الفهرس | Only 14 pages are availabe for public view |
Abstract Sepsis affects more than 30 million people annually, and it results in 6 to 11 million fatalities, according to estimates. The middle east and north Africa are thought to see between 780,000 and 970,000 cases of sepsis each year. Hospitalized sepsis patients account for onefourth of all fatalities. Death rates for the most lethal ailments are almost 50%. Sepsis is a global cause of morbidity, mortality, and healthcare expenses; therefore, effective and precise therapy reduces sepsis consequences. Early diagnosis, early antimicrobial treatment, and early hemodynamic resuscitation remain the cornerstones of sepsis care. According to recent recommendations, the initial therapy and life-saving measures should be initiated within an hour after the suspicion of sepsis. Serious morbidity and mortality are linked to septic shock and severe sepsis. Early goal-directed treatment (EGDT) as a set of evidence-based interventions that have been shown to be more effective when used together than when used individually in therapy. EGDT has significantly enhanced patient outcomes, as evidenced by a 16% decrease in mortality. Nurses contribute in early goal-directed therapy and sepsis management by being critical in the early detection and treatment of sepsis. To prevent the progression of sepsis, they can carefully monitor and assess patients’ health conditions and promptly administer nursing care. Nurses are essential in the early detection, rapid diagnosis, and prompt treatment of patients with sepsis in order to lower mortality and increase patient survival. In addition, nurses’ clinical evaluation skills during triage and their involvement in sepsis research may aid in early identification, precise severity prediction, and speedy sepsis therapy. Barriers relating to patients, nursing, organizations, and healthcare teams have been identified by the studied emergency care nurses that affected on the choice of whether to begin EGDT. All nurses of both gender (60) who are assigned in the direct care of the newly admitted patients with sepsis at the previously mentioned units were included in study. One tool was used in the current study: Barriers of implementing early goal directed therapy among critically ill patients with sepsis questionnaire: This tool consisted of four parts. This tool included five parts: Part one: Sociodemographic Data and work-related data This part included age, gender, level of education, years of experience, and marital status, implementation of early goal directed therapy. Part two: Patient-related barriers: This part included time of admission, diagnosis, severity of disease, complexity and atypical presentation of early symptoms of sepsis, poverty of patient, conscious level of the patient, comorbidity conditions which are complicating initial management such as human immunodeficiency virus (HIV) or malnutrition, variability in environmental factors, or genetic features of host response, presence of relatives at the time of admission, education level of the patients and family, these items rated on a dichotomous scale of (yes or no) and the score assigned for each item as follow: Yes (for correct answer) and equal one, while no (for incorrect answer) and equal zero. Part three: Nurses related barriers: It was used to assess nurse related barriers as Lack of awareness and familiarity about EGDT protocol, lack of knowledge about sepsis, in sufficient knowledge about importance of early goal directed therapy, lack of clinical skills, there are no clinical guidelines for implementing EGDT, delay recognition of sepsis and septic shock, failure of communication between the staff (Handoff failure), the burden of caring several patients (increase nurses’ workload), lack of continuous supervision, mentorship, and support by senior manager, lack of training program, shortage of the staff, lack of expertise in assessment of tissue perfusion indicators, delay in obtaining samples from the patient for sepsis workup, delay in sending sample to the lab, delay in starting management, lack of authority regarding initiation of fluid or vasopressors, lack of motivations. These items rated on a dichotomous scale of (yes or no) and the score assigned for each item as follow: yes (for correct answer) and equal one, while no (for incorrect answer) and equal zero. Part four: Organization related barriers: It was included organization culture does not promote implementation of EGDT, time consumed in admission procedures, lack of expertise, prolonged laboratory turnaround times, lack of laboratory supplies as lactate level devices, lack of medications as vasopressor medications and fluid, lack of supplies for taking blood culture under aseptic technique, lack of cardiac monitor devices, infusion pump, lack of training sessions related to applying sepsis management, policy related barriers in implementing EGDT, lack of collaboration and communications between different departments, lack of agreement with clinical protocol on EGDT, presence of logistics barriers (as places, administration affairs& papers), day of admission (working days and holidays), lack of continuous monitoring and lack of supervision, prolonged turnaround time in implementing EGDT, time consumed in patient transfers and admission, prolonged laboratory turnaround times, limited pharmacy resources, these items rated on a dichotomous scale of (yes or no) and the score assigned for each item a follow: Yes (for correct answer) and equal one, while no (for incorrect answer) and equal zero. Part V: Health care team related barriers: It was used to assess barriers related to health care team other than the studied nurse’s (physician, technician, consultant and other) whose action contributed to the encountered barriers. This part included shortage of staff members, difficult in recognition of the patient condition, delay in diagnosis, delay in prescription of medications, delay in insertion of central venous catheter, Response time to patient (delay in placement of central venous catheter), Resistance to change to the new guidelines of EGDT (doesn’t participate in training programs. each item on this tool was rated on a dichotomous scale of (yes or no) and the score was assigned for each item as follow: Yes (for correct answer) and equal one, while no (for incorrect answer) and equal zero. The main findings of the current study were that: Regarding EGDT implementation barriers among studied emergency care nurses, it was clear that the majority of EGDT implementation barriers were Health care team related barriers in nature, followed by patient related barriers and nurses related barriers in nature. Barriers related to health team such as shortage of health care team, delay in diagnosis is a barrier to them, lack of multidisciplinary collaboration, resistance to change to the new guidelines of EGDT (doesn’t participate in training programs and delay prescription, ordering and delivery of fluids, medications, and vasopressors. Furthermore, patient related barriers such as the presence of relatives at the time of admission, age of the patients (greater than 60 years)diagnosis and comorbidity, severity of the illness (SOFA score) and immunity status of the patient, moreover, nurses related barriers such as Shortage of the staff, the burden of caring for several patients (Increase nurses’ workload),delay recognition of sepsis and septic shock, lack of training program, lack of motivations, lack of awareness and familiarity with EGDT protocol, delay in obtaining samples from the patient for sepsis workup. Finally organization related barriers such as lack of collaboration and communication between different departments, prolonged laboratory turnaround times, presence of logistics barriers (as places, administration affairs& papers),time consumed in admission procedures, lack of expertise of the multidisciplinary team. Finally, it can be recommended that: The following recommendations on educational level are made based on the study’s findings: Include early goal-directed therapy in undergraduate curriculum, teach emergency care nurses about early goal-directed therapy in continuing education courses to update their knowledge of new evidence-based practice, encourage nurses to attend early goal-directed therapy workshops to clarify their role in nursing care, and on an administrative level, include: Implement quality improvement techniques to improve the use of early goal directed therapy, lower the risk of complications from sepsis, and guarantee that the materials required for EGDT implementation are easily accessible. Further studies are needed for developing educational programs to educate healthcare providers about sepsis and EGDT, applying this study on a large popularity sample to validate the results, developing nursing led protocols that empower nursing staff to implement EGDT based on predetermined criteria, electronic reminder that a catheter is still in place. Regarding clinical practice includes: availability of continuous supervision all over 24 hours to monitor implementation of EGDT. Finally regular staff meeting, training and conference should be conducted to discuss barriers of EGDT implementation, their categorization and their control. |