Hi Everyone,
We have the EPIC charting system and will be building sepsis pathways into our
system.
Would anyone have a current sepsis pathway they can share with me? Paper?
Something like this…..but with current guidelines?
Thank you,
Amy
32011-011 R 12/08 (M)D
SEVERE SEPSIS CLINICAL PATHWAY
Room # ___________ ICU admission Date: ___________ Time: ___________
Sepsis Daily Goals
1. Goal directed therapy to
achieve increased O2 delivery:
CVP 8-12mmHg on vent
12-15mmHg
MAP greater than 65mmHg
ScvO2 greater than or equal
to 70%
2. Blood Glucose 90-140 mg/dl
3. Urine output greater than 0.5
ml/kg/hour
4. In patients with acute lung injury
or ARDS;
Yes No Patient on
mechanical ventilator
_______ PaO2 / FiO2 ratio
Yes No Is tidal volume
6ml/kg of ideal body
weight in first 24
hours?
Yes No Are the static or
plateau inspiratory
pressures less than
30cmH2O in first 24
hours?
5.
Date______________________
___________ to ___________
24-72 Hours
______ Confirm Infectious
Source
______ Re-assess need
for broad spectrum
antibiotics based on
culture reports.
Yes No Was the organism that
was identified sensitive
to the initial antibiotic?
______ Discontinue
Vancomycin if
appropriate
______ D/C or taper steriods
if vasopressors off
______ Re-evaluate need
for invasive lines
and tubes
______ Nutrition Therapy
Date______________________
___________ to ___________
6-24 Hours
Yes No Is patient on
vasopressor at greater
than 6 hours
Yes No Was patient assessed
for Eligibility for
Activated Protein C
(Xigris) – (see Infonet
under Pharmacy-Drug
Information or speak
to pharmacist)
Yes No Was patient eligible for
Activated Protein C?
______ If Xigris administered,
Start Time: _________
Yes No Considered
Hydrocortisone
if vasopressor
unresponsive**
______ If hydrocortisone
administered, provide
50mg every 6 hours
Start Time: _________
______ Consider Vasopressin
for refractory septic
shock
Date______________________
___________ to ___________
1-6 Hours
Refer to Severe Sepsis
Resuscitation Algorithm
Yes No Was initial lactate
greater than 4mmol/L?
Yes No Was patient
hypotensive after initial
fluid bolus?
Yes No CVP placed
If no, why? ________
_________________
_______ Time CVP placed
(record first CVP
reading prior to x-ray
confirmation)
Record the first time the
following is achieved:
______ CVP 8-12 mmHg
on vent 12-15 mmHg
______ MAP greater than or
equal to 65 mmHg
______ SCV02 greater than 70%:
mixed venous greater
than or equal to 65%
Yes No Assess for risk
factors for abdominal
compartment syndrome
Date______________________
___________ to ___________
0-1 Hours
______ Initial Labs:
serum lactate,
additional labs as
ordered by physician
Yes No Serum lactate drawn
within 6 hours?
Yes No Blood Cultures X 2
Time 1:_ ___________
Time 2:_ ___________
______ Other Cultures:
______ Establish IV access
______ Volume resuscitate:
initial 20ml/kg over 30
minutes then additional
boluses as needed per
order
______ Time 20 ml/kg bolus
infused
______ Broad Spectrum
Antibiotic-start after
obtain blood culture
(see Infonet under
Pharmacy Guide to
Antimicrobial Therapy)
______ Time antibiotic hung
______ Source Control
NA
Signature:
*Septic Shock defined as:
SBP less than 90mmHg or 40mmHg
decrease from baseline or MAP less than
65mmHg after 20ml/kg fluid bolus
**Vasopressor unresponsive defined as:
Requiring vasopressors after fluid
resuscitation completed.
Please complete the following:
• Severe sepsis or septic shock* diagnosis: Date: ______________________ Time:
___________________________
• Patient transferred from (unit or hospital):
_________________________________________________________________
• Patient was identified as having severe sepsis or septic shock: ❏ ED ❏ Floor
❏ ICU Admission ❏ During ICU Stay
• Decision to move to comfort care in first 24 hours after diagnosis Yes No
• ICU discharge: Date: ________________ Time: ________________
• Discharge status: Alive Expired
Amy L. Sprague MSN, RN, ACNS-BC, CCRN
Clinical Nurse Specialist~Critical Care
Franciscan St. Francis Health
8111 S. Emerson Avenue
Indianapolis, IN 46237
Office (317)528-6800
[email protected]
“People grow through experience if
they meet life honestly and courageously."
Eleanor Roosevelt,
U.S. first lady
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