BACKGROUND In 2013, New York began requiring hospitals to follow protocols for the early identification and treatment of sepsis. However, there is controversy about whether more rapid treatment of sepsis improves outcomes in patients. METHODS We studied data from patients with sepsis and septic shock that were reported to the New York State Department of Health from April 1, 2014, to June 30, 2016. Patients had a sepsis protocol initiated within 6 hours after arrival in the emergency department and had all items in a 3‐hour bundle of care for patients with sepsis (i.e., blood cultures, broad‐spectrum antibiotic agents, and lactate measurement) completed within 12 hours. Multilevel models were used to assess the associations between the time until completion of the 3‐hour bundle and risk‐adjusted mortality. We also examined the times to the administration of antibiotics and to the completion of an initial bolus of intravenous fluid. RESULTS Among 49,331 patients at 149 hospitals, 40,696 (82.5%) had the 3‐hour bundle completed within 3 hours. The median time to completion of the 3‐hour bundle was 1.30 hours (interquartile range, 0.65 to 2.35), the median time to the administration of antibiotics was 0.95 hours (interquartile range, 0.35 to 1.95), and the median time to completion of the fluid bolus was 2.56 hours (interquartile range, 1.33 to 4.20). Among patients who had the 3‐hour bundle completed within 12 hours, a longer time to the completion of the bundle was associated with higher risk‐adjusted in‐hospital mortality (odds ratio, 1.04 per hour; 95% confidence interval [CI], 1.02 to 1.05; P<0.001), as was a longer time to the administration of antibiotics (odds ratio, 1.04 per hour; 95% CI, 1.03 to 1.06; P<0.001) but not a longer time to the completion of a bolus of intravenous fluids (odds ratio, 1.01 per hour; 95% CI, 0.99 to 1.02; P=0.21). CONCLUSIONS More rapid completion of a 3‐hour bundle of sepsis care and rapid administration of antibiotics, but not rapid completion of an initial bolus of intravenous fluids, were associated with lower risk‐adjusted in‐hospital mortality. (Funded by the National Institutes of Health and others.)

Supplement to: Time to treatment and mortality during mandated emergency care for sepsis.

Nurses working in home care play a significant role in observing and identifying changes in the health status of patient with chronic obstructive pulmonary disease (COPD). The aim of this study was to explore and describe nurses' observations of older patients with COPD when providing home nursing care. In this qualitative explorative study, data were collected through observations of 17 home care visits using the think-aloud technique, followed up with individual interviews with the nurses. Qualitative content analysis was used to analyze the data. The findings showed that the nurses' observations (focus, methods, and interpretation) were characterized by their search for deviations from what they judged to be the patient's habitual state. The nurses did not use any tool or guidelines, nor did they follow a standard procedure. Instead, when observing and interpreting, they performed a complex process guided by their experience and knowledge of the patient, and the patient's individual and contextual circumstances. This knowledge contributes to warranted reflection on nurses' practice in this context to secure COPD patients' safety and quality of life.

https://journals.sagepub.com/doi/pdf/10.1177/2333393620946331

“Looking for Deviations”: Nurses’ Observations of Older Patients With COPD in Home Nursing Care:

Sepsis is associated with high levels of morbidity and mortality. All healthcare professionals have a responsibility to ensure they have sufficient knowledge to effectively screen patients for signs and symptoms of sepsis. In the community setting, screening for sepsis can be challenging, due to the complexity within the patient population and difficulties associated with observation for changes in the patient's condition. The Sepsis Trust community nursing sepsis screening tool provides decision-making support to community healthcare professionals, enabling them to make a rapid assessment for risk factors for sepsis, ensuring a proportionate, consistent and appropriate response. Through implementation of a decision-support tool within the clinical setting, it is likely that patients at risk of sepsis will be identified earlier, and patients will be escalated in a more consistent manner. This process of improving consistency in practice can improve patient outcomes, including mortality, morbidity and overall patient experience.

Improving sepsis recognition through use of the Sepsis Trust's community screening tool.

Maternal Early Warning Scores (MEWS) is an acute maternity illness severity scoring and escalation trigger system. Background: The use of the MEWS in Nigerian obstetric practice is rare but with the strong desire for its use reported and the increasing number of international partnerships with clinicians in Nigeria for the introduction of this tool, the use of multiple versions of MEWS into the Nigerian clinical practice has been recognised as a potential patient safety risk best managed through the development of a Nigerian national MEWS version. Aims: We set out to explore the development of a Nigerian National MEWS version that would make an acceptable fit for the Nigerian acute obstetric care environment to be used by all clinicians involved in acute obstetric care in Nigeria. Methods: The United Kingdom MOEWS was used as the baseline (template); following planned training on MEWS using the above template, surveys of experts at these meetings on the suitability (for Nigeria) and necessity for modifications of the template was done using survey monkey and paper-based questionnaires. Results: One hundred and forty one experts responded out of two hundred requests (70.5%), one hundred and twenty five (88.6%) opted for modifications of the template. Of these, one hundred and three (82.4%) favoured the addition of a parameter directly related to pre-eclampsia. Conclusion: A modification of the UK MOEWS by the addition of another parameter related to pre-eclampsia was favoured by the majority of experts in this study for the development of a Nigerian national MEWS.

/pdf/maternal-early-warning-scores-mews-development-of-a-nigerian-v19m2fh0xv.pdf

Maternal Early Warning Scores (MEWS): Development of a Nigerian National Maternal Early Warning Scores (MEWS) Version

The early warning system alarms the rapid response team (RRT) for clinical deterioration monitoring and prediction. Available systems do not perform well to decrease the number of ICU transfers or death. This study aimed to address the requirement of an intelligent warning system for timely and accurate RRT activation.A literature review was conducted in scientific databases to extract data. Then, a questionnaire was developed for experts' views collection (N=12). The collected data were analyzed using the Content Validity Ratio (CVR). According to the Lawshe table for the corresponding number of experts, the cut-off=0.56 for items to be accepted/rejected was considered. A schematic structure was suggested.The analysis of the extracted papers (N=24) and qualitative analysis addressed 44 requirements in the frame of five involved sub-systems, including a patient monitoring system, electronic health record, clinical decision support system, remote monitoring patient, and dashboard &registries. They were confirmed by meeting the least cut-off value (CVR= 0.86).An integrated approach and technologies of IoT, deep and machine learning techniques, big data, advanced databases, and standards to create an intelligent EWS are required. 

Requirement Analysis for an Intelligent Warning System to Alarm the Rapid Response Team Prior to Patient Deterioration

This discussion article focuses on the literature surrounding early warning scoring systems and their use in primary care, specifically within district nursing. Patient deterioration is a global concern, associated with high mortality rates and avoidable deaths. Early recognition and response by nursing and other health care staff has been attributed to early warning scoring systems (EWSS) and tools. However, the use of equivalent tools in the community appears to be lacking. This review concludes that there is no consensus over the use of EWSS in district nursing and culture of practice is varied, rather than standardised.

The use of early warning scores to recognise and respond to patient deterioration in district nursing

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The use of early warning scores to recognise and respond to patient deterioration in district nursing