Implementation strategy of a severe sepsis management protocol in a tertiary hospital

Introduction

Large variability in clinical practice, in addition to the increasing awareness that certain processes of care are associated with improved medical outcome, has led to the development of clinical practice guidelines. Severe sepsis guidelines have been developed and there is a multinational effort to implement them at bedside.

Objective

To describe the methodology of sepsis protocol implementation in a tertiary hospital.

Methods

A team composed of a case manager, physicians, nurses, a clinical pharmacist and a respiratory therapist was created to organize the flow of septic patients in our institution. Every severe septic patient recognized by a physician was followed by the case manager and every member of the team was alerted. The ICU, ER, central lab and imaging service receive simultaneously a message about this patient. Several tools were created in order to facilitate the implementation process, such as patient flow (Figures 1 and 2), continuous education by the web, multidepartmental training and sepsis kit (normal saline bags, arterial and central venous catheter Presep). Also, we have used the individual collect data proposed by the Surviving Sepsis Campaign to obtain information about quality indicators.

Figure 1

Diagnosis flow for severe sepsis.

Figure 2

Treatment flow for severe sepsis.

Conclusion

The management protocol is a useful and feasible tool to implement guidelines for severe sepsis. A specific team is necessary to accomplish this task.