|
|
| (5 intermediate revisions by 2 users not shown) |
| Line 1: |
Line 1: |
| ==Sepsis==
| | #REDIRECT[[Harbor:Sepsis core measures]] |
| ===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)
| |
