1. Winterbottom, Fiona MSN, ACNS-BC, CCRN
  2. Rodriguez, Susan MSN
  3. Nash, Teresa Pharmd
  4. Jennings, Bethany BSN
  5. Gipson, Tina BSN
  6. Seoane, Leonardo MD
  7. Sundell, Erik MD

Article Content


The purpose of the project was to evaluate standardized order sets for the management of patients with severe sepsis and septic shock.



Sepsis is a severe illness caused by overwhelming infection. Sepsis strikes approximately 750,000 people in the US and is responsible for more than 215,000 deaths annually. Mortality remains high at 28-50% at a cost of $17 billion each year.



An interdisciplinary team was created to improve early recognition, process of care, and mortality in septic patients. A plan, do, study, act methodology was used with rapid cycle changes to improve the management of severe sepsis and septic shock. Physician and nursing education was rolled out over 6 months, and sepsis "bundle" order sets were developed for the emergency department and ICU. All patients with a diagnosis of severe sepsis or septic shock were included in the protocol.



Data were collected prospectively with regard to process of care. Mortality data were collected retrospectively.



Early trends show improvement in outcomes for patients with severe sepsis and septic shock. Results from the third quarter of 2008 are the following: 38% reduction in risk-adjusted mortality for sepsis in 2008 over 2007. There was a reduction in raw mortality of 57% despite a 24% increase in appropriately recognizing principle (admitting) diagnosis of sepsis. This equates to 31 lives saved in 2008. Patients with specified "goals met" at 6 hours increased from 33% to 81%.



Six- and 24-hour bundled sepsis orders improve process of care and in-hospital mortality in patients with severe sepsis and septic shock.


Implications for Practice:

Administrative support, team collaboration, and structured process can lead to decreased mortality from sepsis.


Section Description

The 2010 National Association of Clinical Nurse Specialists (NACNS) Annual National Conference is planned for Portland, Oregon, on March 3 to 6. More than 375 clinical nurse specialists (CNSs), graduate faculty, nurse administrators, nurse researchers, and graduate students are expected to attend. This year's theme, "CNS as Internal Consultant: Influencing Local to Global Systems," demonstrates the breadth and depth of CNS practice and leadership at multiple levels in organizations and on healthcare.


A total of 142 abstracts were submitted for review, and 58 (not including student posters) were selected for either podium or poster presentations. Again, this year, there is a CNS student poster session; student abstracts will appear in a later issue of the journal. The abstracts addressed CNS practice in all 3 practice domains as described in the Spheres of Influence Framework for CNS Practice. Abstracts emphasized patient safety and quality care outcomes, leadership, CNS education, evidence-based practice, and new ways to shape CNS practice. Topics include CNS work activities incorporated into the 3 Spheres of Influence, the role of the CNS in developing clinical inquiry skills among staff nurses, use of simulation technology, strategies to maintain clinical excellence, the role of the CNS in National Database for Nursing Quality Indicators (NDNQI) activities, and many new and thoughtful ideas to support CNS education, practice, and research. Collectively, the abstracts represent the breadth, depth, and richness of the CNS's contribution to the well-being of individuals, families, and communities, as well as contributing to the advancement of the nursing profession.


The conference abstracts are published to share new knowledge with those unable to attend the conference. As you read each abstract, appreciate the intellectual talent and clinical scholarship of your CNS colleagues who are advancing the practice of nursing and contributing to the health of society through improved outcomes for patients and healthcare organizations. We encourage you to contact individual presenters to network, collaborate, consult, or share your thoughts and ideas on the conference topics.


Watch for next year's call for abstracts and consider submitting for presentation at the next NACNS annual conference scheduled for March 9-12, 2011, in Baltimore, Maryland.