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Improving Sepsis Outcomes for Acutely Ill Adults Using Interdisciplinary Order Sets

Winterbottom, Fiona MSN, ACNS-BC, CCRN; Seoane, Leonardo MD; Sundell, Erik MD; Niazi, Jawad MHSA; Nash, Teresa PharmD

doi: 10.1097/NUR.0b013e318221f2aa
Feature Article

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 (χ21 [n = 662] = 36.16, P < .001); order set usage explained 24% of the variation in meeting goals, R2 = 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.

Author Affiliations: Clinical Nurse Specialist for Critical Care, Ochsner Medical Center, New Orleans, Louisiana (Ms Winterbottom); Associate Professor of Medicine, Deputy Head of School Curriculum, University of Queensland, Australia, and Ochsner Medical Clinical School, Ochsner Medical Center, New Orleans, Louisiana (Dr Seoane); and Associate Chairman, Department of Emergency Medicine (Dr Sundell), Senior Medical Informatics Analyst, (Mr Niazi), and Critical Care Pharmacy Specialist (Dr Nash), Ochsner Medical Center, New Orleans, Louisiana.

Correspondence: Fiona Winterbottom, MSN, ACNS-BC, CCRN, Ochsner Medical Center, 1514 Jefferson Hwy, New Orleans, LA (fwinterbottom@ochsner.org).

© 2011 Lippincott Williams & Wilkins, Inc.