Implementation of a TSAM-Based Sepsis Evaluation Tool in a Medical ICU Orientation Program 64 views

Background: Sepsis remains a leading cause of morbidity and mortality in critical care, requiring early recognition and timely intervention by competent nursing staff. Local Problem: In the Medical Intensive Care Unit (MICU) at a large tertiary academic health system, orientation evaluations traditionally emphasized task completion rather than a tiered progression of clinical reasoning for sepsis management. This ultimately created a gap in standardized competency assessment. Methods: A quality improvement design that aligned with the Standards for Quality Improvement Reporting Excellence (SQUIRE) guidelines was used. A Tiered Skills Acquisition Model (TSAM)-based sepsis evaluation tool was developed, incorporating tiered progression, preceptor global rating, and orientee reflection prompts. A structured pre-brief was conducted prior to tool use. Interventions: The TSAM Sepsis Evaluation Tool was implemented during orientee participation in sepsis-related patient care. Preceptors completed global ratings aligned with TSAM Tiers 2 through 4, and orientees responded to three structured reflection prompts focused on early recognition, prioritization, and application to future practice. Results: Preliminary results from three orientee evaluations indicate improved alignment between observed performance and tier expectations. Preceptors reported greater clarity in evaluating clinical reasoning, and orientees demonstrated the ability to verbalize sepsis recognition cues, prioritize evidence-based interventions, and apply knowledge to future care. Conclusions: A TSAM-based sepsis evaluation tool provides a structured approach to competency assessment in high-acuity critical care orientation. Standardizing sepsis-focused evaluation may improve consistency in preceptor feedback, orientee readiness, and patient safety outcomes. Keywords: clinical competence; sepsis; nursing education; intensive care units; orientation programs

DNP (Doctor of Nursing Practice)

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2026-04-29