A Quality Improvement Project to Improve Sepsis Survivorship through Nurse Education in a Medical Surgical Unit

Research Article

Austin J Nurs Health Care. 2022; 9(1): 1066.

A Quality Improvement Project to Improve Sepsis Survivorship through Nurse Education in a Medical Surgical Unit

Thomas P*

Johns Hopkins School of Nursing, Johns Hopkins University, USA

*Corresponding author: Thomas P, Johns Hopkins School of Nursing, Johns Hopkins University, 525 N Wolfe Street, Baltimore, Maryland, 21205, USA

Received: March 19, 2022; Accepted: April 25, 2022; Published: May 02, 2022

Abstract

Aim: Sepsis readmission has become one of the significant threats to our healthcare system. The purpose of this project was to decrease the 30-day sepsis readmission rate of a single medical surgical unit by increasing nurses’ knowledge on the challenges of sepsis survivorship.

Design: A quality improvement project with a pre/post-test design was used.

Methods: Nurses’ knowledge on sepsis survivorship and 30-day sepsis readmission rate of the unit at baseline and immediately after an educational intervention were compared. The intervention was an online educational module on sepsis survivorship. The SQUIRE guideline was used.

Results: Results of the final sample showed a statistically significant improvement in nurses’ knowledge on sepsis survivorship. The effect of the intervention on 30- day sepsis readmission rate was inconclusive given the effect of the pandemic on readmission rate.

Keywords: Sepsis; Readmission; Patient education; Survivorship

Introduction

Readmission after an initial hospital discharge has become one of the significant threats to the healthcare system. Hospital readmission is estimated to cost 41.3 billion U.S. dollars annually [1,2]. Increased morbidity, mortality and financial burden are associated with readmission [1]. As a result, Centers for Medicare, and Medicaid Services (CMS) has included 30-day readmission as one of the outcome measures of the quality of care and incentivizes hospitals to reduce readmissions by linking payment with readmission measures [3]. According to the 2013 nationwide readmission database, of all 30- day hospital readmissions, the most common index hospitalization diagnosis was sepsis [4]. Given the dangerous consequences associated with readmissions, acquiring evidence to guide strategies to prevent readmissions and to improve survivorship among adult sepsis survivors is of paramount importance.

Background

Out of 49 million people hospitalized with sepsis worldwide, 38 million survive sepsis hospitalization [5]. Each year more than 1.7 million adults develop sepsis in the United States, more than 1.4 million survive sepsis, and more than a third of sepsis survivors require readmission [6-8]. National 30-day sepsis readmission rate ranges between 17.5% and 29% [9-11]. In the project site, for calendar year 2019 the hospital wide 30-day sepsis readmission rate was 20%. Increase in the number of sepsis survivors with increased morbidity requiring readmission causes a huge financial burden to the patient, family, and the health care system.

There are modifiable and non-modifiable risk factors resulting in sepsis readmission. Patient socio-demographics, comorbidities, and index hospitalization characteristics were proven to influence the 30-day sepsis readmission [1]. Among the index hospitalization characteristics resulting in readmission, inadequate discharge planning is one of the modifiable risk factors that provide room for improvement. Literature recommends including patient education on sepsis survivorship in discharge planning as an ideal approach in preventing sepsis readmission [11].

A review on sepsis readmission pointed out the importance of survivorship education in improving patient health behaviour and motivation and also in reducing 30- day readmission rate in sepsis and heart failure patients [12,13]. Another review highlighted the importance of including modifiable causes of readmission and preventive strategies in the education [11]. Education is crucial to understand one’s health and is essential to empower survivors to participate in their recovery and equip caregivers to act as their advocates [14]. Decrease in readmission rate by 7.3% to 39% was found in heart failure patients who received discharge education on survivorship from nurses who were trained on heart failure management and survivorship [15-18]. Enhancing the discharge process by educating nurses via online and video educational interventions to equip them to educate patients has resulted in a clinically significant reduction in 30-day Emergency Department visits by 7.5% among bariatric surgery patients [19]. Thus, educating nurses and increasing their knowledge on sepsis survivorship using an online educational intervention to equip them to educate sepsis survivors before discharge would be an initial ideal approach in enhancing survivorship and reducing sepsis readmission.

Despite sepsis readmissions being potentially preventable, and survivorship education having an impact on reducing readmissions, no standardized educational intervention on sepsis survivorship currently exists in the institution. Here nurses are required to complete an e-learning module on sepsis protocol or TREWS (Targeted Real Time Early Warning System) which focuses on the identification and management of sepsis in the inpatient setting. However, it does not cover the long-term outcomes of sepsis. Sepsis coordinator educates the nurses during new hire orientation and skills day on sepsis protocol, but it does not include the long- term challenges faced by sepsis survivors.

Therefore, the purpose of this quality improvement project was to decrease the 30-day sepsis readmission rate of a single adult inpatient acute care medical surgical unit by increasing nurses’ knowledge on the challenges of sepsis survivorship. To fulfil the purpose of the project, four aims were formulated:

• Determine the baseline 30-day sepsis readmission rate of the unit.

• Determine the baseline knowledge of the nurses of the unit on the challenges of sepsis survivorship and provide online educational course on sepsis survivorship over an 8-week period.

• Measure the effects of educational intervention on nurses’ knowledge on the challenges of sepsis survivorship.

• Measure the effects of educational intervention on 30-day sepsis readmission rate of the unit.

PICO question

Does educating the nurses of an adult inpatient acute care medical surgical unit on the challenges of sepsis survivorship decrease the 30- day sepsis readmission rate in that unit?

Translational framework

Re-Aim model was found to be the appropriate model in the context of this project as it addresses the different stages of the project. The project site being a healthcare facility, the framework is suitable to the context as its primary aim is health-promotion. The five steps of this model include reaching the target population, ensuring adoption of the intervention by the organization, ensuring implementation consistency of the delivery of intervention, ensuring the effectiveness of the intervention, and maintenance of the intervention for long term use [20,21]. The actual impact of planning, implementation and evaluation of the project will depend on the combined effects of the five steps of the model.

In this project, nurses were the target population. Unit manager, unit educator, and the sepsis champion of the unit were the key stakeholders in the adoption of the intervention. The evidence - based intervention implemented was an online educational module for the nurses on the challenges of sepsis survivorship. After building relationship with the stakeholders and the nurses, an elevator speech was delivered during staff meeting to propose the project to the stakeholders and to overcome the barriers for adoption of the intervention in the unit. Voluntary consent was obtained from the nurses via email and through staff meeting and appropriate training and technical support were provided to ensure the implementation consistency of the intervention. Once, the educational intervention was complete, the effectiveness of the education was evaluated by comparing the pretest and posttest scores. The readmission rate of the unit following the implementation was compared with the readmission rate for three months prior to the intervention. The plan was to sustain the intervention by adding it to the E-learning for new employee orientation and annual competency. A schematic representation of the Re-Aim model is located in Figure 1.