Harbor: Sepsis core measures - Revision history

Rossdonaldson1: Redirected page to Harbor:Sepsis core measures

2015-10-28T18:10:39Z

Redirected page to Harbor:Sepsis core measures

← Older revision		Revision as of 18:10, 28 October 2015
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	~~==Sepsis==~~		#REDIRECT[[Harbor:Sepsis core measures]]
	~~===PERFORMANCE GOALS===~~
	*Inclusion:
	**Age 18 and older
	**ICD-10 diagnosis

	*Exclusion:
	**Comfort care
	**Transferred from another acute care facility
	**Expire w/in 3 hrs of severe sepsis presentation or 6 hrs of septic shock presentation
	**Received IV abx more than 24 hrs prior
	**Documented treatment refusal

	~~IF PATIENT TRIGGERS SEPSIS ALERT BUT IS NOT SEPTIC, DOCUMENT "Not Septic (.ednotseptic)"~~

	~~===DEFINITION===~~
	~~Source + 2 of the following:~~
	*T>38 or <36
	*HR >90
	*RR>20
	*WBC >12 or <4, or >10% bands

	~~===ACTIONS===~~
	*Use Sepsis Order Set
	*3 hour bundle:
	**Draw initial lactate
	**Obtain blood cultures prior to antibiotics
	**Administer broad spectrum antibiotics targeted at source
	*6 hour bundle:
	**Repeat lactate if initially 2 or greater
	**Clock starts when patient meets criteria for severe sepsis or septic shock

	~~===DOCUMENTATION===~~
	~~none specific~~

	~~==Severe sepsis==~~
	~~===DEFINITION===~~
	*Sepsis + acute organ dysfunction
	*1 or more of the following:
	**Hypotension: SBP < 90 or MAP < 65 or SBP decrease >40
	**Hypoxia: requiring oxygen
	**Kidney Injury: Cr > 2 or UOP < 0.5 ml/kg
	**DIC: PLT < 100, INR > 1.5
	**Hepatic dysfunction: bilirubin > 2
	**Lactate > 2

	~~===ACTIONS===~~
	~~Same as sepsis~~

	~~===DOCUMENTATION===~~
	~~Use Severe Sepsis Assessment: (.edseveresepsis)~~

	~~==Septic shock==~~
	~~===DEFINITION (One of the following)===~~
	*Severe sepsis + persistent hypotension despite 30 ml/kg IVF bolus
	*Lactic acid > 4

	~~===ACTIONS===~~
	*3 hour bundle:
	**Start 30 ml/kg IVF bolus
	**Currently no exclusion for fluid overload patient, but use your clinical judgement, and document accordingly.
	*6 hour bundle:
	**Start vasopressors if no improvement


	~~'''Perform “volume status & tissue perfusion assessment”'''~~
	*Option 1: Must include all elements below
	**Vital signs
	**Heart exam: RRR, Irregular, S3, S4
	**Lung exam: Clear, wheezes, crackles, diminished
	**Pulses: 2+, 1+
	**Cap Refill: <2 sec, >2
	**Skin: Mottled, not mottled, pale, pink
	*Option 2: Need 2 of the following
	**Central line: CVP, SCVO2
	**Bedside ultrasound volume assessment
	**Passive leg raise or fluid challenge
	**Clock starts when patient meets criteria for severe sepsis or septic shock

	~~===DOCUMENTATION===~~
	~~(.edsepticshock)~~

	~~==See Also==~~
	*[[Harbor:~~Antibiotics in~~ Sepsis]]

	~~[[Category:Admin~~]]

Cchoff at 21:04, 20 October 2015

2015-10-20T21:04:38Z

← Older revision		Revision as of 21:04, 20 October 2015
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	==See Also==		==See Also==
	*[[Harbor:Antibiotics in Sepsis]]		*[[Harbor:Antibiotics in Sepsis]]

			[[Category:Admin]]

Rossdonaldson1 at 22:49, 5 October 2015

2015-10-05T22:49:52Z

← Older revision		Revision as of 22:49, 5 October 2015
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	===DOCUMENTATION===		===DOCUMENTATION===
	(.edsepticshock)		(.edsepticshock)

			==See Also==
			*[[Harbor:Antibiotics in Sepsis]]

Rossdonaldson1: /* Septic shock */

2015-10-05T22:47:39Z

Septic shock

← Older revision		Revision as of 22:47, 5 October 2015
Line 64:		Line 64:


	'''Perform “volume status & tissue perfusion assessment”''		'''Perform “volume status & tissue perfusion assessment”'''
	*Option 1: Must include all elements below		*Option 1: Must include all elements below
	**Vital signs		**Vital signs

Rossdonaldson1: /* ACTIONS */

2015-10-05T22:47:29Z

ACTIONS

@@ Line 56: / Line 56: @@
 *Lactic acid > 4
-==ACTIONS==
+===ACTIONS===
-•3 hour bundle:
+*3 hour bundle:
-  •Start 30 ml/kg IVF bolus
+**Start 30 ml/kg IVF bolus
-  •Currently no exclusion for fluid overload patient, but use your clinical judgement, and document accordingly.
+**Currently no exclusion for fluid overload patient, but use your clinical judgement, and document accordingly.
-•Perform “volume status & tissue perfusion assessment”
+'''Perform “volume status & tissue perfusion assessment”''
- •Option 1: Must include all elements below
+===DOCUMENTATION===
- •Vital signs
+(.edsepticshock)

Rossdonaldson1: /* SEPTIC SHOCK */

2015-10-05T22:46:16Z

SEPTIC SHOCK

← Older revision		Revision as of 22:46, 5 October 2015
Line 51:		Line 51:
	Use Severe Sepsis Assessment: (.edseveresepsis)		Use Severe Sepsis Assessment: (.edseveresepsis)

	==~~SEPTIC SHOCK~~==		==Septic shock==
	===DEFINITION (One of the following)===		===DEFINITION (One of the following)===
	*Severe sepsis + persistent hypotension despite 30 ml/kg IVF bolus		*Severe sepsis + persistent hypotension despite 30 ml/kg IVF bolus

Rossdonaldson1: /* SEVERE SEPSIS */

2015-10-05T22:46:00Z

SEVERE SEPSIS

← Older revision		Revision as of 22:46, 5 October 2015
Line 34:		Line 34:
	none specific		none specific

	==~~SEVERE SEPSIS~~==		==Severe sepsis==
	===DEFINITION===		===DEFINITION===
	*Sepsis + acute organ dysfunction		*Sepsis + acute organ dysfunction

	*1 or more of the following:		*1 or more of the following:
			**Hypotension: SBP < 90 or MAP < 65 or SBP decrease >40
	~~•Hypotension~~: SBP < 90 or MAP < 65 or SBP decrease >40		**Hypoxia: requiring oxygen
	~~•Hypoxia~~: requiring oxygen		**Kidney Injury: Cr > 2 or UOP < 0.5 ml/kg
	~~•Kidney~~ Injury: Cr > 2 or UOP < 0.5 ml/kg		**DIC: PLT < 100, INR > 1.5
	~~•DIC~~: PLT < 100, INR > 1.5		**Hepatic dysfunction: bilirubin > 2
	~~•Hepatic~~ dysfunction: bilirubin > 2		**Lactate > 2
	~~•Lactate~~ > 2

	===ACTIONS===		===ACTIONS===

Rossdonaldson1: /* Sepsis */

2015-10-05T22:45:25Z

Sepsis

← Older revision		Revision as of 22:45, 5 October 2015
Line 2:		Line 2:
	===PERFORMANCE GOALS===		===PERFORMANCE GOALS===
	*Inclusion:		*Inclusion:
	*Age 18 and older		**Age 18 and older
	*ICD-10 diagnosis		**ICD-10 diagnosis

	*Exclusion:		*Exclusion:
	*Comfort care		**Comfort care
	*Transferred from another acute care facility		**Transferred from another acute care facility
	*Expire w/in 3 hrs of severe sepsis presentation or 6 hrs of septic shock presentation		**Expire w/in 3 hrs of severe sepsis presentation or 6 hrs of septic shock presentation
	*Received IV abx more than 24 hrs prior		**Received IV abx more than 24 hrs prior
	*Documented treatment refusal		**Documented treatment refusal

	IF PATIENT TRIGGERS SEPSIS ALERT BUT IS NOT SEPTIC, DOCUMENT "Not Septic (.ednotseptic)"		IF PATIENT TRIGGERS SEPSIS ALERT BUT IS NOT SEPTIC, DOCUMENT "Not Septic (.ednotseptic)"
Line 16:		Line 16:
	===DEFINITION===		===DEFINITION===
	Source + 2 of the following:		Source + 2 of the following:
	•T>38 or <36		*T>38 or <36
	~~•HR~~ >90		*HR >90
	~~•RR~~>20		*RR>20
	~~•WBC~~ >12 or <4, or >10% bands		*WBC >12 or <4, or >10% bands

	===ACTIONS===		===ACTIONS===
	~~•Use~~ Sepsis Order Set		*Use Sepsis Order Set
	•3 hour bundle:		*3 hour bundle:
	~~•Draw~~ initial lactate		**Draw initial lactate
	~~•Obtain~~ blood cultures prior to antibiotics		**Obtain blood cultures prior to antibiotics
	~~•Administer~~ broad spectrum antibiotics targeted at source		**Administer broad spectrum antibiotics targeted at source
	•6 hour bundle:		*6 hour bundle:
	~~•Repeat~~ lactate if initially 2 or greater		**Repeat lactate if initially 2 or greater
	~~•Clock~~ starts when patient meets criteria for severe sepsis or septic shock		**Clock starts when patient meets criteria for severe sepsis or septic shock

	===DOCUMENTATION===		===DOCUMENTATION===

Rossdonaldson1: Rossdonaldson1 moved page Sepsis Core Measures to Harbor: Sepsis core measures

2015-10-05T22:44:22Z

Rossdonaldson1 moved page Sepsis Core Measures to Harbor: Sepsis core measures

← Older revision	Revision as of 22:44, 5 October 2015
(No difference)

Rossdonaldson1 at 22:43, 5 October 2015

2015-10-05T22:43:31Z

← Older revision		Revision as of 22:43, 5 October 2015
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	~~SEPSIS~~ PERFORMANCE GOALS		==Sepsis==
			===PERFORMANCE GOALS===
			*Inclusion:
			*Age 18 and older
			*ICD-10 diagnosis

	~~•Inclusion~~:		*Exclusion:
	~~•Age 18 and older~~		*Comfort care
	~~•ICD-10 diagnosis~~		*Transferred from another acute care facility
			*Expire w/in 3 hrs of severe sepsis presentation or 6 hrs of septic shock presentation
	~~•Exclusion:~~		*Received IV abx more than 24 hrs prior
	~~•Comfort~~ care		*Documented treatment refusal
	~~•Transferred~~ from another acute care facility
	~~•Expire~~ w/in 3 hrs of severe sepsis presentation or 6 hrs of septic shock presentation
	~~•Received~~ IV abx more than 24 hrs prior
	~~•Documented~~ treatment refusal

	IF PATIENT TRIGGERS SEPSIS ALERT BUT IS NOT SEPTIC, DOCUMENT "Not Septic (.ednotseptic)"		IF PATIENT TRIGGERS SEPSIS ALERT BUT IS NOT SEPTIC, DOCUMENT "Not Septic (.ednotseptic)"

	~~SEPSIS -~~ DEFINITION		===DEFINITION===
	Source + 2 of the following:		Source + 2 of the following:
	•T>38 or <36		•T>38 or <36
Line 21:		Line 21:
	•WBC >12 or <4, or >10% bands		•WBC >12 or <4, or >10% bands

	~~SEPSIS -~~ ACTIONS		===ACTIONS===
	•Use Sepsis Order Set		•Use Sepsis Order Set
	•3 hour bundle:		•3 hour bundle:
Line 31:		Line 31:
	•Clock starts when patient meets criteria for severe sepsis or septic shock		•Clock starts when patient meets criteria for severe sepsis or septic shock

	~~SEPSIS -~~ DOCUMENTATION - none specific		===DOCUMENTATION===
			none specific

			==SEVERE SEPSIS==
			===DEFINITION===
			*Sepsis + acute organ dysfunction

	~~SEVERE SEPSIS - DEFINITION~~		*1 or more of the following:
	~~•Sepsis + acute organ dysfunction~~

	•1 or more of the following:

	•Hypotension: SBP < 90 or MAP < 65 or SBP decrease >40		•Hypotension: SBP < 90 or MAP < 65 or SBP decrease >40
Line 46:		Line 47:
	•Lactate > 2		•Lactate > 2

	~~SEVERE SEPSIS -~~ ACTIONS - Same as sepsis		===ACTIONS===
			Same as sepsis
	~~SEVERE SEPSIS - DOCUMENTATION Use Severe Sepsis Assessment: (.edseveresepsis)~~



	~~SEPTIC SHOCK - DEFINITION~~ (~~One of the following~~)		===DOCUMENTATION===
	~~•Severe sepsis + persistent hypotension despite 30 ml/kg IVF bolus~~		Use Severe Sepsis Assessment: (.edseveresepsis)
	~~•Lactic acid > 4~~

	SEPTIC SHOCK ~~- ACTIONS~~		==SEPTIC SHOCK==
			===DEFINITION (One of the following)===
			*Severe sepsis + persistent hypotension despite 30 ml/kg IVF bolus
			*Lactic acid > 4

			==ACTIONS==
	•3 hour bundle:		•3 hour bundle:
	•Start 30 ml/kg IVF bolus		•Start 30 ml/kg IVF bolus