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| ==Sepsis==
| | #REDIRECT[[Harbor:Sepsis core measures]] |
| ===PERFORMANCE GOALS===
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| *Inclusion:
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| **Age 18 and older
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| **ICD-10 diagnosis
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| *Exclusion:
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| **Comfort care
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| **Transferred from another acute care facility
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| **Expire w/in 3 hrs of severe sepsis presentation or 6 hrs of septic shock presentation
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| **Received IV abx more than 24 hrs prior
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| **Documented treatment refusal
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| IF PATIENT TRIGGERS SEPSIS ALERT BUT IS NOT SEPTIC, DOCUMENT "Not Septic (.ednotseptic)"
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| ===DEFINITION===
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| Source + 2 of the following:
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| *T>38 or <36
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| *HR >90
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| *RR>20
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| *WBC >12 or <4, or >10% bands
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| ===ACTIONS===
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| *Use Sepsis Order Set
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| *3 hour bundle:
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| **Draw initial lactate
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| **Obtain blood cultures prior to antibiotics
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| **Administer broad spectrum antibiotics targeted at source
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| *6 hour bundle:
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| **Repeat lactate if initially 2 or greater
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| **Clock starts when patient meets criteria for severe sepsis or septic shock
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| ===DOCUMENTATION===
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| none specific
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| ==Severe sepsis==
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| ===DEFINITION===
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| *Sepsis + acute organ dysfunction
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| *1 or more of the following:
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| **Hypotension: SBP < 90 or MAP < 65 or SBP decrease >40
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| **Hypoxia: requiring oxygen
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| **Kidney Injury: Cr > 2 or UOP < 0.5 ml/kg
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| **DIC: PLT < 100, INR > 1.5
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| **Hepatic dysfunction: bilirubin > 2
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| **Lactate > 2
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| ===ACTIONS===
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| Same as sepsis
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| ===DOCUMENTATION===
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| Use Severe Sepsis Assessment: (.edseveresepsis)
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| ==Septic shock==
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| ===DEFINITION (One of the following)===
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| *Severe sepsis + persistent hypotension despite 30 ml/kg IVF bolus
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| *Lactic acid > 4
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| ===ACTIONS===
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| *3 hour bundle:
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| **Start 30 ml/kg IVF bolus
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| **Currently no exclusion for fluid overload patient, but use your clinical judgement, and document accordingly.
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| *6 hour bundle:
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| **Start vasopressors if no improvement
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| '''Perform “volume status & tissue perfusion assessment”'''
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| *Option 1: Must include all elements below
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| **Vital signs
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| **Heart exam: RRR, Irregular, S3, S4
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| **Lung exam: Clear, wheezes, crackles, diminished
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| **Pulses: 2+, 1+
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| **Cap Refill: <2 sec, >2
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| **Skin: Mottled, not mottled, pale, pink
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| *Option 2: Need 2 of the following
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| **Central line: CVP, SCVO2
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| **Bedside ultrasound volume assessment
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| **Passive leg raise or fluid challenge
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| **Clock starts when patient meets criteria for severe sepsis or septic shock
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| ===DOCUMENTATION===
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| (.edsepticshock)
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