Journal of Emergency Nursing, March 2015, Vol.41(2), pp.130-137
Emergency nurses play a key role in the initial triage and care of patients with potentially life-threatening illnesses. The aims of this study were to (1) evaluate the impact of a nurse-initiated ED sepsis protocol on time to initial antibiotic administration, (2) ascertain compliance with 3-hour Surviving Sepsis Campaign (SSC) targets, and (3) identify predictors of in-hospital sepsis mortality. A retrospective chart review investigated all adult patients—admitted through either of 2 academic tertiary medical center emergency departments—who were discharged with a diagnosis of severe sepsis or septic shock (N = 195). Pre– and post–protocol implementation data examined both compliance with 3-hour SSC bundle targets and patient outcomes. Multivariate logistic regression analysis identified predictors of in-hospital mortality. Serum lactate measurement (83.9% vs 98.7%, = .003) and median time to initial antibiotic administration (135 minutes vs 108 minutes, = .021) improved significantly after protocol implementation. However, one quarter of antibiotic administration times still exceeded the 3-hour target. Significant predictors of in-hospital mortality were respiratory dysfunction, central nervous system dysfunction, urinary tract infection, vasopressor administration, and patient body weight ( 〈 .05). There were no in-hospital mortality rate differences between the pre– and post–protocol implementation groups. Compliance with serum lactate measurement and blood culture collection goals approached 100% in the post-protocol group. However, compliance with medical interventions requiring multiple health care-provider involvement (ie, antibiotic and fluid administration) remained suboptimal. Efforts focused on multidisciplinary bundle elements are necessary to achieve full compliance with SSC targets.
Sepsis ; Bundles ; Protocol ; Compliance ; Mortality ; Predictors ; Medicine ; Nursing
View record in ScienceDirect (Access to full text may be restricted)