Acute Crit Care.  2024 Nov;39(4):545-553. 10.4266/acc.2023.01473.

Challenges of implementing the hour-1 sepsis bundle: a qualitative study from a secondary hospital in Indonesia

• Sasmito P
• Pranata S
• Pamungkas RA
• Emaliyawati E
• Arifani N

• KMID: 2563543
• DOI: http://doi.org/10.4266/acc.2023.01473

Abstract

Background
Good sepsis management is key to successful sepsis therapy and optimal patient outcomes. Objectives: This study aimed to determine obstacles among nurses and doctors to implementing the hour-1 sepsis bundle in a secondary hospital in Indonesia.
Methods
This was a qualitative study with a phenomenological approach. Data were obtained from one-on-one in-depth interviews with 13 doctors and nurses in the intensive care unit and emergency department who were purposively sampled. Data were analyzed using content analysis.
Results
Five main themes were revealed in the analysis: incomplete implementation of the hour-1 sepsis bundle, lack of knowledge about the hour-1 sepsis bundle, cost issues, lack of supporting facilities, and lack of coordination among health workers.
Conclusions
Optimizing regional health laboratories, optimizing the use of quick Sequential Organ Failure Assessment (qSOFA) and SOFA, and creating a series of sepsis protocols within the hospital are some solutions that secondary hospitals can implement to ensure appropriate management of sepsis cases. Involvement of health policyholders and hospital management is needed to address these challenges.

Keyword

emergency department; hospitals; intensive care unit; sepsis

Figure

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  Figure 1. Participant recruitment process flowchart for intensive care unit (ICU) and emergency department (ED) staff. a) Advanced beginner level nurse: defined as either a Diploma-level nurse with more than 4 years of work experience or a registered nurse (RN) with over 3 years of experience.

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