Emergency Department Nurses' Knowledge and Experience with the New Sepsis-3 Criteria: A Survey
CCCF ePoster library. TOPCAGIC E. Oct 4, 2017; 198179; 112
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Emergency Department Nurses’ Knowledge and Experience with the New Sepsis-3 Criteria: A Survey

​Topcagic, Emina1

Faidi, Walaa2

Clayton, Natasha1,2

Cornell, Kathy1

McDonald, Ellen1,2 

Fox-Robichaud, Alison1,2

Welsford, Michelle1


1 Hamilton Health Sciences, Hamilton, Canada

2 McMaster University, Hamilton, Canada

Introduction: Sepsis is challenging to identify, particularly in those patients that present in the early stages of infection (early presenters). Early recognition reduces the time to treatment, which ultimately saves lives. In 2016, new Sepsis-3 criteria, specifically qSOFA (quick Sepsis-related Organ Failure Assessment) were identified. It is unknown how frontline Registered Nurses (RNs) working in the Emergency Department (ED) are operationalizing these new criteria. 

Objective: We sought to understand how RNs in the ED use the new Sepsis-3 criteria and their clinical experience to identify patients with suspected infection or sepsis, requiring timely treatment. 

Methods: To understand RNs' operationalization of sepsis, including the new Sepsis-3 criteria, a 7-item survey was developed and distributed to all RNs at the Hamilton General Hospital; an urban tertiary-care ED. During phase 1 the questionnaire was piloted with a convenience sample of 7 RNs in which feedback was obtained on sentence structure to 6 questions. Phase 2 tested for clinical sensibility of the questionnaire, a convenience sample of 7 respondents provided feedback using a 5-point Likert scale. The clinical sensibility testing covered several domains: appropriateness, redundancy, and survey completion time. We invited feedback on education around the new Sepsis-3 criteria and preferred learning strategy. Phase 3 included distribution of the final survey using paper versions and electronically via SurveyMonkey®. Respondents were asked to provide demographic data: sex, education, and clinical experience. 

Results: The survey was distributed to 79 ED RNs, of which 50 (63%) completed the survey. The average time to completion was 3.8 minutes. Respondents identified hypotension (64.0%), heart rate (58.0%), and temperature (54.0%) as the best characteristics to identify patients with suspected sepsis. Using a Likert scale, 48 (96%) respondents scored an average of 4.3 out of 5 for their level of confidence with early recognition of patients with sepsis. Despite the new Sepsis-3 criteria published 1 year ago, 33 (66.0%) respondents were not familiar with qSOFA, 13 (26.0%) were aware it existed but had not been educated on it, 4 (8.0%) were familiar with the criteria but relied on other variables to identify septic patients, and none claimed to have thorough understanding of the qSOFA criterion for sepsis. The majority (82%) of respondents agreed that the Sepsis-3 criteria is effective in identifying patients with potential sepsis, and a medical directive should be available for RNs to identify and initiate treatment of septic patients or those at risk. 

Conclusion: We have identified a knowledge gap in nursing understanding of the new Sepsis-3 criteria. In this cohort of ED nurses, hypotension was identified as the number one indicator for sepsis patients, thus matching 1 of the 3-qSOFA criteria. Respondents identified an interest in learning about Sepsis-3 and qSOFA via a variety of educational modes. Furthermore, ED nurses support the use of a medical directive in suspected septic patients. A larger study of Emergency Department nurses to yield further information and impact on practice is recommended. 

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