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| SEPSIS PERFORMANCE GOALS
| | #REDIRECT[[Harbor:Sepsis core measures]] |
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| •Inclusion:
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| •Age 18 and older
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| •ICD-10 diagnosis
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| •Exclusion:
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| •Comfort care
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| •Transferred from another acute care facility
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| •Expire w/in 3 hrs of severe sepsis presentation or 6 hrs of septic shock presentation
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| •Received IV abx more than 24 hrs prior
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| •Documented treatment refusal
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| IF PATIENT TRIGGERS SEPSIS ALERT BUT IS NOT SEPTIC, DOCUMENT "Not Septic (.ednotseptic)"
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| SEPSIS - DEFINITION
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| Source + 2 of the following:
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| •T>38 or <36
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| •HR >90
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| •RR>20
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| •WBC >12 or <4, or >10% bands
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| SEPSIS - ACTIONS
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| •Use Sepsis Order Set
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| •3 hour bundle:
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| •Draw initial lactate
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| •Obtain blood cultures prior to antibiotics
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| •Administer broad spectrum antibiotics targeted at source
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| •6 hour bundle:
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| •Repeat lactate if initially 2 or greater
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| •Clock starts when patient meets criteria for severe sepsis or septic shock
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| SEPSIS - DOCUMENTATION - none specific
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| SEVERE SEPSIS - DEFINITION
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| •Sepsis + acute organ dysfunction
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| •1 or more of the following:
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| •Hypotension: SBP < 90 or MAP < 65 or SBP decrease >40
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| •Hypoxia: requiring oxygen
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| •Kidney Injury: Cr > 2 or UOP < 0.5 ml/kg
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| •DIC: PLT < 100, INR > 1.5
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| •Hepatic dysfunction: bilirubin > 2
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| •Lactate > 2
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| SEVERE SEPSIS - ACTIONS - Same as sepsis
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| SEVERE SEPSIS - DOCUMENTATION Use Severe Sepsis Assessment: (.edseveresepsis)
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| SEPTIC SHOCK - DEFINITION (One of the following)
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| •Severe sepsis + persistent hypotension despite 30 ml/kg IVF bolus
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| •Lactic acid > 4
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| SEPTIC SHOCK - ACTIONS
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| •3 hour bundle:
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| •Start 30 ml/kg IVF bolus
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| •Currently no exclusion for fluid overload patient, but use your clinical judgement, and document accordingly.
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| •6 hour bundle:
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| •Start vasopressors if no improvement
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| •Perform “volume status & tissue perfusion assessment”
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| •Option 1: Must include all elements below
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| •Vital signs
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| •Heart exam: RRR, Irregular, S3, S4
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| •Lung exam: Clear, wheezes, crackles, diminished
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| •Pulses: 2+, 1+
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| •Cap Refill: <2 sec, >2 sec
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| •Skin: Mottled, not mottled, pale, pink
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| •Option 2: Need 2 of the following
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| •Central line: CVP, SCVO2
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| •Bedside ultrasound volume assessment
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| •Passive leg raise or fluid challenge
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| •Clock starts when patient meets criteria for severe sepsis or septic shock
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| SEVERE SEPSIS - DOCUMENTATION (.edsepticshock)
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