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Sepsis bundle implementation in Ghanaian Emergency Departments (ED): The use of the one-hour sepsis bundle in EDs in Ghana: an explanatory sequential mixed-methods study

By Angela Prah, Registered Emergency Nurse, PhD Nursing Student, University of Birmingham, UK

Sepsis bundle implementation in Ghanaian Emergency Departments (ED): The use of the one-hour sepsis bundle in EDs in Ghana: an explanatory sequential mixed-methods study.

The Ghana Scholarship Secretariat, headed by Hon Kingsley Agyemang, is working around the clock to improve tertiary education, producing graduates who could bring innovative ideas to help build the country, especially in healthcare.

Miss Angela Prah, one of the beneficiaries of the GSS funding, a Registered Emergency Nurse specialised in trauma care, is pursuing a PhD in Nursing at the University of Birmingham in the area of adult sepsis care in ED to improve the quality of care of these patients and their outcomes in the country.

Sepsis is a condition whereby an exaggeration of a person’s immune system due to infection leads to acute organ failure and subsequent death when not recognised and treated timely.

In every 2.8 seconds, a person dies from sepsis. All disease conditions could lead to sepsis, including pneumonia, urinary, gastrointestinal, malaria, and the novel coronavirus disease, to mention a few. People with chronic diseases, immunocompromised states and open wounds are at a higher risk of developing sepsis.

The signs of sepsis include extreme cold, shivering, fever, extreme tiredness, slurred speech or confusion, passing no urine in a whole day, mottled or discoloured skin and severe breathlessness.

Looking at the acuity of adult patient presentation to EDs in Ghana, there is the need to rule out sepsis from the initial presentation, which will aid in timely interventions, improving the quality of care and outcome positively.

The WHO in 2017 declared sepsis a global health priority hence encouraged improving recognition and management of sepsis outside the intensive care unit to help improve outcomes.

Ghana as a country has promoted maternal and child health with regards to sepsis. There is minimal evidence to equate the burden of adult sepsis in Ghana, especially patients reporting to EDs.

The Surviving Sepsis Campaign guidelines initiated the sepsis bundle of care as a quality improvement measure. The sepsis bundle of care looks at measuring lactate levels, drawing blood samples before administration of broad-spectrum antibiotics, administration of intravenous fluids in the cases of hypotension (BP<100) and administering vasopressors in the cases of persistent hypotension. One of the

essential factors considered is the source of infection and the constant monitoring of patients. The Global sepsis alliance, the UK sepsis trust, the African sepsis alliance and the Ghanaian sepsis alliance are in support of this research by the provision of expert ideas and awareness creation materials needed to enhance this study and also to ensure the quality of care for these patients presenting into the emergency department with sepsis in Ghana.

Therefore, this research is being conducted in three phases incorporated in seven work packages at the Holy Family Hospital, Techiman in the Bono East Region of Ghana.

In the first phase, the current practices in adult sepsis care in EDs in Ghana will be ascertained by way of 12 months retrospective case note review and interviewing of ED staff on the current flow of patients with sepsis preceded by a systematic review.

This will inform the design of a Ghanaian context intervention based on the sepsis one hour bundle (a protocol/algorithm for identifying sepsis and timely implementation of interventions) and the delivery of a bespoke education to all ED staff. Afterwards, a feasibility study will be conducted to identify intervention effectiveness and barriers or facilitators in its implementation.

This research will help improve the care of adult patients presenting to the ED with sepsis. In addition, it will also inform policymakers in acquiring some of the resources needed to manage sepsis, especially point of care lactate tests and access to blood culture facilities.

The University of Birmingham is one of the top research institutions tackling all manner of global issues, primarily global public health issues.
Professor Anne Topping (Supervisor) states that “Sepsis is a worldwide challenge and this study could help target the activities of healthcare workers in emergency settings to save lives.”

Acknowledgements

This study was funded by the Ghana Scholarships Secretariat. The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the Secretariat.

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