Running Head: QUALITY IMPROVEMENT PROJECT 1

Kathleen E. Fleck

Quality Improvement Project: Code Purple

NUR 4144 Professional Role Development: Servant Leadership

Dr. Ellcessor

March 28, 2018

“I Pledge…”
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Quality Improvement Project: Code Purple

Sepsis is a severe condition caused by infection that can quickly turn to septic shock.

According to the American Journal of Nursing, “sepsis is believed to be a leading cause of

critical illness and hospital mortality, accounting for more than one third of all deaths in U.S.

hospitals” (Contrada, 2018, p.34). Early recognition of a patient experiencing sepsis can greatly

improve patient outcomes due to the patient receiving prompt necessary care to restore them

back to a healthy state. Patients experiencing sepsis are routinely seen in the Emergency

Department so it is important for nurses and the entire Emergency Department team to be well

trained on the identification of sepsis and the immediate steps that should be taken to treat the

patient.

The specific quality improvement project recommended for implementation in the

Emergency Department to improve patient outcomes is a sepsis bundle intervention known as,

Code Purple. The implementation of Code Purple begins once there is a suspected infection and

at least two of the following SIRS criteria: temperature >100.9°F or <96.8°F, heart rate >90 bpm,

respiratory rate >20 bpm, white blood cell count >10,000 or <4,000 or >10% bands, systolic

blood pressure of <90 or MAP <65 or if the patient presents with an abnormal mental status.

Blood cultures and a lactate need to be drawn prior to the administration of the first antibiotic if

it has not already been done. The first intervention in the bundle is to administer a broad

spectrum antibiotic within 30 minutes of the Code Purple being called. Fluid resuscitation is also

important and the patient should receive a fluid bolus of 30ml/kg within 6 hours. Using the Code

Purple worksheet as a guide to help with timely recognition and treatment, the Emergency

Department would see an increase in positive patient outcomes (Surviving Sepsis Campaign,

n.d.).
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Domains of Leadership

The nurse manager should use the four domains of leadership as a guide when

implementing the Code Purple quality improvement project into the Emergency Department.

These four domains are the heart, head, hands, and habit. According to the authors of Lead Like

Jesus, “when your heart, head, hands, and habits are aligned, extraordinary levels of loyalty,

trust, and productivity will result” (Blanchard & Hodges, 2008, p. 31).

The first domain of a servant leader is the heart, which serves as the motivation. The

nurse manager utilizing a system like Code Purple is someone who is primarily a servant leader

rather than a self-serving leader. The overall motivation behind Code Purple would be to see an

increase in positive patient outcomes, as well as helping nurses and other staff members on the

unit to recognize and treat patients who present with sepsis. Involvement of the nurse manager,

in Code Purple situations and through information delivery during huddle, will foster positive

teamwork and ultimately empower other nurses to improve their own patient outcomes using the

Code Purple process.

The head is the second domain and it, “examines your beliefs and theories about leading

and motivating people” (Blanchard & Hodges, 2008, p.32). The nurse manager who implements

Code Purple is someone who has compassion for others and wants to benefit both patients and

nurses on the unit. Having a clear vision is important as the manager in this situation because it

helps to determine and set goals for what needs to be accomplished. The nurse manager in this

instance wants to ensure that guidelines regarding early identification of sepsis and rapid

treatment are implemented to ultimately improve patient outcomes (Contrada, 2018).

The hands of a servant leader are the actions or how the leader will execute the quality

improvement project. The nurse manager is responsible for setting clear goals and expectations
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for the implementation of the project. The creation and distribution of the Code Purple worksheet

is a great way to show other nurses the plan for treating septic patients. Conducting an in-service

in the breakroom for small groups is another way to spread information about Code Purple to the

team members. The participation of the nurse manager in Code Purple situations is also

beneficial because it allows for the nurse manager to observe and make recommendations on

opportunities of improvement and give praise for things that were handled well. One opportunity

that may be addressed is remembering to complete the Code Purple worksheet throughout the

care of the patient. The nurse manager serves as a performance coach allowing other nurses to

take the lead in Code Purple situations once they have received adequate training and

information (Ellcessor, n.d.).

The habits of a servant leader are the things that are done to help the leader stay focused

and grounded despite any undesired stress (Blanchard & Hodges, 2008). Leading others is

rewarding but with those rewards comes difficulties that the nurse leader will need to be strong

enough to overcome. Sepsis is a critical illness and despite the efforts of nurses to treat the

patient the outcome is not always positive. It is extremely important for nurse managers to find

peace in solitude, prayer, or support in relationships in order to work through these tough times.

Five Practices of Exemplary Leadership

The five practices of an exemplary leader are model the way, inspire a shared vision,

challenge the process, enable others to act, and encourage the heart. By modeling the way, the

nurse manager is serving as a role model and setting examples for others on the unit. Rather than

just telling the nurses on the unit what to do when a patient becomes septic, the nurse manager

should also show them by taking initiative and helping out with the Code Purple interventions.
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Nurse managers who set examples “create an environment that makes it possible for everyone to

align themselves with shared values” (Ellcessor, n.d. , slide 8).

Nurse managers who inspire a shared vision are those who envision the future and enlist

others in that vision (Ellcessor, n.d.). Guided by their own set of values and beliefs, servant

leaders can motivate others to work towards a common goal or outcome. Although nursing is all

about flexibility, inspiring a shared vision may be difficult when it comes to veteran nurses on

the unit and resistance to change. By sharing ratios and outcomes related to positive patient

response to Code Purple, the nurse manager can help other nurses to see future benefits to this

quality improvement project.

The nurse manager has the responsibility of challenging the process by always looking

for ways to improve the current practice of Code Purple. Encouraging frequent feedback and

concerns from the nurses who are utilizing Code Purple can provide the nurse manager with

great insight into changes that may need to be applied. For example, the nurse manager may

discover that certain steps in the Code Purple bundle need to be written more clearly on the Code

Purple worksheet to avoid confusion or misinterpretation. Also investigating patient outcome

ratios after a certain period of time can influence the nurse manager’s decision to make changes

or additions to process. The best way for the nurse manager to challenge the process is by

experimenting and taking risks (Ellcessor, n.d.).

Enabling others to act and fostering teamwork and collaboration are crucial in being a

successful servant leader. It is not possible for the nurse manager to be present during every

Code Purple, therefore it is important for the servant leader to equip others with adequate

information and skills so that they are prepared to act when a Code Purple situation arises.

Educating the nurses and providing them with all of the information that they need in regards to
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Code Purple ultimately helps the nurse manager because he/she knows that the septic patients

will be taken care of on her unit to the best of the healthcare team’s ability.

The sooner Code Purple is called on patients in the Emergency Department the sooner

they receive treatment and the better chance that individual has of making a full recovery. With

each early recognition and rapid intervention for Code Purple, the nurse manager should

recognize the excellent work of the nurses and staff involved. The recognition or praise could be

something as simple as the nurse hearing “great work today, you really made a difference” or it

could be that the nurse manager recognizes the work of the unit as a whole during huddle. By

encouraging the team through positivity and reinforcing great work, the servant leader will foster

involvement and motivation of the team to continue to succeed and strive for excellence

(Ellcessor, n.d.).

Professional Practice Implications

Evidence-based practice has shown that the implementation of a sepsis bundle

intervention, like Code Purple, helps with rapid identification and treatment of septic patients in

the Emergency Department. The Code Purple worksheet serves as a guide because it not only

lists criteria for determining when a patient is presenting with sepsis but it also helps the

healthcare team stay on track with the specific interventions that need to be carried out using a

timeline format. The nurses caring for the patient are able to keep track of progress and

interventions on the worksheet which makes it easier to communicate when it comes time for

transfer off the unit. It also serves as a source of documentation that managers can use to make

future improvements.

Outcomes Evaluation
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The implementation of Code Purple into the Emergency Department would hopefully

result in an increase in positive patient outcomes. Giving nurses the tools necessary to recognize

and respond to patients experiencing sepsis will not only increase patient survival rates but it will

also serve to decrease the acuity of care necessary to treat septic patients. The outcome of Code

Purple can be evaluated by first looking at whether or not the patient survives the ordeal. The

outcome can also be evaluated by seeing how quickly all interventions were administered in

relation to which unit the patient was admitted. It may be possible that patient’s receiving earlier

treatment are placed on a medical surgical unit rather than in intensive care. Another aspect of

Code Purple that we could use to evaluate outcomes would be the length of hospital stay for

patients who received early intervention versus those who did not utilize the Code Purple quality

improvement project. All of these measures of evaluation can be used by the nurse manager to

determine the effectiveness of the quality improvement project and whether or not changes need

to be made.
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References

Blanchard, K. H., & Hodges, P. (2008). Lead like Jesus: Lessons for everyone from the greatest

leadership role model of all time. Nashville, TN: Thomas Nelson.

Contrada, E. (2018). Managing sepsis and septic shock: Current guidelines and definitions.

American Journal of Nursing, 118(2). Doi:10.1097/01.naj.0000530243.07593.e7

Ellcessor, B. (n.d.) Module II practices of exemplary [PowerPoint slides]. Retrieved from

https://bsmcon.blackboard.com/webapps/blackboard/execute/displayLearningUnit?course

_id=_3707_1&content_id=_214218_1

Ellcessor, B. (n.d.) Module II servant leadership hands of a servant [PowerPoint slides].

Retrieved from

https://bsmcon.blackboard.com/webapps/blackboard/execute/displayLearningUnit?course

_id=_3707_1&content_id=_214217_1

St. Francis Medical Center. BSR code purple worksheet [PDF document]

Surviving Sepsis Campaign. (n.d.). Retrieved March 25, 2018, from

http://www.survivingsepsis.org/