Effects of the first-hour nursing intervention bundle on selected outcomes among patients with sepsis and septic shock in an emergency department

  • สุทธิชัย แก้วหาวงค์ โรงพยาบาลสมเด็จพระยุพราชธาตุพนม
  • ดลวิวัฒน์ แสนโสม
Keywords: first-hour nursing intervention bundle, patients with sepsis and septic shock, organ dysfunctions


This quasi-experimental research with posttest-only design aimed to compare effects of the First-hour Nursing Intervention Bundle (1-NIB) on selected outcomes among patients with sepsis and septic shock in an emergency department (ED), Thatphanom Crown Prince Hospital. Purposive sampling was used to recruit 94 subjects for this study. The samples were divided into 2 groups. The comparison group included 47 subjects who received conventional sepsis management intervention whereas the experimental group were 47 subjects who received 1-NIB for sepsis management. Effects of the 1-NIB were evaluated to acquire patients’ and nurses’ outcomes. Descriptive statistics were used to obtain means, standard deviations, frequency, and percentage.  Effects of the 1-NIB were calculated using Chi-squared and relative risk.

       Evaluation of patient outcomes showed that 30 patients in the comparison group developed organ dysfunction with the incidence rate of 63.83/1000-persons (95%CI: 51.47-79.12) while only 9 patients in the experimental group developed organ dysfunction with the incidence of 19.14/1000- persons (95%CI: 10.64-34.45). In addition, patients in the comparison group were 3.33 times more likely to develop organ dysfunction within the first 6 hours of ED visit compared to those in the experimental group (RR=3.33, 95%CI=1.78-6.23, p=.0002).  Nurses using 1-NIB reported a high level of adherence (90.21%).  In addition, nurses caring for the experimental group had higher proportion in starting antibiotics within the first hour of ED visit, giving adequate IV fluid for resuscitation within the first hour, and closely monitoring and evaluating patient symptoms.  As a result, the 1-NIB decreased the incidence, risk, and severe symptom severity in patients with sepsis and septic shock. Moreover, it enhanced nurse’s competency and performance in caring for this patient population as well as decreased the time taken to initiate patient care. 


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