The Effect of a Sepsis Order Set on Antibiotic Administration

Abstract

Problem: In 2016 the Surviving Sepsis Campaign updated their clinical practice guidelines to focus on the early detection and management of sepsis. Multiple randomized controlled trials showed with each delayed hour of antibiotic administration, there was an increased mortality rate of 0.5 to 4% among septic patients. Based on this data, the guidelines strongly recommended that intravenous antibiotics be administered within one hour of sepsis diagnosis. In response to the updated guidelines, hospital data was reviewed, and it was found that only 35% of all septic patients were receiving antibiotics within the recommended window of sepsis diagnosis. Purpose: To implement and evaluate the effectiveness of a standardized sepsis protocol/order set in the inpatient medical unit. Methods: A sepsis order set, based off the 2016 Surviving Sepsis Campaign Guidelines, was embedded in the electronic medical record and incorporated as part of the medical unit’s pre-existing Early Warning Signs (EWS) System. Time from sepsis diagnosis to time of antibiotic administration was evaluated weekly during the implementation phase and compared to data from three months prior to the implementation phase. Additional outcomes included provider use of the sepsis order set and 30-day mortality rates. EWS nurses and physician members of the sepsis team assisted providers with identification of septic patients on the unit and implementation of the sepsis order set. Results: The median percentage of patients receiving antibiotics within three hours of sepsis diagnosis increased from 0% (n=24) to 100% (n = 27). The providers utilized the sepsis order set approximately 93% of the time. Thirty-day mortality rates increased from 20% to 26% however were not statistically significant. Conclusions: The implementation of a sepsis order set has shown to increase the percentage of septic patients receiving antibiotics within three hours of sepsis diagnosis. Incorporation of the sepsis order set into a pre-existing EWS protocol may have assisted with noted improvements.