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			<h1 id="firstHeading" class="firstHeading" lang="en">Harbor:Sepsis core measures</h1>
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				<div id="mw-content-text" lang="en" dir="ltr" class="mw-content-ltr"><div id="toc" class="toc"><div id="toctitle"><h2>Contents</h2></div>
<ul>
<li class="toclevel-1 tocsection-1"><a href="#Sepsis"><span class="tocnumber">1</span> <span class="toctext">Sepsis</span></a>
<ul>
<li class="toclevel-2 tocsection-2"><a href="#PERFORMANCE_GOALS"><span class="tocnumber">1.1</span> <span class="toctext">PERFORMANCE GOALS</span></a></li>
<li class="toclevel-2 tocsection-3"><a href="#DEFINITION"><span class="tocnumber">1.2</span> <span class="toctext">DEFINITION</span></a></li>
<li class="toclevel-2 tocsection-4"><a href="#ACTIONS"><span class="tocnumber">1.3</span> <span class="toctext">ACTIONS</span></a></li>
<li class="toclevel-2 tocsection-5"><a href="#DOCUMENTATION"><span class="tocnumber">1.4</span> <span class="toctext">DOCUMENTATION</span></a></li>
</ul>
</li>
<li class="toclevel-1 tocsection-6"><a href="#Severe_sepsis"><span class="tocnumber">2</span> <span class="toctext">Severe sepsis</span></a>
<ul>
<li class="toclevel-2 tocsection-7"><a href="#DEFINITION_2"><span class="tocnumber">2.1</span> <span class="toctext">DEFINITION</span></a></li>
<li class="toclevel-2 tocsection-8"><a href="#ACTIONS_2"><span class="tocnumber">2.2</span> <span class="toctext">ACTIONS</span></a></li>
<li class="toclevel-2 tocsection-9"><a href="#DOCUMENTATION_2"><span class="tocnumber">2.3</span> <span class="toctext">DOCUMENTATION</span></a></li>
</ul>
</li>
<li class="toclevel-1 tocsection-10"><a href="#Septic_shock"><span class="tocnumber">3</span> <span class="toctext">Septic shock</span></a>
<ul>
<li class="toclevel-2 tocsection-11"><a href="#DEFINITION_.28One_of_the_following.29"><span class="tocnumber">3.1</span> <span class="toctext">DEFINITION (One of the following)</span></a></li>
<li class="toclevel-2 tocsection-12"><a href="#ACTIONS_3"><span class="tocnumber">3.2</span> <span class="toctext">ACTIONS</span></a></li>
<li class="toclevel-2 tocsection-13"><a href="#DOCUMENTATION_3"><span class="tocnumber">3.3</span> <span class="toctext">DOCUMENTATION</span></a></li>
</ul>
</li>
<li class="toclevel-1 tocsection-14"><a href="#See_Also"><span class="tocnumber">4</span> <span class="toctext">See Also</span></a></li>
</ul>
</div>

<h2><span class="mw-headline" id="Sepsis">Sepsis</span></h2>
<h3><span class="mw-headline" id="PERFORMANCE_GOALS">PERFORMANCE GOALS</span></h3>
<ul><li>Inclusion: 
<ul><li>Age 18 and older</li>
<li>ICD-10 diagnosis</li></ul></li></ul>
<ul><li>Exclusion: 
<ul><li>Comfort care</li>
<li>Transferred from another acute care facility</li>
<li>Expire within 3 hrs of severe sepsis presentation or 6 hrs of septic shock presentation</li>
<li>Received IV antibiotic more than 24 hrs prior</li>
<li>Documented treatment refusal</li></ul></li></ul>
<p>IF PATIENT TRIGGERS SEPSIS ALERT BUT IS NOT SEPTIC, DOCUMENT "Not Septic (.ednotseptic)"
</p>
<h3><span class="mw-headline" id="DEFINITION">DEFINITION</span></h3>
<p>Source + 2 of the following: 
</p>
<ul><li>T&gt;38 or &lt;36</li>
<li>HR &gt;90</li>
<li>RR&gt;20</li>
<li>WBC &gt;12 or &lt;4, or &gt;10% bands</li></ul>
<h3><span class="mw-headline" id="ACTIONS">ACTIONS</span></h3>
<ul><li>Use Sepsis Order Set</li>
<li>3 hour bundle: 
<ul><li>Draw initial lactate</li>
<li>Obtain blood cultures prior to antibiotics</li>
<li>Administer broad spectrum antibiotics targeted at source</li></ul></li>
<li>6 hour bundle: 
<ul><li>Repeat lactate if initially 2 or greater</li>
<li>Clock starts when patient meets criteria for severe sepsis or septic shock</li></ul></li></ul>
<h3><span class="mw-headline" id="DOCUMENTATION">DOCUMENTATION</span></h3>
<p>none specific
</p>
<h2><span class="mw-headline" id="Severe_sepsis">Severe sepsis</span></h2>
<h3><span class="mw-headline" id="DEFINITION_2">DEFINITION</span></h3>
<ul><li>Sepsis + acute organ dysfunction</li>
<li>1 or more of the following:
<ul><li>Hypotension: SBP &lt; 90 or MAP &lt; 65 or SBP decrease &gt;40 </li>
<li>Hypoxia: requiring oxygen</li>
<li>Kidney Injury: creatinine &gt; 2 or UOP &lt; 0.5 ml/kg</li>
<li>DIC: PLT &lt; 100, INR &gt; 1.5</li>
<li>Hepatic dysfunction: bilirubin &gt; 2</li>
<li>Lactate &gt; 2</li></ul></li></ul>
<h3><span class="mw-headline" id="ACTIONS_2">ACTIONS</span></h3>
<p>Same as sepsis
</p>
<h3><span class="mw-headline" id="DOCUMENTATION_2">DOCUMENTATION</span></h3>
<p>Use Severe Sepsis Assessment: (.edseveresepsis)
</p>
<h2><span class="mw-headline" id="Septic_shock">Septic shock</span></h2>
<h3><span class="mw-headline" id="DEFINITION_.28One_of_the_following.29">DEFINITION (One of the following)</span></h3>
<ul><li>Severe sepsis + persistent hypotension despite 30ml/kg IVF bolus</li>
<li>Lactic acid &gt; 4</li></ul>
<h3><span class="mw-headline" id="ACTIONS_3">ACTIONS</span></h3>
<ul><li>3 hour bundle: 
<ul><li>Start 30ml/kg IVF bolus</li>
<li>Currently no exclusion for fluid overload patient, but use your clinical judgement, and document accordingly.</li></ul></li>
<li>6 hour bundle: 
<ul><li>Start vasopressors if no improvement</li></ul></li></ul>
<p><br />
<b>Perform “volume status &amp; tissue perfusion assessment”</b>
</p>
<ul><li>Option 1: Must include all elements below
<ul><li>Vital signs</li>
<li>Heart exam: RRR, Irregular, S3, S4</li>
<li>Lung exam: Clear, wheezes, crackles, diminished</li>
<li>Pulses: 2+, 1+</li>
<li>Cap Refill: &lt;2 sec, &gt;2 </li>
<li>Skin: Mottled, not mottled, pale, pink</li></ul></li>
<li>Option 2: Need 2 of the following
<ul><li>Central line: CVP, SCVO2</li>
<li>Bedside ultrasound volume assessment</li>
<li>Passive leg raise or fluid challenge</li>
<li>Clock starts when patient meets criteria for severe sepsis or septic shock</li></ul></li></ul>
<h3><span class="mw-headline" id="DOCUMENTATION_3">DOCUMENTATION</span></h3>
<p>(.edsepticshock)
</p>
<h2><span class="mw-headline" id="See_Also">See Also</span></h2>
<ul><li><a href="Harbor_Antibiotics_in_Sepsis.html" title="Harbor:Antibiotics in Sepsis" class="mw-redirect">Harbor:Antibiotics in Sepsis</a></li></ul>

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<p><a href="User_Rossdonaldson1.html" title="User:Rossdonaldson1">Ross Donaldson</a>, <a href="User_Neil.m.html" title="User:Neil.m.young">Neil Young</a>
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