John, We are implementing initiatives in both ED and the rest of the hospital. The ED will be different for us, but the floor they are doing screen based on an Early Warning Score done by the nurse. This is for more than just sepsis but if they meet the sepsis criteria then that triggers our rapid response team to come evaluate and get the bundle going. Each patient gets a score for Early Warning Signs of sepsis. That is the plan anyways. I don't have the specifics on that project, because I'm in charge of the ED initiative, but that's my understanding of the other.
Hope that helps. We also have EICU for our ICUs and we do have a best practice alert that can be turned on eventually too and we are working towards that as well. From: [email protected] [mailto:[email protected]] On Behalf Of John Brady Sent: Tuesday, November 20, 2012 2:05 PM To: Mary Draper; 'Hefton, Suzanne'; [email protected] Subject: Re: [Sepsis Groups] use of vasopressors Currently we are monitoring for SIRS, known or suspected infection, Sepsis and then following guidelines for our severe sepsis and septic shock patients. We actually are doing the lactate, CBC and BC after a positive screening for sepsis. We do these screenings on the floor and the ED. We are trying to roll out a screening process for the ICU but most of our patients meet criteria for sepsis. Does anyone have a process that works for them in the ICU. From: [email protected]<mailto:[email protected]> [mailto:[email protected]]<mailto:[mailto:[email protected]]> On Behalf Of Mary Draper Sent: Tuesday, November 20, 2012 9:43 AM To: 'Hefton, Suzanne'; [email protected]<mailto:[email protected]> Subject: Re: [Sepsis Groups] use of vasopressors Our facility continues to bolus an additional 3-5 liters if the lactate comes back ≥ 4. If after that and we have a CVP that is still < 8, we would continue to bolus. Thanks. Mary Draper RN BSN CCRN Quality Manager-Best Practice Support Quality Management Supervisor Office (925) 674-2045 Cell (925) 451-8792 Fax (925) 674-2373 [email protected]<mailto:[email protected]> [Magnet] From: [email protected]<mailto:[email protected]> [mailto:[email protected]] On Behalf Of Hefton, Suzanne Sent: Monday, November 19, 2012 5:55 PM To: [email protected]<mailto:[email protected]> Subject: [Sepsis Groups] use of vasopressors New to the list serve so I apologize if this has been asked previously....Currently, we report Fluid Bolus of 20ml/kg, CVP for lactate > 4 or inability to maintain MAP and initiation of vasopressors if MAP < 65 as separate measures. Some of our ED physicians have questioned if we should wait to start pressors until we have gotten to a CVP of 8. Example: pt has a MAP of 60 and a CVP of 4 after the fluid bolus -we look for the physician to start pressors. I'm wondering what other facilities are doing? Thanks! ________________________________ Notice from St. Joseph Health System: Please note that the information contained in this message may be privileged and confidential and protected from disclosure. ==================== The information in this message is confidential and may be legally privileged. Access to this message by anyone other than the addressee is not authorized. If you are not the intended recipient, or an agent of the intended recipient, any disclosure, copying, or distribution of the message or any action or omission taken by you in reliance on it, is prohibited and may be unlawful. If you have received this message in error, please contact the sender immediately and permanently delete the original e-mail, attachment(s), and any copies. ====================
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