Harbor: Sepsis core measures: Difference between revisions
| Line 56: | Line 56: | ||
*Lactic acid > 4 | *Lactic acid > 4 | ||
==ACTIONS== | ===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) | |||
Revision as of 22:47, 5 October 2015
Sepsis
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)