Harbor: Sepsis core measures

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)"

SEPSIS - DEFINITION Source + 2 of the following: •T>38 or <36 •HR >90 •RR>20 •WBC >12 or <4, or >10% bands

SEPSIS - 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

SEPSIS - 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

SEVERE SEPSIS - ACTIONS - Same as sepsis

SEVERE 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

SEPTIC SHOCK - 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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