Managing severe sepsis: A national survey of current practices

Purpose. Current practices for managing severe sepsis in U.S. hospitals were studied. Methods. A questionnaire was distributed to nurse managers who were members of the Association of Critical Care Nurses to assess current practices associated with the management of severe sepsis, including assessment of sepsis management priority, patient identification and screening process for sepsis, current treatment practices, process measures and outcomes measurements, and hospital demographics. Differences among small (<200 beds), medium (200-399 beds), and large (>= 400 beds) hospitals were identified using chi-square analysis and Student's t test. Results. A total of 414 surveys were completed, received, and analyzed. As hospital bed size increased, so did the percentage of hospitals with an active severe sepsis program (p = 0.002). Hospitals rated the effect of severe sepsis on mortality as the paramount issue influencing severe sepsis prioritization. Screening for severe sepsis most commonly occurred upon deterioration of laboratory test values, regardless of hospital size. Of 17 Surviving Sepsis Campaign (SSC) treatment guidelines, hospitals most frequently reported adherence to ordering cultures within 6 hours of onset of acute organ dysfunction (71.3%). The least followed guideline was initiation of drotrecogin alfa (activated) within 24 hours of acute organ dysfunction (37.9%). Conclusion. A survey of critical care nurses revealed that of the 17 SSC treatment guidelines, hospitals most frequently reported adherence to those concerning prompt ordering of cultures, prompt administration of broad-spectrum antibiotics, and prompt initiation of deep venous thrombosis prophylaxis. Deterioration of laboratory test values was the most common identifier of severe sepsis, regardless of hospital size. Among all hospitals, the least followed guideline was prompt initiation of drotrecogin alfa (activated) therapy.