Harbor: Sepsis core measures: Difference between revisions

Revision as of 22:45, 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)

Authors:

@@ Line 2: / Line 2: @@
 ===PERFORMANCE GOALS===
 *Inclusion:
-*Age 18 and older
+**Age 18 and older
-*ICD-10 diagnosis
+**ICD-10 diagnosis
 *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)"
@@ Line 16: / Line 16: @@
 ===DEFINITION===
 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===
-•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===