การวิเคราะห์สถานการณ์การจัดการผู้ป่วยออร์โธปิดิกส์ที่มีภาวะติดเชื้อในกระแสเลือด

Abstract

Sepsis must be managed correctly and promptly in order to decrease patients’ complications and mortality rates. Proper management of orthopedic patients with sepsis will promote patient safety. This retrospective descriptive study aimed to analyze the situation of management for orthopedic patients with sepsis in a tertiary hospital. The samples included data of 275 orthopedic patients with sepsis treated in orthopedic wards from January 2017 to December 2019, and 11 healthcare supervisors and 62 healthcare personnel who worked from January 2017 to December 2019. Data collection tools included the Management Situation for Orthopedic Patients with Sepsis Record Form, the Structure Related to Management for Orthopedic Patients with Sepsis Questionnaire and the Semi-Structured Questions, and the Process Related to Management for Orthopedic Patients with Sepsis Questionnaire and the Semi-Structured Questions, all of which were developed by the researcher based on the Donabedian (2003) framework and the International Guidelines for Management of Sepsis and Septic Shock (Rhodes et al., 2017) The findings were as follow: 1. Structures: The organization had a standard policy in the management of patients with sepsis. There were key performance indicators, but no systematic data collection or report. The patient classification score was used for workforce planning and management. There was no patient team care (PCT), collaboration guidelines, or health care team management algorithm for orthopedic patients with sepsis. There was no broad-spectrum antibiotic reserve in any ward. 2. Processes: The average times of the sepsis screening and diagnosis process were 58.73 and 43.28 minutes, respectively. In the sepsis management process, 82.90 percent of the samples had blood collection for culture within 3 hours and 31.27 percent received broad-spectrum antibiotics within 3 hours after being diagnosed with sepsis. In the septic shock management process, 15.63 percent of the samples had blood collection for lactate measurement within 3 hours, 50.00 percent received initial fluid resuscitation within 3 hours and 32.07 percent received vasopressors within 6 hours. 3. Outcomes: Of the samples, 13.18 percent developed septic shock. The samples’ mortality rate was 18.19 percent. The findings have revealed opportunities for improvement in the management of orthopedic patients with sepsis. Improvement of quality in the structures and processes will facilitate better outcomes.