Educational needs assessment identifying opportunities to improve sepsis care.

INTRODUCTION: In 2015, the Centers for Medicare and Medicaid Services developed a national quality bundle for the management of patients with severe sepsis and septic shock (SEP-1). Despite performance improvement measures, compliance remains low. This needs assessment is the first stage of a quality improvement initiative to improve SEP-1 compliance. Using a conceptual outcomes framework, this needs assessment analyses SEP-1 compliance data, knowledge, and competence to identify gaps in care and educational opportunities. METHODS: The needs assessment began with a review of national and statewide SEP-1 compliance data to identify a need for improvement. The needs assessment proceeded with a retrospective chart review to evaluate process measures and identify which providers would most likely benefit from educational interventions. A focus group provided perspective on the chart review findings. RESULTS: During the period of 1 April 2017-31 March 2018, national SEP-1 compliance was 51% and compliance at the studied institution was 19%. The chart review included 51 patients (66.7% severe sepsis, 33.3% septic shock). Frequently missed SEP-1 measures included administration of intravenous fluids (0% severe sepsis, 58.8% septic shock), repeat lactate levels (52.6% severe sepsis, 60% septic shock), documentation of volume and tissue perfusion assessment (58.8%), vasopressor administration (73.3%) and administration of broad-spectrum antibiotics (76.5%, severe sepsis). Focus group perceptions identified themes related to gaps in declarative and dispositional knowledge. CONCLUSIONS: This educational needs assessment highlights gaps in SEP-1 clinician performance, competence and knowledge. A multifaceted education programme is the next step for this performance improvement project. Education should include a series of meetings, activities, and workshops that include declarative knowledge, procedural knowledge and dispositional knowledge. Simulation activities can provide an opportunity for providers to demonstrate competence. Point-of-care prompts and performance measurement and feedback of patient care data can support clinician performance. This needs assessment underscores the need for a multifaceted approach to clinician education and performance to improve SEP-1 compliance.

Treating a Patient with Your Hands Tied: Acute Chest Syndrome in a Jehovah's Witness.

Acute chest syndrome (ACS), a vaso-occlusive crisis in patients with sickle cell anemia, is a life-threatening condition and a leading cause of death in these patients. It is treated with analgesics, antibiotics, intravenous fluid, supplemental oxygen (or ventilatory support in severe cases) with simple or exchange transfusion, being the mainstay of therapy. We report a young Jehovah's Witness (JW) patient with sickle cell anemia who presented with ACS. Her religious beliefs precluded the use of blood products. Despite concomitant hemolytic and aplastic crisis and a hemoglobin nadir of 3.1 g/dL, the patient was treated successfully with supportive care - including mechanical ventilation, sedation, paralysis, and erythropoiesis stimulation - and survived. A maximal supportive strategy consisting of ventilatory support with a high fraction of inspired oxygen, sedation, paralysis, erythropoiesis stimulation, and limitation of blood draws can result in the successful treatment of JW patients who refuse blood products.

The effect of personal relevance on learning stroke symptoms/response.

The aim of this study was to test the effect of increasing the personal relevance of stroke symptom information on learning stroke symptoms/emergency response. A randomized pretest-posttest double-blind study design was used. A total of 173 community-dwelling adults participated. Treatment participants read the personally relevant statement, "Learn about stroke to save someone you love," completed the Stroke Action Test pretest, read the National Institute of Neurological Disorder and Stroke pamphlet titled Know Stroke. Know the Signs. Act in Time, and responded to the Stroke Action Test posttest. The control condition differed only in the omission of the personally relevant statement. The treatment group learned significantly more than the control group, F(1, 170) = 7.46, p < .007, eta2 = .02. The mean items learned by the treatment group was 8.3 (SD = 5.67) compared to the control group mean of 6.2 (SD = 5.76). Prefacing stroke prevention information with the statement, "Learn about stroke to save someone you love," could result in greater learning of stroke symptoms/response.