Difference between revisions of "Harbor:Sepsis core measures"

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**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 within 3 hrs of severe sepsis presentation or 6 hrs of septic shock presentation
**Received IV abx more than 24 hrs prior
+
**Received IV antibiotic more than 24 hrs prior
 
**Documented treatment refusal
 
**Documented treatment refusal
  
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**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
**Kidney Injury: Cr > 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
 
**Hepatic dysfunction: bilirubin > 2
 
**Hepatic dysfunction: bilirubin > 2
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==Septic shock==
 
==Septic shock==
 
===DEFINITION (One of the following)===
 
===DEFINITION (One of the following)===
*Severe sepsis + persistent hypotension despite 30 ml/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 30 ml/kg IVF bolus
+
**Start 30ml/kg IVF bolus
 
**Currently no exclusion for fluid overload patient, but use your clinical judgement, and document accordingly.
 
**Currently no exclusion for fluid overload patient, but use your clinical judgement, and document accordingly.
 
*6 hour bundle:  
 
*6 hour bundle:  

Latest revision as of 06:35, 11 August 2016

Sepsis

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 (.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: 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

Use Severe Sepsis Assessment: (.edseveresepsis)

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
    • 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
    • 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

DOCUMENTATION

(.edsepticshock)

See Also