Improving Sepsis Outcomes for Acutely Ill Adults Using Interdisciplinary Order Sets Fiona Winterbottom, MSN, ACNS-BC, CCRN n Leonardo Seoane, MD n Erik Sundell, MD n Jawad Niazi, MHSA n Teresa Nash, PharmD Purpose/Objective: The objective of the study was to measure outcomes following implementation of standardized order sets for managing patients with severe sepsis/septic shock. Background/Rationale: Sepsis is a severe illness, affecting approximately 750 000 people in the United States, with mortality rates of 28% to 50%, and costing $17 billion each year. Project Description: An interdisciplinary team was created to improve early recognition and process of care in patients with severe sepsis/septic shock. Education was rolled out over 6 months, and sepsis ‘‘bundle’’ order sets were implemented. Setting and Sample: Adult patients (N = 674) with a diagnosis of severe sepsis or septic shock who were admitted to an emergency department or critical care unit at a 563-bed tertiary care teaching facility from May 2008 through October 2010 were included in data analysis. Methods: A plan, do, study, act methodology was used. Outcomes following project implementation were measured prospectively including appropriate recognition of patients with a diagnosis of sepsis, hospital site where the order set was initiated, and attainment of treatment goals within 6 hours of onset of severe sepsis/septic shock. Findings: When order set usage was analyzed, the use of order sets was significantly associated with meeting ‘‘6-hour goals’’ successfully (# 2 1 [n = 662] = 36.16, P G .001); order set usage explained 24% of the variation in meeting goals, R 2 = 0.24, F 1,661 = 38.51, P G .0001. Conclusions: Order sets improved management of septic patients through effective change in delivery systems to support evidence-based medical care. Implications for Practice: Administrative support, team collaboration, and standardized order sets can lead to improved process of care. KEY WORDS: interdisciplinary teamwork, order set, sepsis S epsis is the body’s response to an infection, which can progress to organ dysfunction. Mortality is higher for patients with multiple organ failure due to severe sepsis and septic shock. Sepsis continues to increase in incidence and is the most common cause of death in non- coronary critical care units. 1,2 Evidence suggests that heightened recognition and timely initiation of appropri- ate therapy in the early hours after diagnosis of severe sepsis improve clinical outcomes. 3Y8 As reported by Rivers et al 3 in 2001, early goal-directed therapy with timely in- tervention to achieve hemodynamic resuscitation goals led to reduced in-hospital mortality for patients with se- vere sepsis and septic shock. 3 This study involving 263 emergency department (ED) patients was the foundation for the Surviving Sepsis Campaign (SSC) guidelines that promote 6- and 24-hour bundled care with specific hemo- dynamic targets. 3Y6 Based on the initial work of Rivers et al, optimal hemodynamic goals for successful resuscita- tion in sepsis include central venous pressure (CVP) greater than 8 mm Hg, which indicates adequate fluid re- suscitation, and both mean arterial pressure (MAP) greater Author Affiliations: Clinical Nurse Specialist for Critical Care, Ochsner Medical Center, New Orleans, Louisiana (Ms Winterbottom); Associate Pro- fessor of Medicine, Deputy Head of School Curriculum, University of Queensland, Australia, and Ochsner Medical Clinical School, Ochsner Medi- cal Center, New Orleans, Louisiana (Dr Seoane); and Associate Chairman, Department of Emergency Medicine (Dr Sundell), Senior Medical Infor- matics Analyst, (Mr Niazi), and Critical Care Pharmacy Specialist (Dr Nash), Ochsner Medical Center, New Orleans, Louisiana. Correspondence: Fiona Winterbottom, MSN, ACNS-BC, CCRN, Ochsner Medical Center, 1514 Jefferson Hwy, New Orleans, LA (fwinterbottom@ ochsner.org). DOI: 10.1097/NUR.0b013e318221f2aa 180 www.cns-journal.com July/August 2011 Clinical Nurse Specialist A Copyright B 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Feature Article Copyright @ 201 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited. 1