The impact of evidence-based sepsis guidelines on emergency nursing practice and medical management: A mixed methods study
- Publication Type:
- Thesis
- Issue Date:
- 2025
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ππ»ππΏπΌπ±ππ°ππΆπΌπ»: Globally, sepsis continues to be a significant cause of morbidity and mortality within hospitals. Improving the early recognition and management of sepsis has become the corner stone in reducing preventable adverse patient outcomes. However, the longitudinal impact of the New South Wales sepsis guideline on emergency clinical practice remains unclear. The aim of this study was to understand the impact of the implementation of the New South Wales sepsis guideline on emergency nursing practice and medical management of patients presenting with sepsis to ED.
π π²ππ΅πΌπ±π: A two phase explanatory sequential mixed methods design was used for this study. Phase 1: A 12-month retrospective randomised medical record audit of adult patients with a sepsis related diagnosis was conducted 12-months before, 12-months after and four years post the implementation of the New South Wales sepsis guideline. Phase 2: Semi-structured interviews (n=34) were conducted with triage nurses, emergency medical officers and stakeholders. Focus groups (n=6) were also conducted with emergency nurses.
π₯π²πππΉππ: After the implementation of the sepsis guideline, all patients in the after group (n=165; 100%) and the follow-up group (n=81; 100%) received intravenous antibiotics. The findings from phase 1 identified an 87-minute reduction (p β€ .001) in the median time to antibiotics four years after the implementation of the sepsis guideline. There was a sustained improvement in allocation of urgent triage categories in the follow-up group (n=43; 53.1%). Phase 2 demonstrated clinician behaviour change was influenced by implementation strategies that included a multi-level leadership structure approach; guideline design; education and training; audit and feedback; and networking.
ππΌπ»π°πΉπππΆπΌπ»: This mixed methods study has demonstrated the sustained impact of the New South Wales sepsis guideline on emergency nursing practice and medical management of septic patients. Time to antibiotics has been reduced and patients are being allocated more urgent triage categories. Five implementation strategies were used to facilitate clinician behaviour change within clinical settings. The Behaviour Change Wheel can be used to evaluate guideline implementation and further develop an understanding the role of motivation in achieving sustained clinician behaviour change.
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