Introduction of an emergency medicine pharmacist-led sepsis alert response system in the emergency department: A cohort study.

OBJECTIVE: To determine effects of implementing a sepsis alert response system in the ED that included early intervention by emergency medicine (EM) pharmacists. METHODS: A prospective cohort (8 February 2016 to 28 February 2018) of patients after implementation of a sepsis alert response system in an Australian ED was compared to a retrospective cohort (3 January 2015 to 7 February 2016) of patients with sepsis who presented during EM pharmacist working hours and were admitted to the ICU. RESULTS: There were 184 patients, including 80 patients pre- and 104 patients post-implementation. The post-intervention cohort was triaged at a higher acuity, had higher quick Sepsis-related Organ Failure Assessment (qSOFA) scores and higher initial lactate measurements. After the intervention, antimicrobial agents were administered to patients within 60 min of presentation more often (21 [26.3%] to 85 [81.7%], P < 0.001). After adjusting for presenting triage category, admission lactate and presenting qSOFA scores, this association remained significant (adjusted odds ratio 9.99; 95% confidence interval 4.7-21.3). Significant improvements were observed for proportion of patients who had intravenous fluids initiated within 60 min (47.5% vs 72.1%); proportion of patients who had serum lactate measured within 60 min (50.0% vs 77.9%) and proportion of patients who had blood cultures performed within 60 min (52.5% vs 85.6%). CONCLUSION: Implementation of a sepsis alert response that included early involvement of the EM pharmacist was associated with improvement in time to antimicrobials and other components of the sepsis bundle. An upfront, multidisciplinary approach to patients presenting to the ED with suspected sepsis should be considered more broadly.

The impact of an educational video about the role of an emergency nurse, viewed by emergency nurses' support systems, on emergency nurses' wellbeing.

BACKGROUND: High stress daily events contribute to burnout in emergency nurses. Strong and informed support systems are essential in ensuring emergency nurses are actively dealing with their workplace-generated stress, through informal social support. METHODS: A pre and post intervention design over a 6-month period in a single ED. A video was created by emergency nurses to orientate their support system to their role and work environment. Its impact on nurse well-being was assessed. RESULTS: More than half of the participants considered their spouse/partner to be their main support system (n = 52, 58%). The majority of participants found their support system: (i) had a greater understanding of their everyday work (n = 79, 88%), (ii) were more engaged when talking about work (n = 72, 80%), (iii) asked more questions about work (n = 63, 70%), and (iv) reported they had an improved ability to debrief with their support system (n = 67, 74%). The median total World Health Organization wellbeing score improved by two points (7%, p < 0.001). CONCLUSION: Emergency nurses' support systems had a greater understanding of the emergency nurse's role and work environment following exposure to the video. This in turn improved the emergency nurses' ability to debrief at home, experience of support, and ultimately their wellbeing.

The influence of nurse allocated triage category on the care of patients with sepsis in the emergency department: A retrospective review.

BACKGROUND: 'Gold standard' sepsis care encompasses the recognition and treatment of sepsis within one hour of emergency department (ED) presentation. Early treatment of patients with sepsis reduces mortality. The aim of this study was to examine the effect that the nurse allocated Australasian Triage Scale (ATS) Category allocation had on ED patient treatment for severe sepsis and septic shock. METHODS: A two-year retrospective observational cohort study from a single major metropolitan ED, including all patients with severe sepsis or septic shock. RESULTS: Sixty patients were included in this study. Sepsis was recognised at triage for the majority of patients (n=38, 63%), and most were allocated an ATS Category Two (n=39). Almost half of the patients received all elements of the sepsis bundle within one hour of arrival (n=27,45%). Patients allocated an ATS Category One or Two had a shorter time to lactate collection (p=0.003), blood culture procurement (p=0.009) and intravenous antibiotic administration (p=0.021) compared with patients who were allocated ATS Category Three or Four. CONCLUSIONS: Most patients presenting with sepsis were recognised by the triage nurse and allocated a high acuity ATS category accordingly. As sepsis is a time-critical condition and a high acuity triage allocation reduces time to treatment, we recommend all Australian EDs should implement a standard approach to sepsis triage by allocating an ATS Category of One or Two to all patients suspected of having sepsis, thus reflecting the urgency of their disease.