Study says order sets benefit septic patients
Using a standardized order set for ED patients in septic shock is linked with more rigorous fluid resuscitation, more appropriate initial antibiotic treatment, and a lower 28-day mortality, says a new study.1
Researchers at Barnes-Jewish Hospital in St. Louis compared treatment of patients with septic shock before and after a standardized hospital order set was implemented, with 60 patients in each group. Patients in the "after" group received more intravenous fluids while in the ED, were more likely to receive intravenous (IV) fluids of >20 mL/kg body weight before vasopressor administration, and were more likely to be treated with an appropriate initial antimicrobial regimen, compared with patients in the "before" group.
Implementation of the "Surviving Sepsis" treatment pathways should be a priority for ED nurses, says Jennifer Williams, MSN, RN, BC, M-S CNS, CEN, CCRN, one of the study's authors and clinical nurse specialist for emergency services at Barnes Jewish. "Our patients will have the greatest potential for survival and limiting morbidity if the ED nurse places a filter for sepsis at triage," says Williams.
At Barnes-Jewish, ED nurses do this for every patient by looking for two abnormal vital signs and a potential infection. "This is a simple process to incorporate in triage practices," Williams says. "However, to filter out the overwhelming number of patients that could be septic based on the above criteria, we implemented a nursing triage protocol that allows the nurse to obtain a point-of-care lactate level. If the patient has a level greater than 4, other treatments are implemented."
ED nurses at Barnes-Jewish now do central venous pressure monitoring, central venous oxygen saturation monitoring and arterial lines, says Williams. "Not all EDs are equipped to monitor these parameters, so partnering with an [intensive care unit] is ideal," she says. "An alternative is to obtain a venous blood gas with saturation every 30 minutes."
- Micek ST, Roubinian N, Heuring T. Before-after study of a standardized hospital order set for the management of septic shock. Critical Care Med 2006; 34:2,707-2,713.