Publication Date

Spring 4-2015

Degree Type

Doctoral Project

Degree Name

Doctor of Nursing Practice (DNP)

Department

Nursing

First Advisor

Danette Dutra

Second Advisor

Beth Stephens-Hennessy

Third Advisor

Laura Senn

Keywords

Maternal sepsis, Septic shock, Perinatal sepsis, Early goal-directed therapy

Abstract

Septic shock is rare in pregnancy; however, sepsis remains an important contributor to maternal mortality. The perinatal patient can appear deceptively well before rapidly deteriorating to septic shock. There is a need for protocols regarding early recognition and management of maternal sepsis. The Surviving Sepsis Campaign developed guidelines to provide guidance for the clinician caring for patients with severe sepsis or septic shock. The purpose of this doctoral project was to evaluate compliance with early goal directed therapy before, during, and following the implementation of a standardized physician order set and interprofessional education for nurses and physicians in the perinatal setting. The systemic inflammatory response criteria were adjusted for consideration of the physiological effects of pregnancy to accurately screen for sepsis. A retrospective study included 97 patients screening positive for sepsis from April 2014 to January 2015. The indicators for early goal-directed therapy included drawing of lactate and blood cultures, administration of 30ml/kg crystalloid intravenous fluid bolus, additionally the administration of a broad-spectrum antibiotic to determine the effects of sepsis protocol. When comparing pre and post intervention in patients with sepsis, statistical significance was achieved for draw lactate (p=. 029), administering a broad-spectrum antibiotic (p=. 006), and drawing a repeat lactate (p=. 034). In patients with severe sepsis and septic shock, statistical significance was achieved for administering a broad-spectrum antibiotic (p=. 010). The importance of education and a perinatal sepsis protocol using a multidisciplinary approach can improve compliance with the sepsis bundles.

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