Challenges, Compliance and Impact of Implementation of Sepsis Code in Tertiary Care Hospital in India

INTRODUCTION: Sepsis is a serious medical condition that occurs when the body's response to an infection becomes dysregulated, leading to life-threatening complications. The timely and appropriate management of sepsis is crucial for improving survival rates. Integrated clinical care approaches, including sepsis code protocols and dedicated sepsis teams, play a vital role in optimizing early management strategies. OBJECTIVES: This study aimed to investigate the challenges encountered in implementing a sepsis code program. It also sought to evaluate the adherence rate to the sepsis care bundle in patients with sepsis and septic shock, comparing it to a group where the sepsis code was not activated. MATERIAL AND METHOD: A qualitative, hospital-based, prospective observational study was conducted over six months, from March 1, 2024, to August 31, 2024. Researchers developed a detailed sepsis code protocol checklist using the ABCDE approach to identify patients with suspected sepsis. This checklist included SOFA score calculation, consideration of early warning signs, and assessment of high-risk criteria. It guided the activation of the sepsis code and ensured adherence to the sepsis care bundle. The sepsis care bundle included interventions such as: Obtaining blood cultures before administering antibiotics. Measuring lactate levels. Initiating intravenous fluid resuscitation. Administering vasopressors when necessary. Providing post-resuscitation care and transferring patients to the critical care unit. Educational programs were conducted to train doctors and nurses on the sepsis code program. Antibiotic stewardship principles were implemented to promote the prudent use of antibiotics. To minimize costs, a specific sepsis kit and sepsis lab bundle were coded. A universal activation code facilitated coordination among departments involved in sepsis care. A consecutive sampling technique was used, recruiting 24 doctors and nurses who were interviewed, and 68 patients. Data collection involved direct observation, interviews with doctors, nurses, and patients, and a review of patient medical charts. Statistical analysis was performed using SPSS version 25. RESULTS: Lack of awareness and knowledge of the sepsis code program, along with cost concerns, were identified as significant challenges. The study found that 92% of patients in the sepsis code program received the recommended initial fluid resuscitation after lactate measurement, and 82.6% received broad-spectrum antibiotics. However, blood cultures were taken before antibiotic administration in 92.3% of patients. The implementation of the sepsis code program resulted in significant reductions in key time intervals. The mean door-to-antibiotic time decreased from 87 minutes to 54 minutes, and the average time to transfer patients to critical care areas decreased from 74 minutes to 44 minutes. Both reductions were statistically significant (p < 0.05). CONCLUSION: The implementation of the sepsis code program improved compliance with the sepsis care bundle, particularly in antibiotic use and fluid resuscitation. The study highlighted the importance of educational programs in raising awareness and knowledge among healthcare professionals about sepsis management protocols. Continued educational initiatives are recommended to reinforce sepsis care principles and ensure sustained compliance with the program. A follow-up assessment is planned after one year to evaluate the program's impact on morbidity and mortality rates.