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Titre : | Impact of Nurse-Initiated ED Sepsis Protocol on Compliance With Sepsis Bundles, Time to Initial Antibiotic Administration, and In-Hospital Mortality (2015) |
Auteurs : | Heather R. Bruce, Auteur ; Jeanne Maiden, Auteur ; Peter F. Fedullo, Auteur ; et al., Auteur |
Type de document : | Article |
Dans : | Journal of Emergency Nursing (Vol. 41, n°2, March 2015) |
Article en page(s) : | p. 130-137 |
Langues: | Anglais |
Descripteurs : |
HE Vinci Adhésion au traitement médicamenteux ; Infections ; Infirmiere d'urgence ; Interdisciplinarité ; Médicament ; Mortalité ; Observance par le patient ; Protocole ; Recherche ; Signes et symptômes ; Soins d'urgence ; Thérapeutique |
Résumé : |
Introduction
Emergency nurses play a key role in the initial triage and care of patients with potentially life-threatening illnesses. The aims of this study were to (1) evaluate the impact of a nurse-initiated ED sepsis protocol on time to initial antibiotic administration, (2) ascertain compliance with 3-hour Surviving Sepsis Campaign (SSC) targets, and (3) identify predictors of in-hospital sepsis mortality. Methods A retrospective chart review investigated all adult patientsadmitted through either of 2 academic tertiary medical center emergency departmentswho were discharged with a diagnosis of severe sepsis or septic shock (N = 195). Pre and postprotocol implementation data examined both compliance with 3-hour SSC bundle targets and patient outcomes. Multivariate logistic regression analysis identified predictors of in-hospital mortality. Results Serum lactate measurement (83.9% vs 98.7%, P = .003) and median time to initial antibiotic administration (135 minutes vs 108 minutes, P = .021) improved significantly after protocol implementation. However, one quarter of antibiotic administration times still exceeded the 3-hour target. Significant predictors of in-hospital mortality were respiratory dysfunction, central nervous system dysfunction, urinary tract infection, vasopressor administration, and patient body weight (P Discussion Compliance with serum lactate measurement and blood culture collection goals approached 100% in the post-protocol group. However, compliance with medical interventions requiring multiple health care-provider involvement (ie, antibiotic and fluid administration) remained suboptimal. Efforts focused on multidisciplinary bundle elements are necessary to achieve full compliance with SSC targets. |
Disponible en ligne : | Non |
Exemplaires (1)
Cote | Support | Localisation | Section | Disponibilité |
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REV | Périodique papier | Woluwe | Espace revues | Consultation sur place uniquement Exclu du prêt |