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A multimodal nursing pedagogy utilizing simulation was incorporated into annual nurse competencies at a 465-bed academic medical center to translate into practice the required surveillance of a potentially septic patient and the necessary clinical decision-making. Pretest/posttest was used to determine knowledge retention from simulation. Nurses' sepsis knowledge following simulation was improved. Simulation can provide long-term knowledge retention of sepsis for application into clinical practice and be a viable option for competency assessment for professional nurses. [ABSTRACT FROM AUTHOR]

Objectives: To identify circumstances in which repeated measures of organ failure would improve mortality prediction in ICU patients.Design: Retrospective cohort study, with external validation in a deidentified ICU database.Setting: Eleven ICUs in three university hospitals within an academic healthcare system in 2014.Patients: Adults (18 yr old or older) who satisfied the following criteria: 1) two of four systemic inflammatory response syndrome criteria plus an ordered blood culture, all within 24 hours of hospital admission; and 2) ICU admission for at least 2 calendar days, within 72 hours of emergency department presentation.Intervention: NoneMEASUREMENTS AND MAIN RESULTS:: Data were collected until death, ICU discharge, or the seventh ICU day, whichever came first. The highest Sequential Organ Failure Assessment score from the ICU admission day (ICU day 1) was included in a multivariable model controlling for other covariates. The worst Sequential Organ Failure Assessment scores from the first 7 days after ICU admission were incrementally added and retained if they obtained statistical significance (p < 0.05). The cohort was divided into seven subcohorts to facilitate statistical comparison using the integrated discriminatory index. Of the 1,290 derivation cohort patients, 83 patients (6.4%) died in the ICU, compared with 949 of the 8,441 patients (11.2%) in the validation cohort. Incremental addition of Sequential Organ Failure Assessment data up to ICU day 5 improved the integrated discriminatory index in the validation cohort. Adding ICU day 6 or 7 Sequential Organ Failure Assessment data did not further improve model performance.Conclusions: Serial organ failure data improve prediction of ICU mortality, but a point exists after which further data no longer improve ICU mortality prediction of early sepsis. [ABSTRACT FROM AUTHOR]