Sepsis guideline implementation: benefits, pitfalls and possible solutions

Kissoon, Niranjan

doi:10.1186/cc13784

Cited by 16 publications

(19 citation statements)

References 17 publications

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“…[3] We have also reported the process of improving BCCH sepsis guideline in another study. [2] As a follow up, we conducted the present study in order to identify barriers for the use of sepsis guideline at BCCH.…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…[1,2] While early recognition and treatment of sepsis can improve survival, [1][2][3] the full benefit of therapy has not been realized. This is partly due to the fact that while adherence to Clinical Practice Guidelines (CPGs) [4] may improve care processes and outcomes and decrease costs, [1,3,5,6] low adherence to CPGs still persists. Suboptimal adherence [2,5,[7][8][9][10] is due to several factors including clinicians disagreement with the content of the guideline, perceived lack of relevance to the patient population or their practice, and resource limitations to implement the guideline.…”

Section: Introductionmentioning

confidence: 99%

“…[16] At the same time, we conducted a literature review about benefits, pitfalls and possible solutions for the implementation of sepsis guidelines that was reported elsewhere. [3] Meanwhile, in an effort to improve adherence to sepsis guideline, we conducted a survey (present project) to identify the barriers using an accepted framework [17,18] and identify mechanisms to circumvent them when implementing the guideline. The purpose of this manuscript is to report the barriers identified for implementing a sepsis guideline at BCCH.…”

Section: Introductionmentioning

confidence: 99%

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Barriers to the implementation of sepsis guideline in a Canadian pediatric tertiary care centre

Mosavianpour

Collet

Sarmast

et al. 2016

JNEP

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Introduction: Adherence to Clinical Practice Guidelines for sepsis can improve care processes and outcomes; however, sepsis guideline adherence is plagued by many barriers. The purpose of this article is to report the perceived barriers for implementing a sepsis guideline at British Columbia's Children Hospital. Methods: This is a mixed method study. Data were collected from clinicians using a questionnaire that covered 3 major domains and included two open-ended questions. Quantitative data analysis focused on the Mean Overall Barrier Score (MOBS) in each category using descriptive and inferential statistical techniques. Qualitative data were analyzed thematically through deductive and inductive approaches. Results: A total of 176 clinicians participated in the study. Nurses and physicians were the largest groups of participants (52.7% and 41.2%, respectively). Nurses perceived more barriers (MOBS: 3.3; 95% CI: 3.1-3.4) compared to attending physicians (MOBS: 3.6; 95% CI: 3.3-3.8). The most frequent type of barriers reported was contextual, including environmental and guideline related barriers (MOBS: 3.1; 95% CI: 2.9-3.3), whereas the least barrier reported was lack of motivation (MOBS: 4.0; 95% CI: 3.9-4.2). Clinicians who were highly motivated and perceived less environmental barriers were more likely to use the guideline (Odds Ratio of 2.2 [p = .036] and 2.2 [p = .092], respectively). Conclusions: Motivation was the most important predictor of guideline use while contextual barriers hindered use. Therefore, motivating the clinicians and removing external barriers offers the best chance for successful guideline implementation. Furthermore, removing barriers for the use of sepsis guideline among nursing group needs more consideration.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Barriers to the implementation of sepsis guideline in a Canadian pediatric tertiary care centre

Mosavianpour

Collet

Sarmast

et al. 2016

JNEP

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“…Every hour of delay in administering the required antibiotic treatment is associated with about a 7% increase in mortality (Barochia et al, 2010). Evidence shows that establishing a standard protocol (e.g., Sepsis Bundle) with a set of evidence-based treatment process in a timely multidisciplinary fashion can decrease mortality and associated costs (Levy et al, 2010;Masterton, 2007;Kissoon, 2014;Schramm et al, 2011). Although several conventional quality improvement (QI) interventions have been proposed to increase patient compliance with treatment bundles, studies show that conventional QI has a limited impact on clinical practice (Reid et al, 2005;Arabi et al, 2014).…”

Section: Introductionmentioning

confidence: 99%

System analysis and process redesign for quality improvement of sepsis resuscitation

Al-Qudah

Dong

et al. 2014

IJCENT

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Severe sepsis and septic shock are serious medical emergencies that require timely treatment. The Sepsis Resuscitation Bundle was implemented to frame the resuscitation time within 6 h of onset. Missing this goal has a major impact on treatment outcomes and cost. This study demonstrates the potential of applying a systems engineering approach to improve resuscitation compliance. Root cause analysis, an industrial engineering tool, was used to analyse the existing process and identify sources of delay. Simulation modelling was performed to study event dynamics and propose alternatives. Sensitivity analysis was used to test the proposed alternatives. Results showed that improvements could be achieved by adopting major event adjustments. 84 S.K. Alqudah et al.Applying these adjustments is projected to increase compliance from 50% to 71% and reduce average patient cycle time by 32%, improving the quality of sepsis and septic shock resuscitation in the ICU.

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Resource availability for the management of maternal sepsis in Malawi, other low‐income countries, and lower‐middle‐income countries

Abdu

Wilson

Mhango

et al. 2017

Intl J Gynecology & Obste

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Objective: To assess the availability of key resources for the management of maternal sepsis and evaluate the feasibility of implementing the Surviving Sepsis Campaign (SSC) recommendations in Malawi and other low-resource settings. Methods:A cross-sectional study was conducted at health facilities in Malawi, other low-income countries, and lower-middle-income countries during January-March 2016. English-speaking healthcare professionals (e.g. doctors, nurses, midwives, and administrators) completed a questionnaire/online survey to assess the availability of resources for the management of maternal sepsis. Conclusion:The implementation of existing SSC recommendations is unrealistic in low-income countries because of resource limitations. New maternal sepsis care bundles must be developed that are applicable to low-resource settings.

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Sepsis guideline implementation: benefits, pitfalls and possible solutions

Abstract: This article is one of ten reviews selected from the Annual Update in Intensive Care and Emergency Medicine 2014 and co-published as a series in Critical Care. Other articles in the series can be found online at

Cited by 16 publications

References 17 publications

Barriers to the implementation of sepsis guideline in a Canadian pediatric tertiary care centre

Barriers to the implementation of sepsis guideline in a Canadian pediatric tertiary care centre

System analysis and process redesign for quality improvement of sepsis resuscitation

Resource availability for the management of maternal sepsis in Malawi, other low‐income countries, and lower‐middle‐income countries

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