Challenges to implementation of sepsis guidelines
© BioMed Central Ltd 2009
Published: 11 November 2009
International surviving sepsis guidelines identified an important role for acute medicine in early management of severe sepsis, but local and multicentre international audits show poor adherence to these guidelines.
We evaluated the use of a Sepsis Case Record (SCR) supported by a systematic educational programme to improve standards. A one-page SCR was derived from surviving sepsis guidelines, to prompt recognition of sepsis syndromes, comprehensive secondary assessment, initiation of resuscitation and antibiotic treatment bundles, and appropriate specialist consultations. The SCR was introduced in the emergency and acute assessment units in our teaching hospital setting within central London, accompanied by a seminar-based educational programme for medical and nursing staff.
Two months after its introduction, the use of the SCR form was audited in all acute medical admissions who met the clinical criteria for sepsis. One hundred sequential patients were assessed in a 6-week period over the winter.
Abx guide compliant
Need for isolation
The SCR was well received but not used consistently. The lack of abnormal temperature may contribute to this. The use of the SCR did improve early management of sepsis, but a number of deficiencies persisted. Implementation of sepsis guidelines remains a major challenge in clinical practice. Succinct guidelines were helpful in this setting but need additional educational and feedback support to improve standards of practice.