Assess the availability, components, and reported use of sepsis-specific nurse-initiated standing orders (NISOs) in emergency departments, inpatient wards, and rapid response team settings.
Approach:
Design and setting: Cross-sectional survey conducted in October and November 2025 among hospitals participating in the Hospital Medicine Safety Consortium in Michigan.
Analysis: Survey responses described NISO availability, components, and use by care setting and hospital characteristics; setting differences were assessed using the Fisher-Freeman-Halton exact test.
Key Findings:
Of 68 responding hospitals, 54 (79%) reported NISOs and 48 (71%) had a sepsis-specific NISO.
Among 84 setting-specific sepsis NISOs, 39 (57%) were in emergency departments, 22 (32%) inpatient, and 23 (34%) through rapid response teams.
Lactate testing was included in 80 NISOs (95%); blood cultures in 63 (75%), complete blood counts in 59 (70%), and comprehensive metabolic profiles in 49 (58%).
Intravenous fluids were included in 27 NISOs (32%), more often in rapid response team orders than inpatient or emergency department orders. No sepsis-specific NISO included antibiotic orders.
Only 11 NISOs (13%) were reported as used in more than half of sepsis cases; usage data were unavailable for 30 (36%).
Rural hospitals more often reported sepsis-specific NISOs in any setting than urban or suburban hospitals (100% vs 64%).
Interpretation:
The authors report that these NISOs appear chiefly designed to accelerate sepsis evaluation rather than initial treatment. Availability was more common than frequent reported use, and use was often unknown.
Limitations:
The survey included hospitals from a single state.
Survey responses may have been inaccurate.
Observations across hospital settings were not independent.
The study could not assess NISOs’ effects on sepsis management or patient outcomes.
Conclusion:
The survey found that many participating hospitals had sepsis-specific NISOs, most commonly in emergency departments, but reported practical use was limited or unknown. The authors call for further research on core NISO components and effects on management and outcomes.
