Ver el código de «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)"

===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)