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

• Harbor:Antibiotics in Sepsis