Clinical simulation: caring for a critically ill patient with sepsis

Introduction

The purpose of this simulation research was to assess whether bedside nurses could better apply currently recommended therapeutic interventions for patients with sepsis by using a horizons trends clinical decision support tool, rather than just standard monitoring screen displays alone.

Methods

Simulation research participants (n = 75) were first required to attend a didactic training session focusing on recognition and evidence-based treatment for critically ill patients with sepsis. Participants were then directed to apply these treatments in a simulated sepsis experience. Data were collected at two sites (AACN National Teaching Institute Critical Care Nursing Conference, New Orleans, May 2005 and Long Beach Memorial Medical Center's Health Skills Education Center). A METI HPS (human patient simulator) was connected to a Philips Medical Systems Intellivue MP 70 in a simulated critical care environment. Participants were given the patient history, and completed the rest of their assessment using the HPS and Intellivue patient monitoring. Data were collected to compare the use of bedside monitor displays with and without horizon screen trends in the care of patients with sepsis. Group 1 (n = 37) completed the sepsis scenario using a standard screen display, and group 2 (n = 38) had the addition of horizon trends on the display.

Results

The point that marked the onset of sepsis was when each of the physiologic parameters met the current evidence-based screening criteria (HR > 90, RR > 20, MAP < 65, temperature >38°C). Results of this study found statistically significant differences between the standard screen and horizons screen participant groups in the speed in which clinicians were able to reach each measured outcome. This was true in each of the five outcome measurements: onset of sepsis (P < 0.001), initiation of fluid bolus (P < 0.001), initiation of vasopressor (P < 0.001), blood culture order (P = 0.012), and antibiotic administration (P = 0.020).

Conclusion

These results support the hypothesis that monitoring using horizons trending does indeed contribute to faster clinical decision-making in the simulated septic patient experience. Future research should concentrate on replicating these results in a real clinical environment.