The Impact of a Nurse-Initiated Patient Care Order Set in Severe Sepsis and Septic Shock

Sunday, February 23, 2025

9:45am – 10:45am Eastern Time

Location: Connections Central Theater 1

Carly N. Redstone, MSN, RN (she/her/hers)

University of Michigan

Disclosure(s): No relevant financial relationship(s) to disclose.
RH

Renee Havey, DNP, RN, CCRN, ACNS-BC, CEN, TCRN

Clinical Nurse Specialist
University of Michigan

Disclosure information not submitted.
TG

Tami Garcia, MSN,RN

Sepsis Process Lead
University of Michigan

Disclosure information not submitted.
EP

Ella Purington, MD

Emergency Medicine Resident Physician
University of Michigan

Disclosure information not submitted.
RB

Ruoer Bei, n/a

Research Assistant
University of Michigan

Disclosure information not submitted.
JC

Jim Cranford, Ph.D.

Associate Research Scientist
University of Michigan

Disclosure information not submitted.
PE

Peter England, MD

Assistant Professor of Emergency Medicine
University of Michigan

Disclosure information not submitted.

Disclosure(s):

Carly Redstone, MSN, RN: No relevant financial relationship(s) to disclose.

Introduction: The Surviving Sepsis Campaign guidelines recommend early identification and treatment for patients with severe sepsis and septic shock. The majority of septic patients enter the health system through the Emergency Department (ED). Due to inpatient boarding and institutional throughput challenges, patients spend extended periods of time in the ED waiting room, which can delay identification and treatment of patients with sepsis. We hypothesized that a Nurse-Initiated Patient Care Order set (NIPCO) would lead to improved identification of septic patients and bundle compliance for patients with severe sepsis and septic shock.

Methods: We performed a single-site retrospective cohort study in adult patients presenting to our tertiary care ED from 7/1/2022 to 5/31/2024 with severe sepsis and septic shock. Inclusion criteria included an ICD-10 code for either severe sepsis or septic shock that met criteria for onset in the ED prior to disposition. The primary outcome was compliance with the three-hour sepsis bundle for patients that had a NIPCO compared to those who did not. Secondary outcomes included time to antibiotics, ICU length of stay(LOS), total hospital LOS, and in-hospital mortality. Differences between independent proportions were analyzed using the z-test with an alpha level of .05, and all analyses were conducted with the R statistical software package.

Results: 1611 patients were included in our analysis, and 589 (36.6%) received a sepsis NIPCO. Patients that received the NIPCO were significantly more likely to be bundle compliant as compared to those who did not (53.5% vs. 29.6%, [z=9.5, p< 0.001 ]). In-hospital mortality was significantly lower in patients that received the NIPCO (16.8% vs. 23.2%, [z=-3.0, p=0.002]. Time to antibiotics was quicker in patients that received the NIPCO (129 min vs. 69 min). ICU LOS was shorter (3.9 d vs. 4.0 d, 0.6 d), along with total hospital LOS (8.0 d vs. 9.2, 1.2 d).

Conclusions: Nurses play an integral role in early identification and time to treatment for patients with sepsis in an overcrowded ED. Sepsis NIPCO utilization is associated with substantially improved three-hour bundle compliance, quicker antibiotic delivery, shorter ICU and hospital lengths of stay, and overall lower in-hospital mortality.