Harbor:Sepsis core measures

Sepsis Core Measure

PERFORMANCE GOALS

  • Inclusion:
    • Age 18 and older
    • ICD-10 diagnosis
  • Exclusion:
    • Comfort care
    • Transferred from another acute care facility
    • Expire within 3 hrs of severe sepsis presentation or 6 hrs of septic shock presentation
    • Received IV antibiotic more than 24 hrs prior
    • Documented treatment refusal

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

DEFINITION

Source + 2 of the following:

  • T>38.3 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 (includes all supplemental O2 from NC to BiPAP, CPAP, mechanical ventilation)
    • Kidney Injury: creatinine > 2 or UOP < 0.5 ml/kg
    • DIC: PLT < 100, INR > 1.5
    • Hepatic dysfunction: bilirubin > 2
    • Lactate > 2

ACTIONS

Same as sepsis

DOCUMENTATION

None specific

Septic shock

DEFINITION (One of the following)

  • Severe sepsis + persistent hypotension despite 30ml/kg IVF bolus
  • Lactic acid >/= 4

ACTIONS

  • 3 hour bundle:
    • Start 30ml/kg IVF bolus for ideal body weight
  • Document contraindication for fluid overload patient, use your clinical judgement, and document accordingly.
  • 6 hour bundle:
    • Start vasopressors if no improvement
    • Document reassessment after IVF completed (Can use F5 in Cerner for time stamp)

DOCUMENTATION

  • .sepsissepticshocktreatment (especially important in cases in which a 30mL/kg bolus is contraindicated)
  • .sepsisreassessment

See Also