The Utilization of Capnography to Measure End Tidal Carbon Dioxide in Skilled Nursing Facility Residents for the Early Detection of Sepsis to Reduce Hospitalizations.
The Utilization of Capnography to Measure End Tidal Carbon Dioxide in Skilled Nursing Facility Residents for the Early Detection of Sepsis to Reduce Hospitalizations.
Date
2018-05
Authors
Machesney, Dawn
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Nursing Practice
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Abstract
Background
Sepsis is a significant illness in older adults. The incidence of sepsis in community dwelling older adults is 1.9% and increases to 14% among those residing in nursing facilities. Delays in diagnosis impede timely interventions and result in increased hospitalizations,
complications, and deaths. Serum lactate levels have been used for early identification of sepsis in hospital settings, but collection is not possible in most prehospital settings. Capnography is non-invasive, alternative method to serum lactate for the identification of sepsis in prehospital settings which improves patient outcomes through timely interventions of fluid resuscitation and antibiotic administration. The purpose of this project was to implement an evidence-based Capnography Guideline in the skilled nursing facility population to obtain end tidal carbon dioxide levels for the early detection of sepsis in older adults to reduce hospitalizations.
Methods
A one-month pilot change utilizing a Capnography Guideline was implemented in a skilled nursing facility. Pre and post practice change data were analyzed to determine the primary outcome of reducing hospitalizations via the early detection of sepsis by capnography.
Pre and post practice change data was analyzed to determine the secondary outcome of reduced hospital length of stay from early detection of sepsis by capnography.
Results
The limited SNF sample size and data supported capnography to identify sepsis. However, the small sample size of five SNF participants and the time constraints of
implementation, affected the pilot outcomes as no reduction in hospital admissions or length of stay was demonstrated.
Discussion
Capnography as a prognostic tool for utilization in Hospice referrals was an unexpected outcome presented during implementation. This outcome should be explored as it has the potential to improve palliative care in the fragile SNF population.
Further exploration with a larger SNF sample size are needed to effectively evaluate capnography and its effectiveness for the early identification of sepsis to reduce hospitalizations and length of stay for the improvement of patient care and outcomes.
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Keywords
Sepsis,
Septic Shock,
Capnography,
End Tidal CO2,
End Tidal Carbon Dioxide,
End Tidal Capnography
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