Harbor: Sepsis core measures: Difference between revisions

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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
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•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:  
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   •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  
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   •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

Revision as of 22:43, 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 sec
•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

SEVERE SEPSIS - DOCUMENTATION (.edsepticshock)

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