Abstract Rationale Ensuring guideline adherence and consistency of care for critical care patients amid high staff turnover is challenging. We aim to evaluate the effectiveness of nursing instructions included in norepinephrine orders in the EMR to trigger initiation of vasopressin at the appropriate dosing threshold in septic shock, per the Surviving Sepsis guidelines. Methods A single center, retrospective chart review was conducted in 113 patients hospitalized with septic shock requiring norepinephrine and vasopressin support. Non-septic shock etiologies were excluded. Initial patterns of norepinephrine and vasopressin prescription were recorded with respect to Surviving Sepsis guidelines. Vasopressin initiation was driven by nursing request when norepinephrine dose was ≥ 0.25 mcg/kg/min or 14 mcg/min. Compliance was assessed at 3- and 6-months post-implementation. Results Baseline compliance with vasopressor guidelines was 33%. This was attributed to non-weight-based norepinephrine dosing in some of the cases, as well as the practice of starting vasopressin when norepinephrine dose was 20-25 mcg/min. After implementing the new nursing instruction in the norepinephrine order, a non-statistically significant 11% increase in guideline adherent commencement of vasopressin in septic shock was noted (Chi-square: 1.44, p = 0.23 Fisher’s exact test odds ratio 0.6, p = 0.27). Conclusions Nursing instructions alone resulted in a non-significant 11% absolute increase in guideline compliance with a Chi-squared value of 1.44, p = 0.23, Fisher Exact Test odds ratio 0.6, p = 0.27. Although the results were not statistically significant, the results do merit further research. This abstract is funded by: None
O’Rear et al. (Fri,) studied this question.