We use EPIC as well. We have a few sentences on the Sepsis order sheet about the need for fluids, and the order sheet provides the options to do the bundle component.
However, we do not have the pathway in the detail that you have listed. If someone has this or some develops this for Epic it would be valuable. It is especially nice to have it cue the right process for the right time. George George Kramer, PhD Resuscitation Research Lab Dept. of Anesthesiology UTMB, Galveston 409-939-3040 From: "Sprague Amy L - St. Francis Hospital and Health Centers" <[email protected]<mailto:[email protected]>> Date: Friday, March 28, 2014 10:01 AM To: "sepsis_expedition ([email protected]<mailto:[email protected]>)" <[email protected]<mailto:[email protected]>>, "[email protected]<mailto:[email protected]>" <[email protected]<mailto:[email protected]>> Subject: [Sepsis Groups] Sepsis Pathways 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]<mailto:[email protected]> “People grow through experience if they meet life honestly and courageously." 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