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Infection at any body site can lead to sepsis, a primary blood stream infection. Sepsis caused over 34,800 deaths in 2007, and remains the leading cause of death in noncardiac intensive care units (Xu, Dochanek, Murchy, & Tejada- Vera, 2010). Mortality rates due to sepsis have remained unchanged for the last several decades, ranging from 23% to 43% (Durthaler, Ernst, & Johnston, 2009). The cost of sepsis in the United States is over $400 bil- lion annually (Vodovotz & Billiar, 2013; World Health Organization, 2011).
Literature Review
Sepsis is the leading cause of death in hospitalized patients and has sub- stantial impact on health care resources. Sepsis is difficult to identify because the signs and symptoms are often subtle, and they mirror the signs and symptoms of other condi- tions (Gaieski, Edwards, Kallan, & Carr, 2013). About 1.6 million people are treated in U.S. hospitals annually for sepsis, and this number has more than doubled in recent years (Powell, Khare, Courtney, & Feinglass, 2010). A thorough literature review on the effect of protocols on sepsis outcomes was conducted using CINAHL, Cochrane Database of Systematic Reviews, PubMed, National Guideline Clearinghouse, ISI Web of Know- ledge, and Ebsco Discovery Service for 2009-2013.
The use of standardized order sets for the management of sepsis should be recommended strongly for better performance in treatment. Standard order sets use serum lactate values because of the relationship to organ dysfunction in sepsis (Mikkelsen et al., 2009). Miller and colleagues (2013) found using standard order sets for sepsis reduced mortality for 4,329 adult patients in intensive care units (ICU) from 21.7% to 9.7% in 6 years (2004-2010). As the standard order set compliance increased, a marked reduction in hospital mor- tality occurred. Similar findings were noted in older adults when the use of standardized order sets for sepsis was associated with reduced mortali- ty and reduced length of stay because of improved initial appropri- ate therapy (Heppner et al., 2012).
The majority of cases of sepsis are identified in ICUs and emergency rooms; however, management of patients on medical-surgical units can decrease mortality and costs because nurses will identify symptoms and initiate the sepsis bundle early (Daniels, Nutbeam, McNamara, & Galvin, 2011). Signs and symptoms of sepsis include fever, chills, altered white...