Mikolajetz, A., Schwarzkopf, D., Cohen, J., Hartog, C. S., Pletz, M., … & Reinhart, K. (2018). Challenges in assessing the burden of sepsis and understanding the inequalities of sepsis outcomes between National Health Systems: secular trends in sepsis and infection incidence and mortality in Germany. Intensive Care Medicine, 44(11), 1826-1835. doi:10.1007/s00134-018-5377-4.

Haque, M., Sartelli, M., McKimm, J., & Bakar, M. A. (2018). Health care-associated infections–an overview. Infection and Drug Resistance, 11, 2321-2333. doi:10.2147/idr.s177247.

Lukewich, J. A., Tranmer, J. E., Kirkland, M. C., & Walsh, A. J. (2019). Exploring the utility of the Nursing Role Effectiveness Model in evaluating nursing contributions in primary health care: A scoping review. Nursing Open, 6(3), 685-697. doi:10.1002/nop2.281.

McNeill, G., & Bryden, D. (2013). Do either early warning systems or emergency response teams improve hospital patient survival? A systematic review. Resuscitation, 84(12), 1652-1667. doi:10.1016/j.resuscitation.2013.08.006.

Murad, M. H., Asi, N., Alsawas, M., & Alahdab, F. (2016). New evidence pyramid. BMJ Evidence-Based Medicine, 21(4), 125-127. doi: 10.1136/ebmed-2016-110401.

Portney, L. G. (2020). Foundations of Clinical Research: Applications to Evidence-Based Practice. FA Davis.

Ryan, G. (2018). Introduction to positivism, interpretivism and critical theory. Nurse Researcher, 25(4), 41-49. doi:10.7748/nr.2018.e1466.

Stürmer, T., Wyss, R., Glynn, R. J., & Brookhart, M. A. (2014). Propensity scores for confounder adjustment when assessing the effects of medical interventions using nonexperimental study designs. Journal of Internal Medicine, 275(6), 570-580. doi:10.1111/joim.12197.