Implementation of S-M-A-R-T Initiatives to Enhance Sepsis Knowledge and Care Practice among Nurses

By Carol Suk Ping Tong, RN, BSc, MSc, PDip, RQP


The purpose of this project was to identify if implementation of a sepsis awareness campaign would increase nurse knowledge, timeliness of antibiotic administration, and early awareness of sepsis signs and symptoms. The effect of the campaign was evaluated by the improvement of knowledge assessment and performance of appropriate sepsis care.


Sepsis is one of the top ten causes of death in the United States, killing “one in four people.”
Lack of standardized recognition, communication of findings, and response to sepsis result in prolonged time from recognition to response. This can lead to septic shock and patient harm.

Hong Kong Sanatorium & Hospital (HKSH) has not utilized a screening tool for sepsis identification. Nurses have insufficient guidance regarding sepsis care. Standardization of timely antibiotic administration to septic patients is suboptimal. Antibiotic Stewardship Programme (ASP) audits conducted at HKSH revealed that 11-25% of audited broad-spectrum antibiotic cases had a severe clinical infection with septic shock. Most importantly, negative septic patient outcomes in 2015 and early 2016 were concerning.

Nurses are in a unique position to identify clinical changes in a patient that signal sepsis. Without early recognition, early intervention is impossible. Therefore, education about sepsis is
important to nursing practice. 


A Sepsis Awareness Campaign was conducted in five targeted units in April and May 2016. One hundred forty-two nurses in adult (Outpatient Department and two Oncology Wards) and paediatric (Paediatric Ward and Nursery Department) areas were included. Prior to campaign kick-off, a “SMART” Team, including members of the Infection Control Team and two SMART Nurses from each unit, was created to promote S-M-A-R-T initiatives.


More than 88% of 142 participating nurses demonstrated understanding of sepsis-related parameters after the intervention, improved from less than 60% prior to the intervention. Overall knowledge assessment mean score increased by 20% (adult) and 15% (paediatric). Timely (within one hour) broad-spectrum antibiotic administration in septic patients progressively improved from baseline (33%) to 2-months post intervention (68%), and 4-months post-
intervention (78%).


Promoting S-M-A-R-T initiatives in a variety of patient care settings can enhance patient safety. SMART Nurses are beneficial to the unit for enhancing patient’s safety and service quality. A quarterly audit of broad-spectrum antibiotics administration timing for sepsis patients ensures a sustained practice. An additional measure that may be enhance this campaign would be the development of an electronic sepsis screening tool and “Sepsis Alert” pop up message.


Evidence-based early sepsis recognition education should be provided to frontline nurses. This should emphasize the importance of timely antibiotic administration to decrease the incidence of septic shock. Sepsis education can be delivered via the Nurse Residency Programme as an orientation pathway for all new joined nurses. Frontline nurses are empowered to recognize patients in the early stages of sepsis through frequent and proactive case discussion with the