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Evidence-Based Guidelines and Scripting to Support Nurses in Sepsis

Recognition, Reporting, and Treatment

Article  in  Critical Care Nurse · April 2015

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 Instructions for Continuing Nursing Education Contact Hours appear on page 239.
Scripting Nurse Communication to
Improve Sepsis Care
epsis is caused by overwhelm-
S ing immune response to
infection. Risk factors include
baseline immunocompetence of the
patient, presence of comorbid con-
ditions, and patient age (Kleinpell &
Schorr, 2014). Severe sepsis can
cause damage to and failure of mul-
tiple organ systems. In sepsis, chem-
icals released by the body to fight
infection trigger widespread inflam-
mation. Chemical mediators re-
leased through the sepsis response
damage the endothelial lining of
blood vessels and lead to increased
capillary leakage. Cytokine release
prompts production of adhesion
molecules on vascular endothelial
cells and neutrophils, causing fur-
ther endothelial injury through
release of the neutrophil compo-
nents. Activated neutrophils release
nitric oxide, a potent vasodilator
that contributes to septic shock
(Opal & van der Poll, 2015). These
events collectively can cause vasodi-
lation, hypotension, misdistribu-
tion of blood flow, and hypoperfu-
sion and dysfunction. Sepsis severi-
ty and the time to sepsis recogni-
tion and treatment impact the like-
lihood of mortality from organ dys-
function (Kleinpell & Schorr, 2014).
Severe sepsis is a significant prob-
lem, with an incidence of 300 to
more than 1,000 cases per 100,000
persons annually in the United
States (Gaieski, Edwards, Kallan, &
Carr, 2013). For 2000-2008, the rate
of hospitalized patients with a prin-
cipal diagnosis of septicemia or sep-
sis more than doubled from 11.6 to
July-August 2016 • Vol. 25/No. 4
Dawn Marie Drahnak
Marilyn Hravnak
Dianxu Ren
Alice J. Haines
Patricia Tuite
Providing nurses with current evidence to inform practice for treat-
ment of patients with sepsis, coupled with appropriate tools (elec-
tronic screening and scripting) for report of positive screens, forms
a strong foundation on which to build an interprofessional and
organizational sepsis treatment program.
24.0 per 10,000 patients, with in- screening, nurses must be familiar
hospital mortality of 15%-30%; with a patient’s sepsis risk factors
mortality associated with severe and predisposition for infection
sepsis ranged even higher at 30%- (e.g., chronic disease, impaired
60% (Hall, Williams, DeFrances, & immunocompetence), as well as
Golosinskiy, 2011). A brief by Torio factors likely to contribute to organ
and Andrews (2013) reported sepsis dysfunction (e.g., causative organ-
resulted in an aggregate healthcare ism, genetic composition, preexist-
cost of $20.3 billion in 2011. Hall ing organ dysfunction, timely ther-
and colleagues (2011) identified the apeutic intervention, extremes of
estimated annual inpatient cost of age [infants and elderly]) (Angus &
sepsis nationwide in 2008 as $14.6 van der Poll, 2013).
billion.
Nurses play a vital role in early
sepsis recognition and initiation of Literature Review
targeted treatment. Nurses’ ability A literature review (2009-2016)
to assess a patient’s vital signs and using keywords sepsis, evidence-
physical condition is key to early based practice, nurse-driven, sepsis
sepsis recognition (Kleinpell & screening, scripting, guidelines, and
Schorr, 2014). For knowledgeable sepsis bundles was conducted using
Dawn Marie Drahnak, DNP, RN, CCNS, CCRN, is Assistant Professor, University of Pittsburgh
at Johnstown, Johnstown, PA.
Marilyn Hravnak, PhD, RN, CRNP, BC, FCCM, FAAN, is Professor, University of Pittsburgh
School of Nursing, Pittsburgh, PA.
Dianxu Ren, MD, PhD, is Associate Professor, University of Pittsburgh School of Nursing,
Pittsburgh, PA.
Alice J. Haines, DNP, RN, CMSRN, is Assistant Professor, University of Pittsburgh School of
Nursing, Pittsburgh, PA.
Patricia Tuite, PhD, RN, CCNS, is Assistant Professor, University of Pittsburgh School of
Nursing, Pittsburgh, PA.
233
CINAHL and Ovid MEDLINE. Early
goal-directed therapy involving
fluid resuscitation and appropriate
antibiotic administration has been
reported to improve patient out-
comes, including significantly de-
creased mortality (Angus et al.,
2001; Gaieski et al., 2010). From the
most recent studies (ProCESS,
ARISE, ProMISe), some clinicians
agree early identification impacts
patient outcomes more than specif-
ic goal-directed algorithms that fol-
low initial treatment/resuscitation
(Mouncey et al., 2015; The ARISE
Investigators and the ANZICS
Clinical Trials Group, 2014; The
ProCESS Investigators, 2014).
One initiative to improve sepsis
care is the Surviving Sepsis Cam-
paign (Dellinger et al., 2013), which
advocates systematic application of
routine sepsis screening and early
patient treatment. This campaign
was initiated in 2004 and updated
in 2008 by the Society of Critical
Care Medicine; a third edition of
evidence-based recommendations
was published in 2013 (Surviving
Sepsis Campaign [SSC], 2013) to
improve patient care and outcomes.
Moore and co-authors (2009)
reported a decrease in sepsis-related
mortality from 35% to 23%
through use of the guidelines for
early identification and treatment.
Although guidelines provide essen-
tial information, they do not ensure
a local practice change (Kuehn,
2013).
Care bundles from the Institute
for Healthcare Improvement (IHI)
offer evidence-based interventions
for defined patient populations and
care settings to streamline guide-
lines into a set of actionable items
for use in a healthcare facility or
practice. Their use has had a pro-
found positive impact on patient
outcomes (Resar, Griffin, Haraden,
& Nolan, 2012). Current sepsis bun-
dles provide screening protocols
and interventions for early treat-
ment of sepsis at two time points (3
and 6 hours). The 3-hour bundle
includes blood cultures and meas-
urement of lactate values, with
administration of broad-spectrum
antibiotics (within 1 hour) and flu-
ids (30 ml/kg) for hypotension.
234
Within 6 hours, vasopressor treat-
ment is initiated to control hypo-
tension unresponsive to fluid resus-
citation. Monitoring of central
venous pressure, central venous
oxygen saturation, and lactate val-
ues (if initially elevated) also is rec-
ommended (Dellinger et al., 2013).
A nurse manager survey devel-
oped by the American Association
of Critical-Care Nurses (AACN)
focused on current practice for the
management of sepsis. More than
half of hospital respondents appear-
ed to have a systematic approach
for the identification and screening
of patients with severe sepsis. Direct
patient care providers (e.g., pulmo-
nologists, critical care physicians/
nurses) were involved most com-
monly in process development and
implementation (Durthaler, Ernst,
& Johnston, 2009). However, once
procedures were developed, nurses
reportedly had minimal responsibil-
ity to identify patients with severe
sepsis. This trend remains true to
date; having nurses at the point of
care to implement sepsis bundles
based on current evidence may
result in less variability in screening
and fewer missed opportunities for
early diagnosis and treatment.
The Third International Consen-
sus Definitions for Sepsis and Septic
Shock (Sepsis-3) (2016) provides
updated definitions and clinical cri-
teria. This revision, the first since
2001, will replace previous defini-
tions, offer greater consistency for
studies and clinical trials, and facili-
tate earlier recognition and more
timely management of patients
with sepsis or at risk of developing
sepsis (Singer et al., 2016).
Improvement Needs/CQI
Model
The Six Sigma quality improve-
ment model DMAIC (Define,
Measure, Analyze, Improve, and
Control) was used to guide this
project (Pyzdek & Keller, 2010).
As part of a gap analysis to deter-
mine the state of sepsis care (using
the new SSC 2012 3- and 6-hour
bundle criteria), the investigator
conducted a pre-intervention, retro-
spective chart review. A random
July-August 2016 • Vol. 25/No. 4
sample (n=71) of total patient med-
ical records (N=492) for July 2012-
March 2013 revealed sepsis as one
of the hospital’s top-10 diagnoses
(Diagnosis-Related Groups 870,
871, & 872). The audit found nurses
were not completing the sepsis
screen consistently (once per day
recommended); adherence to IHI’s
3- and 6-hour bundles also was
inconsistent. When the sepsis
screen was implemented in 2010,
process improvement follow up was
not implemented to determine if
the screening tool was reliable, user-
friendly, or being used. Also, failure
to develop supporting resources,
such as nursing policy and physi-
cian order sets, may have con-
tributed to nurses’ poor guideline
adherence. Nurse administrators
called for action to improve patient
care and nurses’ involvement in
SSC compliance.
Overall goal of this project was to
improve sepsis care by adopting the
SSC guidelines and IHI bundles,
applying a nurse education inter-
vention, and using an electronic
health record (EHR) sepsis screening
and documentation tool.
Data Collection
Design
A single-group pre-post survey
design was used to assess the impact
of education on nurses’ knowledge,
perception, and attitudes regarding
sepsis and screening adherence. A
chart audit was conducted to deter-
mine adherence to sepsis screening,
report, and treatment recommenda-
tions according to the SSC 2012
guidelines before and after the
nurse education was completed and
an EHR tool was initiated. Permis-
sion to conduct the project was
obtained from the institution’s Vice
President of Patient Care Services.
The project then was approved as a
quality improvement project by the
institution’s Scientific Review Com-
mittee of the Office of Research
Administration.
Setting and Sample
The project took place in a 648-
bed Level 1 trauma hospital, part of
Scripting Nurse Communication to Improve Sepsis Care

FIGURE 1.
McKesson Horizon Expert Documentation™ Sepsis Screening Tool

Copyright © 2014 McKesson Corporation and/or one of its subsidiaries. All rights reserved. Used with permission.
Horizon Expert Documentation is a trademark of McKesson Corporation and/or one of its subsidiaries.

TABLE 1.
Sepsis Screening Criteria and Assessment

General Variables Inflammatory Variables

• Fever >38.3°C • White-cell count >12,000/mm3 or <4,000/mm3
• Hypothermia <36°C • Normal white-cell count with >10% immature forms
• Heart rate >90 beats per minute • Elevated plasma C-reactive protein
• Tachypnea • Elevated plasma procalcitonin
• Altered mental status
• Edema or positive fluid balance
• Hyperglycemia >120 mg/dl in the absence of diabetes

Hemodynamic Variables Organ-Dysfunction/Tissue-Perfusion Variables

• Systolic pressure <90 mm Hg • Partial pressure of arterial oxygen to the fraction of
• Mean arterial pressure <70 mm Hg inspired oxygen <300
• Elevated mixed venous oxygen saturation >70% • Urine output <0.5 ml/kg/hr or 45 ml/hr for at least 2 hours
• Elevated cardiac index • Serum creatinine >0.5 mg/dl
• Coagulation abnormalities
• Absence of bowel sounds
• Platelets <100,000/mm3
• Plasma total bilirubin >4 mg/dl
• Lactate >1 mmol/liter
• Decreased capillary refill or mottling

Source: Adapted from Dellinger et al. (2013)

a regional health system in central
Pennsylvania. The sample included
681 nurses (60% of the facility’s
acute care clinical nurses) who
attended an annual clinical educa-
tion session.
EHR Tool to Capture Sepsis
Screening, Recognition, and
Reporting
Education introduced nurses to
the institution’s newly developed
Nursing Practice Policy for Sepsis
Screening and Reporting, with a
requirement for screening all
patients older than age 18 as part of
the 8-hour nursing assessment (8:00
a.m., 4:00 p.m., midnight) with the
McKesson Horizon Expert Docu-
mentation™ Sepsis Screening Tool
(McKesson Techonology Solutions,
Alpharetta, GA; see Figure 1). The
screening criteria and nursing
assessment for signs of infection
facilitate early recognition of sepsis
(see Table 1). Nurses were instructed
to report positive screens to the
healthcare provider and obtain
orders to implement the SSC’s 3-
and 6-hour bundles. The policy also
provided a script for nurses to
report screening findings with use
of the ISBAR tool (Introduction,
Situation, Background, Assessment,
and Recommendation) to eliminate
communication barriers (AACN,

July-August 2016 • Vol. 25/No. 4 235

2013); use of the tool was practiced
and reinforced in the education
intervention.
Educational Intervention for
Nurses to Increase
Knowledge of Sepsis
The primary author developed a
voice-over slide presentation that
included review of sepsis pathophys-
iology, patient assessment (see Table
1), risk factors, SSC guideline bun-
dles, documentation, and report of
findings. An expert panel of the
institution’s Nurse Planning Com-
mittee and the manuscript authors
reviewed the presentation and made
recommendations for revision. After
three rounds of review and revision,
consensus was achieved. Nurse par-
ticipants completed a 5-minute sur-
vey before and after the 30-minute
education, which concluded with a
role-playing case study to increase
nurses’ comfort with using the EHR
sepsis tool and reporting positive
findings to the provider. The module
served as the sepsis competency for
all nurses attending the annual edu-
cational session and now is viewed
by new staff during hospital orienta-
tion.
Nurses’ Perception and
Attitude Concerning Sepsis
Awareness
Construction of the nurse assess-
ment tool followed the same pro-
cess of iterative expert panel review
and revisions; four rounds were
conducted before consensus was
achieved. Pre-test included nurse
demographics (sex, age, education,
years since graduation, years on
project unit). Pre- and post-tests
included Likert-style items about
nurse perceptions and attitudes
related to sepsis care (1=don’t know,
5=strongly agree), and 10 items about
nurses’ sepsis knowledge (1=very
uncomfortable, 4=very comfortable).
The last section assessed nurses’
knowledge of sepsis pathophysiolo-
gy and appropriate measures for
identification, reporting, and treat-
ment of sepsis. Pre- and post-tools
were numbered to ensure linkage of
each nurse’s survey responses, but
no identifiable information was col-
lected.
236
Institutional Adherence to
Recommended Sepsis
Guidelines
Sepsis screening adherence was
concurrently audited (using the
established policy at the time: sepsis
screening once each day of the
patient’s hospitalization at 8:00
a.m.). A point prevalence audit for
nurses’ adherence with sepsis
screening was completed 1 month
after education via a report run
from McKesson Horizon Expert
Documentation. Total patient cen-
sus (N=360) was analyzed and only
inpatients for 24 hours (n=178)
were included. A comparison of the
percentage of adherence to sepsis
screening before and after educa-
tion based on the established policy
at the time was conducted.
Results
Demographic information col-
lected for nurses (N=680) who partic-
ipated in the education revealed par-
ticipants were primarily young (ages
19-29), Caucasian, and female. Most
nurses held diploma degrees and
were in the profession 0-5 years.
Results of the survey of nursing per-
ception and attitudes before and
after participating in the education-
al process were favorable. The
Wilcoxon Signed-Rank Test was
used to evaluate the Likert scale
items. Nurses rated themselves as
significantly more knowledgeable
about sepsis after the education, sig-
nificantly more certain the hospital
has a consistent definition and
treatment for sepsis, an increased
belief peers were aware of the differ-
ences in sepsis states, and increased
comfort about their ability to recog-
nize sepsis and report it to a
provider (all p<0.0001).
The pre- and post-nursing know-
ledge scores are listed in Table 2.
Responses to multiple-choice know-
ledge questions were dichotomized
as correct or incorrect, and the
Statistical Analysis System (SAS)
Version 9.3 (Cary, NC) PROC FREQ
program was conducted to compute
tests and measures of association in
a 2 X 2 contingency table (Pre and
Post by Correct and Incorrect) using
July-August 2016 • Vol. 25/No. 4
McNemar’s test for paired data. All
10 knowledge questions demon-
strated a statistically significant dif-
ference between the pre- and post-
test (all p<0.001). For 9 of 10 ques-
tions, statistically significant im-
provement was found in the per-
centage of nurses who answered the
item correctly in the post-test
(improvement ranges for scores
increased by 7.28%-63.5%). One
question (“What is the first step in
the initial management of the
patient with sepsis?”) was answered
correctly less frequently in the post-
test (-18.25% of nurses).
An audit to measure adherence to
documentation of nursing sepsis
screening post-education was con-
ducted. A comparison of adherence
to sepsis screening from the gap
analysis before education (once per
day) and 1-month after intervention
(three times per day) was completed.
The majority of all units experi-
enced a decrease in the percentage
of patients for whom sepsis screen-
ing never occurred. Although full
adherence to the protocol was not
achieved post-education, the full
adherence requirement increased
from screening once per 24 hours in
the pre-phase to three times in 24
hours in the post-phase. Neverthe-
less, dichotomization of the results
as never screened or screened at least
once in 24 hours (combining the cat-
egories screened > never but < compli-
ant, and compliant combined) dem-
onstrated the number of patients
who never received the recom-
mended screening decreased from
40.6% to only 8.9% (see Figure 2),
while the number who received at
least some screening increased from
59% to 91%. Further analysis of the
data using chi-square test demon-
strated statistical significance in
improved incidence of sepsis screen-
ing post-educational intervention
(p<0.0001).
Limitations
The voice-over slide presentation
ensured consistent delivery of edu-
cational material to the intended
audience, served as a future resource
for new staff, and maximized nurs-
Scripting Nurse Communication to Improve Sepsis Care

TABLE 2.
Outcome Frequency Distribution* Pre and Post-Test Sepsis and Systemic Inflammatory
Response Syndrome (SIRS) Knowledge

Pre-Test Post-Test McNemar’s

Answered Correct Answered Correct Difference in % Test
Variable Frequency (%) Frequency (%) Pre- & Post-Test (p-value)
A lactate greater than __ mEq/L would N=660 N=672 +62.39 p<0.0001
warrant a critical value report. 205 (31.06) 628 (93.45)
Blood cultures should be obtained and the N=677 N=677 +9.16 p=0.0001
first antibiotics administered within how 345 (50.96) 407 (60.12)
many hours of diagnosis of sepsis?
How often should a patient be screened for N=667 N=677 +42.76 p<0.0001
sepsis? 298 (44.68) 592 (87.44)
Identification of the SIRS or a sepsis state N=674 N=676 +63.55 p<0.0001
case study (depicting patient with severe 129 (19.14) 559 (82.69)
sepsis)
Identification of the SIRS or a sepsis state N=674 N=677 +33.56 p<0.0001
case study (depicting patient with sepsis) 406 (60.24) 635 (93.80)
Identification of the SIRS or a sepsis state N=662 N=676 +83.04 p<0.0001
case study (depicting patient with SIRS) 317 (47.89) 658 (97.37)
What is the first step in the initial N=669 N=672 -18.25 p<0.0001
management of the patient with sepsis? 362 (54.11) 241 (35.86)
Severe sepsis may be manifested as (circle N=674 N=677 +34.40 p<0.0001
all that apply): 261 (38.72) 495 (73.12)
The initial sepsis resuscitation bundle in the N=598 N=675 +55.16 p<0.0001
adult patient with sepsis and hypotension 238 (39.80) 641 (94.96)
calls for a bolus of which amount and kind
of intravenous fluid?
Which of the vital signs are out of the N=658 N=675 +7.28 p<0.0001
normal range according to the SIRS 536 (81.46) 599 (88.74)
criteria?

ing resources. However, not having
an expert consistently available for
questions and clarification may
have contributed to nurses answer-
ing the “initial management” know-
ledge item incorrectly more often
after intervention. Additionally, dif-
ficulties in implementing the inter-
vention in different settings (emer-
gency department, acute care,
intensive care) have been recog-
nized. The study was limited to one
facility with acute care nurses and a
post-intervention adherence meas-
urement immediately after the
intervention. Finally, patient man-
agement with a focus on escalation
or transition of care was not dis-
cussed adequately and should be
addressed in future education.
The same number of nurses did
not complete both surveys, and some
individuals did not complete every
item (see Table 2). Although surveys
were distributed and collected sys-
tematically, nurses were not moni-
tored for completion of surveys prior
to collection. However, differences
between groups and items were small
and unlikely to bias results. In addi-
tion, authors did not determine if
improvements in sepsis care as illus-
trated by improved nurse knowledge
and adherence to sepsis screening
resulted in decreased rates of sepsis
and sepsis mortality. A longer project
time, collection, data specific to rates
of sepsis and sepsis outcome, and
more advanced analysis and control
for patient acuity would be needed
for this determination.
Nursing Implications
Application of sepsis care bun-
dles has reduced mortality in hospi-
tals participating in the SSC, but the
number of hospitals involved and
their adherence remain low (SSC,
2013). Adoption of IHI bundles for
sepsis care can be improved locally
through use of a nursing education
intervention and bundle compo-
nents, coupled with a systematic
method to screen for sepsis, recog-
nize screening findings, and com-
municate them in a systematic
manner.
National Patient Safety Goals
(NPSGs) focus on solving problems
in healthcare safety. The Joint
Commission (2016) initially identi-
fied effective communication as

July-August 2016 • Vol. 25/No. 4 237

 FIGURE 2.
Comparison of Non-Adherent, Partially Adherent, and Adherent
Pre
100%
90%
80%
70%
60%
50%
40.6% 40.6%
40%
30%
20%
8.9%
10%
0 screening.
Non-Adherent Partially Adherent
Comparison of percentage of all hospitalized patients for whom staff were never
adherent to recommended sepsis screening, recognizing, and reporting or adherent
at least once in a 24-hour period before and after Surviving Sepsis Campaign guide-
line adoption, nurse education, and use of the EHR sepsis screening and documen-
tation tool. Chi-square test demonstrated a statistical significance in improvement in
incidence of sepsis screening post-intervention (p<0.0001).
one of its NPSGs and the 2016
update (“Get important test results
to the right staff person on time”)
continues to address effective com-
munication. The Situation-Back-
ground-Assessment-Recommend-
ation (SBAR) process has been effec-
tive as a communication tool in
acute care settings to structure high-
urgency conversation (Velji et al.,
2008). Increasing nurses’ knowl-
edge of sepsis and sepsis screening,
as well as providing them with the
SBAR approach, supports nurses in
communicating positive sepsis
screens to providers.
Education and supportive nursing
practice policy lead to more consis-
tent use of the EHR sepsis screening
documentation tool and improved
screening. Electronic templates and
decision-support tools can assist
nurses with consistent documenta-
tion and adherence to protocols and
care standards. Electronic prompts
and worklists can also enhance
adherence (Turisco & Rhoads, 2008).
A method for sepsis screening using
the Systemic Inflammatory Re-
sponse Syndrome Criteria was pro-
238
Post
69.1%
18.5% 21.9%
Adherent
ven to be a valid tool for the early
identification of sepsis. Implemen-
tation of the tool and a logic-based
sepsis protocol decreased sepsis-relat-
ed mortality in one surgical inten-
sive care by one-third (Moore et al.,
2009). Continued auditing for
screening adherence (every 8 hours)
with communication to nursing staff
on the degree of adherence must
continue. Real-time feedback will
allow nurses to improve aherence.
The project’s focus was screening
and reporting positive findings. Next
steps will include further education
to support recognition of tissue
hypoperfusion and its treatment (6-
hour bundle components) and use
of newly developed computerized
physician order entry sepsis care
orders.
Auditing for adherence to screen-
ing should go further to determine
if screening results in appropriate
reporting and initiation of the care
bundles, which would in turn be
expected to improve sepsis patient
outcomes. Auditing also should
focus on retrospective rapid re-
sponses, analyzing if patients were
July-August 2016 • Vol. 25/No. 4
screened, the screen was positive
and reported in a timely manner,
and treatment was implemented
according to SSC 2012 guidelines.
Many units have unique patient
needs and therefore perform nurs-
ing assessments and vital sign meas-
urements differently. A standard-
ized approach to sepsis screening
may not be the answer. It may be
appropriate to examine similar
units, and collaborate with nurses
and other clinicians to determine
appropriate frequency and timing
for sepsis screening according to the
unit’s specific patient population.
Further study will be needed to
determine if patient outcomes are
better with 8-hour vs. 12-hour
Conclusion
Providing nurses with current
evidence to inform practice for
treatment of patients with sepsis,
coupled with appropriate tools
(electronic screening and scripting)
for report of positive screens, forms
a strong foundation on which to
build an interprofessional organiza-
tional sepsis treatment program.
Education, communication script-
ing, nursing policy, and EHR
prompts can improve adoption of
the IHI bundles and SCC 2012
guidelines for sepsis care. Contin-
uous quality improvement efforts
and auditing will position the
organization to improve processes
and provide optimal patient out-
comes. Nevertheless, continued vig-
ilance and administrative support
for this initiative will be needed to
enhance adherence and ensure suc-
cess.
REFERENCES
American Association of Critical-Care Nurses
(AACN). (2013). Breaking through barri-
ers: Effectively communicating sepsis
conditions. Retrieved from http://www.
aacn.org/wd/elearning/docs/elearning
pdf/breaking-through-barriers.pdf
Angus, D., Linde-Zwirble, W., Lidicker, J.
Clermont, G., Carcillow, J., & Pinsky, M.
(2001). Epidemiology of severe sepsis in
the United States: Analysis of incidence,
outcome, and associated costs of care.
Critical Care Medicine, 29(7), 1303-
1310.
Scripting Nurse Communication to Improve Sepsis Care

Instructions For Continuing Nursing Education Contact Hours

Scripting Nurse Communication to Improve Sepsis Care
Deadline for Submission: August 31, 2018 MSN J1612

The author(s), editor, editorial board, content reviewers,

To Obtain CNE Contact Hours
1. For those wishing to obtain CNE contact hours, you must read the
article and complete the evaluation through the AMSN Online
Library. Complete your evaluation online and print your CNE
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completion of the evaluation, a certificate for 1.2 contact hour(s) may
be printed.
Learning Outcome
After completing this learning activity, the learner will be able to describe
communication strategies for improving sepsis care.
Fees — Member: FREE Regular: $20
and education director reported no actual or potential
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This educational activity is jointly provided by Anthony J.
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AMSN Education Director.

Angus, D., & van der Poll, T. (2013). Severe
sepsis and septic shock. The New
England Journal of Medicine, 369(21),
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