Implementing the Surviving Sepsis Campaign in an Ambulatory Clinic for Patients With Hematologic Malignancies

Background: Infectious complications can occur in patients receiving cancer treatment and are the most common cause of death not directly related to malignancy. Established international best practices for recognition and management of early sepsis with bundled interventions reduce sepsis-related morbidity and mortality in many patient populations. Integration of these practices is common in emergency departments but has not been documented in ambulatory oncology clinics, where many patients with cancer present for evaluation of infectious symptoms.

Objectives: The current quality improvement project embedded sepsis best practices into routine care for ambulatory clinic patients receiving chemotherapy or undergoing hematopoietic stem cell transplantation for hematologic disease or malignancies.

Methods: An interprofessional protocol was implemented that included guideline-based universal screening, nurse-activated standing orders for recommended interventions, and clinician-supported decision making for the first six hours.

Findings: Evaluation of implementation of the protocol showed improved timeliness and adherence to sepsis practice guidelines. Postintervention adherence to threshold times for obtaining blood cultures and blood lactate and start of antibiotics showed improvement. All recommended interventions were completed within the target time frame for the majority of patients.