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St. Luke’s University Health Network

2013 SEPSIS SCREENING

Highmark Quality Blue Pay-for-Performance Program: SEPSIS

0.5 CE/Credit

Directions for Completion

1. Before proceeding to the posttest, be sure you have read the 3 documents that follow this cover page:

• Highmark Quality Blue Pay-for-Performance Program: SEPSIS SCREENING Education

• Severe Sepsis Screening Flowchart

• Evaluation for Severe Sepsis Screening Tool (“Screening Tool”)

2. Exit after reading the 3 documents and complete the posttest which is final step of this education.

← “Take Test” is a brief posttest measuring your knowledge of content.

← Remember, no attendance record is needed.

← Completion of the posttest will be sent electronically to your EduTracker record once a 100% is achieved.

← Print the Certificate of Completion for your records if desired.

Comments, questions, or suggestions regarding the content

can be directed to Jessica Heckenberger, Patient Care Manager, PPHP 7 (484-526-1741) or any member of the Highmark Sepsis Project Committee

Highmark Quality Blue Pay-for-Performance Program: SEPSIS SCREENING Education

What are we doing?

• Measure: Implementation of the Sepsis Resuscitation and Sepsis Management Bundles in the Emergency Department, ICU and non-ICU settings for patients >16 years of age.

• Intent: To promote rapid identification of patients admitted with or developing severe sepsis and/or septic shock and improve the quality of care provided by aligning treatment with evidence-based guidelines.

• Outcome: Reduced morbidity and mortality due to severe sepsis and/or septic shock.

What is Sepsis?

• Sepsis is the body's response to a localized (e.g. tooth abscess) or systemic infection (e.g. septicemia)

• Sepsis is a medical emergency just like a heart attack or a stroke because there is an interruption of oxygen and nutrients to the tissues including the vital organs such as the brain, intestines, liver, kidneys and lungs.

• Infections leading to sepsis can be community acquired or hospital acquired (nosocomial)

• Hospital-acquired infections are generally more difficult to manage because:

o The patient is often already sick

o The infecting microorganism may be more dangerous

o Resistance to common treatments due to the widespread use of antibiotics in hospitals

• Sepsis is becoming more common as a result of:

o Medical and technological advances associated with treatments

o Increasing number of elderly or debilitated people

o Patients with underlying diseases (e.g. cancer) requiring therapy

o Widespread use of antibiotics which encourages growth of drug-resistant microorganisms

Who is at risk?

• Everyone (infant to adult) is at potential risk

• Sepsis is most likely to develop in people who:

o Are very young or very old

o Have a weakened/compromised immune system

o Have wounds or injuries (e.g. burns, penetrating wounds, etc.)

o Have certain addictive habits such as alcohol or drugs

o Are receiving invasive treatments/medical care (e.g. IV fluids/access, urinary catheters, etc.)

Stages of Sepsis

• Uncomplicated Sepsis, such as that caused by the flu and other viral infections, gastroenteritis, or dental abscesses, is very common.

o Experienced by millions of people each year

o Majority of these people will not need hospital treatment

• Severe Sepsis arises when sepsis occurs in combination with problems in one or more of the vital organs, such as the heart, kidneys, lungs, or liver.

o Are likely to be very ill and require admission

o More likely to die (in 30-35 % of cases)

• Septic Shock occurs when sepsis is complicated by low blood pressure that does not respond to fluid administration.

o Leads to problems in one or more of the vital organs

o The body does not receive enough oxygen to properly function and vasopressors are used to raise the blood pressure.

o Patients are very ill and require rapid emergency medical care

o Despite active treatment, the death rate is around 50%

Most Common Sources of Sepsis

• An infection in any part of the body. The following regions are most common:

o Lungs - usually associated with pneumonia

o Abdomen (e.g. appendicitis, gallbladder infections, peritonitis)

o Urinary Tract - particularly patients needing a urinary catheter

o Skin (e.g. wounds, skin inflammations)

o Bones (e.g. inflammation and infections of the bone, marrow, sinuses, etc.)

o Central Nervous System (e.g. meningitis or encephalitis) or spinal cord

• The source of the sepsis cannot be found in about 20% of cases

Highmark Sepsis Project Definitions

• SEPSIS is defined as a documented or suspected infection with one or more of the following:

o Hyperthermia >101.0 F

o Hypothermia 90b pm

o Tachypnea >20bpm

o Leukocytosis WBC count >12,000

o Leukopenia WBC Count 60 secs)

▪ Thrombocytopenia (platelet count 2.0 mg/dL or 35 mmol/L)

▪ Hemodynamic variables:

• Arterial hypotension (SBP 20 bpm

( Hypothermia < 36.0ºC (96.8ºF) ( Leukocytosis (WBC count > 12,000 IJL – 1)

( Tachycardia > 90 bpm ( Leukopenia (WBC count < 4000 IJL – 1)

**If the answer is yes to both questions 1 & 2, SUSPICION of INFECTION is present.

• Notify the Physician / PA-C / CRNP

• The following lab work is indicated and will need an order to obtain:

STAT lactic acid, blood cultures, CBC with differential, basic chemistry labs, bilirubin

• At the physician’s discretion, obtain: UA, chest x-ray, amylase, lipase, ABG, CRP, CT scan

3. Are any of the following organ dysfunction criteria present at a site remote from the site of

the infection that ARE NOT considered to be chronic conditions? Yes No

( Acutely altered mental status

( SBP < 90 mmHg or MAP < 65 mmHg

( SBP decrease > 40 mmHg from baseline

( Bilateral pulmonary infiltrates with a new (or increased) oxygen requirement to maintain SpO2 > 90%

( Bilateral pulmonary infiltrates with PaO2/FiO2 ratio < 300

( Creatinine > 2.0 mg/dl (176.8 mmol/L)

( Urine Output < 0.5 ml/kg/hour for > 2 hours

( Bilirubin > 2 mg/dl (34.2 mmol/L)

( Platelet count < 100,000

( Coagulopathy (INR > 1.5 or aPTT > 60 secs)

( Lactate > 4 mmol/L (18.0 mg/dl)

If SUSPICION of INFECTION (#1 & #2) is present and ORGAN DYSFUNCTION (#3) is present, the patient meets the criteria for SEVERE SEPSIS and should be entered into the Severe Sepsis Protocol. NOTE: Antibiotic must be infused within 3 hours for ED and 1 hour for non-ED patients.

Signature (Physician/PA-C/CRNP)___________________________________________________________

( Patient is already receiving antibiotics ( Severe Sepsis has been identified ( YES ( NO

Date: ______________ Time severe sepsis recognized: _________ Form faxed by (initials): _______

***MUST Fax to Laura Kohler at x691- 4055 (SLB)***

For questions or concerns please contact the Critical Care Attending / PA-C / CRNP

Adapted from the ©2005 Surviving Sepsis Campaign and the Institute for Healthcare Improvement (10.23.2012)

This document is NOT part of the permanent medical record

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