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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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