Improving sepsis outcomes for acutely ill adults using interdisciplinary order sets

Clin Nurse Spec. Jul-Aug 2011;25(4):180-5. doi: 10.1097/NUR.0b013e318221f2aa.

Abstract

Purpose/objective: The objective of the study was to measure outcomes following implementation of standardized order sets for managing patients with severe sepsis/septic shock.

Background/rationale: Sepsis is a severe illness, affecting approximately 750 000 people in the United States, with mortality rates of 28% to 50%, and costing $17 billion each year.

Project description: An interdisciplinary team was created to improve early recognition and process of care in patients with severe sepsis/septic shock. Education was rolled out over 6 months, and sepsis "bundle" order sets were implemented.

Setting and sample: Adult patients (N = 674) with a diagnosis of severe sepsis or septic shock who were admitted to an emergency department or critical care unit at a 563-bed tertiary care teaching facility from May 2008 through October 2010 were included in data analysis.

Methods: A plan, do, study, act methodology was used. Outcomes following project implementation were measured prospectively including appropriate recognition of patients with a diagnosis of sepsis, hospital site where the order set was initiated, and attainment of treatment goals within 6 hours of onset of severe sepsis/septic shock.

Findings: When order set usage was analyzed, the use of order sets was significantly associated with meeting "6-hour goals" successfully (χ1 [n = 662] = 36.16, P < .001); order set usage explained 24% of the variation in meeting goals, R = 0.24, F1,661 = 38.51, P < .0001.

Conclusions: Order sets improved management of septic patients through effective change in delivery systems to support evidence-based medical care.

Implications for practice: Administrative support, team collaboration, and standardized order sets can lead to improved process of care.

MeSH terms

  • Adult
  • Critical Care / organization & administration*
  • Emergency Service, Hospital / organization & administration
  • Humans
  • Intensive Care Units / organization & administration
  • Interprofessional Relations
  • Nurse Clinicians
  • Outcome and Process Assessment, Health Care*
  • Patient Care Team / organization & administration*
  • Sepsis / diagnosis
  • Sepsis / nursing
  • Sepsis / therapy*
  • Severity of Illness Index
  • Shock, Septic / nursing
  • Shock, Septic / therapy