Improving Sepsis Care Using “Nurse-Triggered” Sepsis Pathway Activation
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Abstract
Background: Sepsis is a time-sensitive emergency in which delayed recognition and treatment increase the risk of organ dysfunction, intensive care admission, prolonged hospitalization, and death. Nurses are often the first healthcare professionals to detect clinical deterioration, but escalation may be delayed when structured activation systems are absent. Objective: To assess whether implementation of a nurse-triggered sepsis pathway improved early sepsis care among adult patients with suspected sepsis in a tertiary-care hospital in Karachi, Pakistan. Methods: A prospective pre–post cohort study was conducted among 240 adult patients with suspected sepsis, including 120 patients during routine pre-pathway care and 120 patients after pathway implementation. Trained nurses used standardized bedside criteria to activate sepsis escalation while prescribing decisions remained physician-led. Outcomes included time-to-antibiotics, lactate collection, antibiotic administration within one hour, fluid compliance, ICU transfer, mortality, length of stay, and staff confidence. Results: Median time to first antibiotic decreased from 132 to 64 minutes. Timely lactate collection increased from 48.3% to 76.7%, antibiotic administration within one hour from 31.7% to 68.3%, and fluid compliance among eligible patients from 42.9% to 72.6%. Median hospital stay decreased from 8 to 6 days, while ICU transfer and mortality showed non-significant numerical reductions. Staff confidence improved from 2.8 ± 0.9 to 4.1 ± 0.6. Conclusion: Nurse-triggered sepsis pathway activation significantly improved early sepsis process measures and staff confidence, with favorable but statistically inconclusive trends in ICU transfer and mortality.
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