Harbor:Sepsis core measures: Difference between revisions
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==Sepsis== | ==Sepsis Core Measure== | ||
===PERFORMANCE GOALS=== | ===PERFORMANCE GOALS=== | ||
*Inclusion: | *Inclusion: | ||
| Line 12: | Line 12: | ||
**Documented treatment refusal | **Documented treatment refusal | ||
IF PATIENT TRIGGERS SEPSIS ALERT BUT IS NOT SEPTIC, DOCUMENT "Not Septic (. | IF PATIENT TRIGGERS SEPSIS ALERT BUT IS NOT SEPTIC, DOCUMENT "Not Septic (.sepsisnotseptic)" | ||
===DEFINITION=== | ===DEFINITION=== | ||
Source + 2 of the following: | Source + 2 of the following: | ||
*T>38 or <36 | *T>38.3 or <36 | ||
*HR >90 | *HR >90 | ||
*RR>20 | *RR>20 | ||
| Line 39: | Line 39: | ||
*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 (includes all supplemental O2 from NC to BiPAP, CPAP, mechanical ventilation) | ||
**Kidney Injury: creatinine > 2 or UOP < 0.5 ml/kg | **Kidney Injury: creatinine > 2 or UOP < 0.5 ml/kg | ||
**DIC: PLT < 100, INR > 1.5 | **DIC: PLT < 100, INR > 1.5 | ||
| Line 49: | Line 49: | ||
===DOCUMENTATION=== | ===DOCUMENTATION=== | ||
None specific | |||
==Septic shock== | ==Septic shock== | ||
===DEFINITION (One of the following)=== | ===DEFINITION (One of the following)=== | ||
*Severe sepsis + persistent hypotension despite 30ml/kg IVF bolus | *Severe sepsis + persistent hypotension despite 30ml/kg IVF bolus | ||
*Lactic acid > 4 | *Lactic acid >/= 4 | ||
===ACTIONS=== | ===ACTIONS=== | ||
*3 hour bundle: | *3 hour bundle: | ||
**Start 30ml/kg IVF bolus | **Start 30ml/kg IVF bolus for ideal body weight | ||
* | *Document contraindication for fluid overload patient, use your clinical judgement, and document accordingly. | ||
*6 hour bundle: | *6 hour bundle: | ||
**Start vasopressors if no improvement | **Start vasopressors if no improvement | ||
**Document reassessment after IVF completed (Can use F5 in Cerner for time stamp) | |||
* | |||
* | |||
===DOCUMENTATION=== | ===DOCUMENTATION=== | ||
(. | *.sepsissepticshocktreatment (especially important in cases in which a 30mL/kg bolus is contraindicated) | ||
*.sepsisreassessment | |||
==See Also== | ==See Also== | ||
Latest revision as of 20:00, 1 December 2021
Sepsis Core Measure
PERFORMANCE GOALS
- Inclusion:
- Age 18 and older
- ICD-10 diagnosis
- Exclusion:
- Comfort care
- Transferred from another acute care facility
- Expire within 3 hrs of severe sepsis presentation or 6 hrs of septic shock presentation
- Received IV antibiotic more than 24 hrs prior
- Documented treatment refusal
IF PATIENT TRIGGERS SEPSIS ALERT BUT IS NOT SEPTIC, DOCUMENT "Not Septic (.sepsisnotseptic)"
DEFINITION
Source + 2 of the following:
- T>38.3 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 (includes all supplemental O2 from NC to BiPAP, CPAP, mechanical ventilation)
- Kidney Injury: creatinine > 2 or UOP < 0.5 ml/kg
- DIC: PLT < 100, INR > 1.5
- Hepatic dysfunction: bilirubin > 2
- Lactate > 2
ACTIONS
Same as sepsis
DOCUMENTATION
None specific
Septic shock
DEFINITION (One of the following)
- Severe sepsis + persistent hypotension despite 30ml/kg IVF bolus
- Lactic acid >/= 4
ACTIONS
- 3 hour bundle:
- Start 30ml/kg IVF bolus for ideal body weight
- Document contraindication for fluid overload patient, use your clinical judgement, and document accordingly.
- 6 hour bundle:
- Start vasopressors if no improvement
- Document reassessment after IVF completed (Can use F5 in Cerner for time stamp)
DOCUMENTATION
- .sepsissepticshocktreatment (especially important in cases in which a 30mL/kg bolus is contraindicated)
- .sepsisreassessment