Harbor:Sepsis core measures - Revision history

Bchap23: /* ACTIONS */

2026-01-05T23:12:35Z

ACTIONS

← Revisión anterior		Revisión del 23:12 5 ene 2026
Línea 73:		Línea 73:
	*6 hour bundle:		*6 hour bundle:
	**Start vasopressors if no improvement		**Start vasopressors if no improvement
	**Document reassessment after IVF completed ~~(Can use F5 in Cerner for time stamp)~~		**Document reassessment time after IVF completed

	===DOCUMENTATION===		===DOCUMENTATION===

Bchap23: /* DOCUMENTATION */

2026-01-05T23:11:48Z

DOCUMENTATION

← Revisión anterior		Revisión del 23:11 5 ene 2026
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	===DOCUMENTATION===		===DOCUMENTATION===
	* Utilize '''.~~edsepsisprotocol~~'''		* Utilize '''.edSepsisprotocol'''
	** Can addend the chart up to 30 days after hospital discharge (review real-time scorecards for any opportunities to fix)		** Can addend the chart up to 30 days after hospital discharge (review real-time scorecards for any opportunities to fix)
	** Use the "not sepsis" statement if abnormal vital signs are not felt to be from sepsis but you document sepsis anywhere in your MDM; must specify “not septic shock or severe sepsis”		** Use the "not sepsis" statement if abnormal vital signs are not felt to be from sepsis but you document sepsis anywhere in your MDM; must specify “not septic shock or severe sepsis”

Bchap23: /* DOCUMENTATION */

2026-01-05T23:11:00Z

DOCUMENTATION

← Revisión anterior		Revisión del 23:11 5 ene 2026
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	===DOCUMENTATION===		===DOCUMENTATION===
	*.~~sepsissepticshocktreatment (especially important in cases in which a 30mL/kg bolus is contraindicated)~~		*.edSepsisprotocol
	*.sepsisreassessment

	==See Also==		==See Also==

Bchap23: /* DOCUMENTATION */

2025-12-20T01:41:57Z

DOCUMENTATION

← Revisión anterior		Revisión del 01:41 20 dic 2025
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	===DOCUMENTATION===		===DOCUMENTATION===
	* Utilize '''.edsepsisprotocol'''		* Utilize '''.edsepsisprotocol'''
	** Can addend the chart up to 30 days after ~~initial presentation~~ (review real-time scorecards for any opportunities to fix)		** Can addend the chart up to 30 days after hospital discharge (review real-time scorecards for any opportunities to fix)
	** Use the "not sepsis" statement if abnormal vital signs are not felt to be from sepsis but you document sepsis anywhere in your MDM; must specify “not septic shock or severe sepsis”		** Use the "not sepsis" statement if abnormal vital signs are not felt to be from sepsis but you document sepsis anywhere in your MDM; must specify “not septic shock or severe sepsis”
	** Specify how much IVF you are giving and WHY you are not doing 30ml/kg if not clinically indicated		** Specify how much IVF you are giving and WHY you are not doing 30ml/kg if not clinically indicated

Bchap23: /* ACTIONS */

2025-12-15T21:40:46Z

ACTIONS

← Revisión anterior		Revisión del 21:40 15 dic 2025
Línea 20:		Línea 20:

	===ACTIONS===		===ACTIONS===
	*Use Sepsis Order Set		* Use Sepsis Order Set "ED Sepsis Screening and Management Bundle" for labs, IVF, and antibiotics
	* '''3-hour bundle''' (within 3 hours of severe sepsis recognition):		* '''3-hour bundle''' (within 3 hours of severe sepsis recognition):
	** Draw initial lactate		** Draw initial lactate

Bchap23: /* ACTIONS */

2025-12-15T21:39:02Z

ACTIONS

← Revisión anterior		Revisión del 21:39 15 dic 2025
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	===ACTIONS===		===ACTIONS===
	*Use Sepsis Order Set		*Use Sepsis Order Set
	*3 hour bundle:		* '''3-hour bundle''' (within 3 hours of severe sepsis recognition):
	**Draw initial lactate		** Draw initial lactate
	**Obtain blood cultures prior to antibiotics		** Obtain blood cultures prior to antibiotics
	**Administer broad spectrum antibiotics targeted at source		** Administer broad spectrum antibiotics targeted at source
	*6 hour bundle:		** IV fluids (within 6 hours before recognition and up to 3 hours after recognition of severe sepsis)
	**Repeat lactate if initially 2 or greater		*** Nursing reassessment within 1 hour of IVF bolus completion
	**~~Clock starts when patient meets criteria for severe sepsis or~~ septic shock		* '''6-hour bundle:'''
			** Clock starts when patient meets criteria for severe sepsis or septic shock
			** Repeat lactate if initially 2 or greater
			** Provider reassessment within 6 hours of recognition of septic shock

	===DOCUMENTATION===		===DOCUMENTATION===

Bchap23: /* DOCUMENTATION */

2025-12-15T21:33:19Z

DOCUMENTATION

← Revisión anterior		Revisión del 21:33 15 dic 2025
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	===DOCUMENTATION===		===DOCUMENTATION===
	* Utilize '''.edsepsisprotocol'''		* Utilize '''.edsepsisprotocol'''
			** Can addend the chart up to 30 days after initial presentation (review real-time scorecards for any opportunities to fix)
	** Use the "not sepsis" statement if abnormal vital signs are not felt to be from sepsis but you document sepsis anywhere in your MDM; must specify “not septic shock or severe sepsis”		** Use the "not sepsis" statement if abnormal vital signs are not felt to be from sepsis but you document sepsis anywhere in your MDM; must specify “not septic shock or severe sepsis”
	** Specify how much IVF you are giving and WHY you are not doing 30ml/kg if not clinically indicated		** Specify how much IVF you are giving and WHY you are not doing 30ml/kg if not clinically indicated

Bchap23: /* PERFORMANCE GOALS */

2025-12-15T21:29:23Z

PERFORMANCE GOALS

← Revisión anterior		Revisión del 21:29 15 dic 2025
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	**Received IV antibiotic more than 24 hrs prior		**Received IV antibiotic more than 24 hrs prior
	**Documented treatment refusal		**Documented treatment refusal

	~~IF PATIENT TRIGGERS SEPSIS ALERT BUT IS NOT SEPTIC, DOCUMENT "Not Septic (.sepsisnotseptic)"~~

	===DEFINITION===		===DEFINITION===

Bchap23: /* DEFINITION (One of the following) */

2025-12-15T21:28:53Z

DEFINITION (One of the following)

← Revisión anterior		Revisión del 21:28 15 dic 2025
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	==Septic shock==		==Septic shock==
	===DEFINITION (One of the following)===		===DEFINITION (One of the following)===
	*Severe sepsis + persistent hypotension ~~despite~~ 30ml/kg IVF bolus		*Severe sepsis + persistent hypotension within one hour of completion of 30ml/kg IVF bolus
	*Lactic acid >/= 4		*Lactic acid >/= 4

Bchap23: /* DOCUMENTATION */

2025-12-15T21:27:59Z

DOCUMENTATION

← Revisión anterior		Revisión del 21:27 15 dic 2025
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	===DOCUMENTATION===		===DOCUMENTATION===
	~~none specific~~		* Utilize '''.edsepsisprotocol'''
			** Use the "not sepsis" statement if abnormal vital signs are not felt to be from sepsis but you document sepsis anywhere in your MDM; must specify “not septic shock or severe sepsis”
			** Specify how much IVF you are giving and WHY you are not doing 30ml/kg if not clinically indicated
			*** The patient has a BMI > 30 so their ideal body weight of [ _ ] Kg was used and [ _ ] mL of fluids were given instead of the calculated target volume
			*** Due to concern for volume overload ( [ _ ] CHF, [ _] non-collapsing IVC on ultrasound, [ _] CKD, [ _ ] signs of volume overload on exam), [ _ ] mL IV fluid bolus was given instead of the calculated target volume
			*** The patient received _ ml of blood (colloid) and this was subtracted from the calculated target volume of [___] mL (30 mL/kg)
			*** The patient improved after [____]mL
			** Focused exam requirement is met by writing “I completed the sepsis reassessment” within 6h of start of last fluid bolus
			** BCx after abx is OK only if provider documents that a deteriorating condition would make a delay in starting the antibiotic detrimental (eg, rapid deterioration would place patient at risk if delay in antibiotics)
			** The time on the note will apply to everything on the note (including recognition of septic shock) unless there is an updated time stamp, so please clarify the time recognition occurred.

	==Severe sepsis==		==Severe sepsis==