Have you ever wondered why you get so many epic chats reminding you to use the sepsis order set? Or why you are constantly reminded to reassess the status of your patient to see if they still meet sepsis requirements?
Well, there is a good reason, there is strong evidence to back up the use of sepsis order sets.
Christopher Dale et al. published the paper in 2023 titled “Order Set Usage is Associated With Lower Hospital Mortality in Patients With Sepsis” – Read the paper for yourself HERE
| Order Set Usage is Associated With Lower Hospital Mortality in Patients With SepsisThe Surviving Sepsis Campaign recommends standard operating procedures for patients with sepsis. Real-world evidence about sepsis order set implementation is limited.To estimate the effect of sepsis order set usage on hospital mortality.Retrospective …www.ncbi.nlm.nih.gov |
This was a retrospective cohort study that involved over 100k patients at 54 hospitals over 2 years.
Included:
Patients > 18 years of age
Diagnosis of sepsis
Excluded:
Any patients where comfort care was initiated in the first 12 hours.
They sought to determine whether the utilization of a sepsis order set improved hospital mortality.
58,091 patients included where a sepsis order set was used
46,571 patients included where a sepsis order set was NOT used
The Sepsis Order Set included:
- A “Sepsis Management” order to denote the patient as a “septic patient.”
- Nursing orders for more frequent “sepsis vital signs,” with licensed independent provider call parameters.
- Serum lactate measurement every 2 hours for two measurements.
- A 30 mL/kg crystalloid bolus with options for normal saline or Ringer’s Lactate.
- Noninvasive cardiac monitoring to assess fluid responsiveness, where available.
- Norepinephrine infusion for hypotension.
- Antimicrobial decision support based on source of infection and type of sepsis (sepsis vs severe sepsis or septic shock), risk of multidrug-resistant organisms, and local antibiograms.
Results:
The study evaluated many variables associated with the utilization of the order set, but some of the main results are as follows.
The use of the sepsis order set was associated with a shorter median time from ED triage to antibiotic administration (125 min vs. 179 min p < 0.01) in all patients, and for patients with sepsis present on arrival (122 min vs. 163 min, p < 0.01)
Use of the sepsis order set was associated with a 6.3% lower hospital mortality (9.7% vs. 16.0%, p < 0.01)
Patients classified as severe sepsis had a 4% lower mortality, and patients found to have septic shock had a 12.9% lower mortality.
Order set utilization was associated with the administration of antibiotics 31 minutes faster from ED triage.
The authors believe that at least some of the lower hospital mortality seen in patients for which the order set was used was due to a faster time to antibiotics and less time that a patient experienced hypotension.
However, these were likely not the sole reasons for the observed lower mortality. Another aspect that contributes is a shared mental model for treating this patient. Once the patient is on the sepsis pathway, providers, nurses, and techs get constant reminders to reassess fluid status, lactate levels, update vitals etc.
With the entire team aware of the patient’s septic status, their care improves. The order set allows a cognitive offload by providing pre-populated antibiotic regimens specific to the source of sepsis, making providing the patient with appropriate care as effortless as possible.
Especially now that we are all leveling up into new roles at both sites, it is a good time to remember to please use the sepsis order set for your patients and get them on the sepsis pathway when they require it.
As shown, the utilization of high-quality order sets at increased levels, will not only improve quality from a structural level but also save lives.
