Evaluation of a Nurse-Initiated Sepsis Protocol in the Emergency Department

Evaluation of a Nurse-Initiated Sepsis Protocol in the Emergency Department
Thesis
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Full Abstract: The aims of this study were to evaluate the impacts of a nurse-initiated sepsis protocol on compliance with sepsis resuscitation bundle guidelines from the Surviving Sepsis Campaign and to identify predictors of patient mortality. A retrospective chart review was conducted among patients admitted with severe sepsis or septic shock to two emergency departments at a university-affiliated medical center in southern California from October 2011 to May 2012, which included 78 and 108 patients for pre- and postintervention groups, respectively. There were no statistically significant differences between two groups in sepsis resuscitation bundle compliance (p > 0.05). The compliance rate for administration of broad spectrum antibiotics within three hours of ED admission declined slightly from pre- to postintervention group (80.8% to 76.7%), even though the mean time to the first antibiotic administration improved numerically by 21 minutes in the postintervention group (p > 0.05). The increased oxygen requirement to keep oxygen saturation > 90%, elevated bilirubin level (> 4.0), prolonged INR (> 1.5) or aPTT > 60 sec, and use of vasopressors were significant positive predictors of patient mortality whereas body weight was the negative predictor. In conclusion, the implementation of a nurse-initiated sepsis protocol had no significant impacts on compliance with sepsis resuscitation bundle guidelines. Other strategies to improve the compliance need to be explored.
 
 
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