Theses and Dissertations at Montana State University (MSU)

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    Post-sepsis syndrome: improving morbidity & mortality following hospitalization
    (Montana State University - Bozeman, College of Nursing, 2020) Woods-Tatarka, April Ann; Mauws, Amanda Frances; Chairperson, Graduate Committee: Angela Jukkala
    Sepsis is the life-threatening organ dysfunction caused by a dysregulated host response to infection. Globally, statistics are grim with 19 million cases diagnosed annually. Each year in the United States (US) there are over 1.6 million people diagnosed with sepsis; over 250,000 of these will not survive. Currently, it is a leading cause of morbidity, mortality, and hospital readmissions in the US. The population of focus was those residing within the north-central Montana region. The purpose of this project was to explore the topic of post-sepsis syndrome (PSS) and its occurrence following a primary diagnosis of sepsis. The goal of this project was the development of a quality improvement initiative focused on establishing a care-management program for patients diagnosed with sepsis. Ultimately, maximizing patient health and healthcare organization outcomes. An interprofessional team was convened to develop an evidence-based quality-improvement plan to decrease the human and financial costs of sepsis and PSS. The purposed evaluation of the quality-improvement project includes monthly PDSA cycles with project goals reviewed bi-annually.
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    Outcomes of a quality improvement project: integrating sepsis bundles in the rural emergency department
    (Montana State University - Bozeman, College of Nursing, 2019) Popp, Kierston Christian; Chairperson, Graduate Committee: Casey Cole
    BACKGROUND: Rural hospitals have a poor adherence to the Surviving Sepsis Campaign guidelines, which includes door-to-antibiotic administration times under 60 minutes leading to a higher risk of mortality (Mohr et al., 2018). The aim of this project was to improve door-to-antibiotic times through the implementation of a sepsis bundle, which would place all necessary orders together. The project was set in a rural emergency department in southwestern Montana. Participants included provider staff at the facility including family nurse practitioners, physician assistants, and medical doctors. METHODS: The FADE (focus, analyze, develop, execute, and evaluate) method of quality improvement was used for this project. Baseline assessment included a review of patient medical records who met sepsis criteria from January-June 2017. Antibiotic administration times were reviewed using data collection from the patient charts. A literature review was conducted to identify appropriate sepsis bundle implementation interventions. INTERVENTIONS: Sepsis bundles were introduced to the provider staff through education and meetings to aid in identifying the need for sepsis bundles in the emergency department. Baseline times were also presented to the staff to provide evidence that the current practices were not meeting goals. A sepsis bundle was chosen by the medical director and the Doctor of Nursing Practice (DNP) student that fit best with the resources available in the emergency department. RESULTS: Three months after the implementation of sepsis bundles, a chart review was performed on all patients that met sepsis criteria. Again, door-to-antibiotic administration times was reviewed. Door-to-antibiotic administration times improved by 40.5 minutes, which is a 22 percent improvement. CONCLUSION: The use of sepsis bundles in the care of the septic patient improved door-to-antibiotic administration times. Although improvement in the quality improvement measures was noted, additional work is needed to achieve Surviving Sepsis Campaign's goal of door-to-antibiotic times of under 60 minutes.
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    Sepsis bundle evaluation for quality improvement
    (Montana State University - Bozeman, College of Nursing, 2019) O'Connor, Christine Elizabeth; Chairperson, Graduate Committee: Susan Luparell
    Sepsis is a common diagnosis in the acute care setting. Left untreated, sepsis can result in many long-term complications including permanent organ damage and death. Sepsis has become such a common diagnosis that the Centers for Medicare & Medicaid (CMS) have implemented core measures that are meant to aid in quickly diagnosing and treating septic patients. Because sepsis requires prompt treatment, these guidelines have been divided into three- and six-hour bundles to assure prompt treatment after diagnosis. If hospitals fail to follow these core measures, the institution is not reimbursed for the cost of medical care for that patient. Implementation of the three and six-hour bundles have been shown to improve patient outcomes, decreasing mortality associated with sepsis. Compliance rates with these core measures in a rural hospital in Northwest Montana, which will be called Hospital X, have been consistently below the goal of 80% compliance. This quality-improvement project (QIP) utilized interventions to identify where non-compliance was occurring and interventions to improve overall institution compliance rates. Chart review and process flow observation were used to identify which parts of the bundle were not being implemented according to CMS guidelines. Use of a newly created sepsis handoff tool and implementing nurse education on the core measures were interventions used in an effort to increase overall institution compliance. Results: Overall compliance rates improved from 57% in May, 2018 to 87% in June, 2018 after implementation of interventions. For the months of June, 2018 - September, 2018, compliance rates remained >70%. Conclusion: The two interventions that were implemented during the course of this project seemed to improve compliance based off a significant improvement in overall compliance rates during months where the interventions were implemented. There are many recommendations for future research and interventions based off the findings from this project.
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