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Translating Research into Practice (TRIP) Improving Sepsis Recognition and Treatment

Translating Research into Practice (TRIP) Improving Sepsis Recognition and Treatment. What does the evidence say? Severe sepsis and septic shock continue to be major health care problems with a high mortality. One in four patients die and the incidence continues to increase.

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Translating Research into Practice (TRIP) Improving Sepsis Recognition and Treatment

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  1. Translating Research into Practice (TRIP) Improving Sepsis Recognition and Treatment What does the evidence say? • Severe sepsis and septic shock continue to be major health care problems with a high mortality. One in four patients die and the incidence continues to increase. • Providing prompt and appropriate therapy in the initial hours of treatment is the biggest contributor to improving outcomes. Therapy in the first 6-hours directed at meeting initial resuscitation goals has been shown to significantly decrease mortality. • Each hour delay in administering effective antibiotics is associated with a significant increase in mortality. Changes in practice: • New and updated evidence-based Sepsis Early Recognition Assessment and Treatment badge cards are provided to assist with earlier identification of patients with possible sepsis for ICU and med-surg. • If sepsis is suspected, inform the MD/Provider using SBAR communication and request/recommend an order to draw a BMP, CBC, lactate and blood cultures. Blood cultures must be drawn prior to initiating antibiotic therapy. • The initial recommended fluid bolus is now 30ml/kg of crystalloid. Repeat this dose if there is no response to the initial bolus. • Maintain a hemoglobin 7-9g/dLby transfusing one PRBC for a hgb < 7g/dL. • Norepinephrine is the vasopressor of choice in severe sepsis and septic shock. Epinephrine may be added to norepinephrine when an additional agent is needed. • Vasopressin is used as an adjunct to norepinephrine or epinephrine to either raise MAP or wean norepinephrine. Consider using dopamine as an alternative to norepinephrine only in highly selected patients. • CALL a MET response to ensure prompt treatment of patients developing sepsis in med-surg. • Initiate the newly updated Severe Sepsis Order Set upon transfer to the ICU to improve resuscitation. • Remember to obtain cultures and administer antibiotics within the FIRST HOUR of recognition of severe sepsis or septic shock! Suspect Sepsis when a patient has ≥ 2 SIRS criteria (Systemic Inflammatory Response Syndrome) and a possible infection SOURCES OF INFECTION □ Pneumonia □ UTI □ Acute Abdomen □ Meningitis □ Skin/soft tissue □ Bone/joint □ Wound □ Endocarditis □ Central line catheter □ Implantable device SIRS CRITERIA □ HR >90 □ RR >20 □ Temp >38.3 or < 36°C □ WBC >12 or <4 □ % Neutrophils > 72 or <39 on differential For Heme/Onc/BMT patients: 2 consecutive 38oC fevers within 1 hour or any fever greater than or equal to 38.3oC require a call to the MD. GOALS OF INITIAL RESUSCITATION □ CVP 8-12 mmHg □ MAP > 65 mmHg □ Urine output > 0.5ml/kg/hr □ SvO2 saturation > 65% Dellinger R.P., Levy M.M., Rhodes A, et al. (2012) Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012.Critical Care Medicine. 41(2):580-637. (LOE 1) Developed by and approval date: Thornton O, Johnson S, Makic MBF Sept 2013

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