Impact of nurse-initiated ED sepsis protocol on compliance with sepsis bundles, time to initial antibiotic administration, and in-hospital mortality.
INTRODUCTION
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.


METHODS
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.


RESULTS
Serum lactate measurement (83.9% vs 98.7%, P = .003) and median time to initial antibiotic administration (135 minutes vs 108 minutes, P = .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 (P < .05). There were no in-hospital mortality rate differences between the pre- and post-protocol implementation groups.


DISCUSSION
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.
['Bruce|Heather Rose|HR|', 'Maiden|Jeanne|J|', 'Fedullo|Peter F|PF|', 'Kim|Son Chae|SC|']
D000328:Adult D000368:Aged D000369:Aged, 80 and over D000900:Anti-Bacterial Agents D016529:Emergency Nursing D004636:Emergency Service, Hospital D005260:Female D019983:Guideline Adherence D017052:Hospital Mortality D006801:Humans D007902:Length of Stay D008297:Male D008875:Middle Aged D012189:Retrospective Studies D018805:Sepsis D013997:Time Factors D055815:Young Adult
Sepsis Protocol Compliance Bundles Mortality Predictors