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Data Analytics Part II

Alison Douglas

School of Health Professions and Wellness, Jacksonville State University

NU716: Interprofessional Healthcare & Informatics

Dr. Arlinda Wormely, DNP, MPA, FNP-BC

July 16, 2021

Sepsis continues to be an issue in hospitals throughout the country affecting

approximately 750,000 patients in the U.S. each year and killing about 210,000 annually (Dugar,

Choudhary, & Duggal, 2020). Sepsis is broadly defined with a range of pathology, beginning

with an infection that develops to bacteremia, further progressing into sepsis followed by septic

shock; if left untreated multiple organ dysfunction syndrome (MODS) and death ensue. The

current definition of systemic inflammatory response syndrome (SIRS) has recently been

excluded, as an infection does not exclusively cause the syndrome. “Early sepsis” includes

infection (organisms that have invaded healthy tissues) and bacteremia (measurable bacteria in

the blood) in their initial forms, which may progress to sepsis. In 2016, the Society of Critical

Care Medicine (SSCM) and the European Society of Intensive Medicine (ESICM) defined sepsis

formally as the dysregulation of a host response to infection that causes life-threatening organ

dysfunction or septic shock. Septic shock is classified as a distributive shock of vasodilation,

increasing patient mortality risk despite resuscitation efforts. MODS is the severe culmination of

the infectious process involving the body’s inadequacy to maintain homeostasis without

intervention and is classified as primary or secondary MODS. Primary MODS is caused by the

insult of infection as rhabdomyolysis would cause renal failure, and secondary MODS is a total

body response to the infection; an example, acute respiratory distress syndrome (ARDS) is

caused by pneumonia (Neviere, 2021).

Sepsis risk factors include bacteremia, the elderly, immunosuppression, diabetes, obesity,

cancer, community-acquired pneumonia, ICU admission, prior hospitalization, and genetic

factors (Neviere, 2021). The student finds sepsis to be a complex and thought-provoking

disorder that needs continued attention to positively impact the lives of our patients. However,

observance of recent clinical gaps of delay and improper implementation of IV fluid

resuscitation/protocol bundle of septic patients left the nurse concerned about patient recovery

from this deadly disorder. Research and education are needed for nursing staff to clearly

understand hospital protocol and sepsis bundle implementation to decrease hospital length of

stay and mortality related to sepsis. Therefore, the following PICO(T) question was developed

for the student DNP project: In adult septic patients, how does adequate IV fluid resuscitation,

compared to current hospital IV fluid resuscitation practices, impact relief of septic symptoms

and improve hospital length of stay?

Baseline data of septic patients will strategically be gathered through data mining in the

electronic health record (EHR); this involves using the computer software program Meditek to

glean data necessary to study. Data mining is helpful for the collection of several types of data

as patterns and relationships become evident (McGonigle, & Mastrain, 2022). Other baseline

data needed to support the student DNP project analysis include reviewing current guidelines for

sepsis treatment, reviewing Redmond Regional Medical Center’s outcomes and protocols for

sepsis, tracking patients that meet sepsis criteria, and pre-test methodology to determine provider

knowledge base and barriers. In addition, the student will teach current evidence-based practice

data during implementation, create badge reminders, and trend data changes in IV resuscitation

timing for septic patients. Lastly, during post-implementation, the student will re-administer

post-test methodology, compare data before intervention and post-intervention, and share results

with staff through a presentation. In addition, the student plans to utilize data obtained through

sepsis tracking in assistance through the hospital’s assistant emergency room manager and

former sepsis coordinator (Meredith Qualley, BSN, RN), and quality improvement officer

(Shelly Proctor).
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Data sourcing and acquisition needed for this DNP project includes but may not be

limited to the hospital reported sepsis Centers for Medicare and Medicaid Services (CMS) SEP-1

protocol compliance, electronic health record sepsis predictions/alerts/protocols, trends in ICD

coding for sepsis, quality improvement initiative data, electronic medication tracking data (for

example antibiotics, intravenous fluid, and vasopressor administration). Other sources may

include quantitative data collection of microbiology, serum lactates, serum creatinine, total

bilirubin, and platelet counts. Epidemiological data that may be needed could include

demographics of the patient, hospital location, comorbidities, patient billing, hospital mortality

rates, hospital sepsis rates, and classification of onset such as from the community or hospital

(Centers for Disease Control and Prevention [CDC], 2018). Additional data acquired includes

staff knowledge through the pre-and post-testing methodology.

A large percentage of data is stored in the hospital EHR system Meditek; however, data

will likely also be collected through a pre-and post-survey methodology of nursing staff. After

the project ethical review committee (PERC) approval, the DNP project requires institutional

review board (IRB) appraisal and approval. Obtaining specific data needed for this project

requires the student to follow high standards of integrity and quality during data mining.

Integrity includes data that is whole, full, accurate, and reliable. Intentional data collection is

imperative during student study design as projects can be compromised through human error,

software computer in nature; computer hardware issues, transmission errors, and hackers may

also hinder project integrity. High-quality data eliminates the use of errors of duplicate,

incomplete, or outdated information. Along with integrity, high data quality needs careful

consideration because quality data more accurately exemplifies the DNP project concept.
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Ethical data mining also includes protecting patient identity and maintaining confidentiality

(McGonigle, & Mastrain, 2022).

The student accesses data through the hospital’s EHR as an employee; that access is

overseen and comes from the company information technology (I.T.) department and is

beneficial in accessing patient data related to demographics, sepsis criteria, alerts, and

treatments. As mentioned above, further access to data will come from quality indicators,

Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores,

hospital-directed tracers, and improvement projects. Our quality improvement officer is Shelly

Proctor, and the student anticipates working closely with her as mentioned above, alongside

Meredith Qualley, the assistant manager and former sepsis coordinator, and Stephanie Jones, the

hospital chief nursing officer (CNO) and project preceptor. These vital organizational

stakeholders will be beneficial in assisting the student in gaining access to areas needed and

guide data mining over the next year while completing the DNP project.
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References

Centers for Disease Control and Prevention. (2018). Hospital toolkit for adult sepsis

surveillance. U.S. Department of Health and Human Services.

https://www.cdc.gov/sepsis/pdfs/Sepsis-Surveillance-Toolkit-Mar-2018_508.pdf

Dugar, S., Choudhary, C., & Duggal, A. (2020). Sepsis and septic shock: guideline-based

management. Cleveland Clinic Journal of Medicine, 81(1), 53-64.

https://www.ccjm.org/content/ccjom/87/1/53.full.pdf

McGonigle, D. & Mastrian, K. G. (2022). Nursing informatics and the foundation of knowledge

(5th ed.). Jones and Bartlett Learning.

Neviere, R. (2021). Sepsis syndromes in adults: Epidemiology, definitions, presentation,

diagnosis, and prognosis. UpToDate. Retrieved July 16, 2021, from

https://www.uptodate.com/contents/sepsis-syndromes-in-adults-epidemiology-

definitions-clinical-presentation-diagnosis-and-prognosis?

search=sepsis&source=search_result&selectedTitle=1~150&usage_type=default&displa

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