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The Successful Implementation of a Collaborative Sepsis Bundle at a Community Hospital

Gita Wasan Patel, Pharm.D., Nicki Roderman, R.N., M.S.N., CCRN, Hollie Gehring, M.S.N., R.N., RNP-BC, ENP, CEN, John Saad, M.D., William Bartek, M.D.
Medical Center of Plano, Texas

Septicemia was the 10th leading cause of death in the United States in 2006. Mortality is reported to be over 25% for severe sepsis and as high as 70% for septic shock. These numbers prompted us to investigate our own institution’s mortality rates. Recognition of a need for improvement led to the design and implementation of a sepsis bundle program.

A multidisciplinary team was created to develop, implement, and monitor a two-part sepsis bundle program consisting of an Emergency Department (ED) screening tool and diagnosed sepsis admission orders.  The program was developed over a six month period and, after being approved for use, order sets were activated and education completed. The program itself was implemented on January 1, 2007. After one year, it was decided to conduct a retrospective review comparing clinical outcomes and mortality for all adult patients from 2006 with a discharge diagnosis of severe sepsis or septic shock with those from 2007 diagnosed with severe sepsis or septic shock who were treated with the full sepsis bundles.

The Institute for Health Care Improvement sepsis data collection tool was used for both groups. Data collected included demographics, use of vasopressors, days on vasopressors, blood glucose, use of drotrecogin, use of steroids, intensive care unit (ICU)/hospital lengths of stay, use of ventilator, ventilator days, time to culture, time to first dose of antibiotics, time to transfer from ED to ICU, fluid resuscitation in the first 24 hours, percentage of patients started on dialysis, and mortality.

Demographics, blood glucose, drotrecogin use, steroid use, ICU/hospital lengths of stay, ventilator use, and ventilator days were statistically similar between both groups. Median time to cultures, time to the first dose of antibiotics, and time to transfer to ICU were all reduced.  The percentage of patients in 2006 on vasopressors was 87% versus 66.7% in 2007 (p=0.011).  Fewer patients were started on dialysis in 2007 (0%) versus 2006 (14.8%) (p=0.02).  Median days on vasopressors was 3 (1-24) in 2006 and 2 (1-16) in 2007 (p=0.024).  Median fluid administered in the first 24 hours was 2200 ml (100-13,996 ml) in 2006 and 7143 ml (1,000-19,104 ml) in 2007 (p<0.0001).  Mortality was 61.1% in 2006 versus 20% in 2007 (p<0.0001). 

Implementation of a 2-part sepsis bundle program developed in a collaborative effort yielded a positive impact on clinical outcomes and mortality in the septic patients in our non-academic, community hospital setting.

View a pdf of the poster from the Midyear Meeting (660 KB).