From the Guidelines
A sepsis order set is a standardized collection of medical orders designed to guide healthcare providers in the rapid assessment and treatment of patients with suspected or confirmed sepsis, typically including protocols for obtaining blood cultures, administering broad-spectrum antibiotics, and initiating intravenous fluid resuscitation. These order sets are crucial for implementing time-sensitive interventions within the first hour (the "golden hour"), as each hour of delay in appropriate antibiotic administration increases mortality by approximately 7-8% 1. The key components of a sepsis order set include:
- Obtaining blood cultures
- Administering broad-spectrum antibiotics (such as piperacillin-tazobactam, cefepime, or meropenem)
- Initiating intravenous fluid resuscitation (usually crystalloids at 30 ml/kg)
- Measuring lactate levels
- Monitoring vital signs
- Orders for vasopressors like norepinephrine if needed for hypotension
- Specific laboratory tests to assess organ function
- Parameters for ongoing reassessment The use of sepsis order sets helps reduce treatment variability, minimize delays in critical interventions, and improve patient outcomes by ensuring that evidence-based practices are consistently followed across all healthcare providers treating sepsis patients 1. In addition to these components, sepsis order sets should also consider the feasibility of achieving prompt administration of appropriate antimicrobials, which is central to the beneficial effect of these agents, and address potential delays in obtaining blood and site cultures pending antimicrobial administration 1. Overall, the implementation of sepsis order sets is a critical step in improving outcomes for patients with sepsis, and their use should be guided by the most recent and highest-quality evidence available.
From the Research
Definition of Sepsis Order Set
- A sepsis order set is a standardized set of orders for the management of severe sepsis and septic shock, as described in the study by Thiel et al. 2.
- The order set typically includes aggressive fluid resuscitation, appropriate antibiotic therapy, and other interventions aimed at reducing morbidity and mortality.
Components of Sepsis Order Set
- The components of a sepsis order set may vary, but typically include:
- Aggressive fluid resuscitation, with the goal of administering a certain volume of fluid within a specified time period, as seen in the study by Thiel et al. 2.
- Appropriate antibiotic therapy, with the goal of administering antibiotics within a certain time period after the onset of sepsis, as discussed in the study by Thiel et al. 2 and Micek et al. 3.
- Other interventions, such as vasopressor support and mechanical ventilation, as needed.
Benefits of Sepsis Order Set
- The use of a sepsis order set has been associated with improved patient outcomes, including:
- Reduced hospital mortality, as seen in the studies by Thiel et al. 2 and the study on sepsis order set use associated with increased care value 4.
- Decreased incidence of organ failure, as seen in the study by Thiel et al. 2.
- Improved antibiotic therapy, as discussed in the study by Thiel et al. 2 and Micek et al. 3.
- Reduced healthcare resource consumption, as seen in the study by Micek et al. 3 and the study on sepsis order set use associated with increased care value 4.
Implementation of Sepsis Order Set
- The implementation of a sepsis order set can be challenging, and may require significant changes to hospital policies and procedures, as discussed in the study by Micek et al. 3.
- However, the use of a sepsis order set has been shown to be effective in improving patient outcomes, and is recommended by several organizations, including the Surviving Sepsis Campaign.