We are working on a process to initiating sepsis tx including antibiotics in the with our county EMS and am looking at all of you for your expertise.
1. Develop an algorithm for EMS with SIRS criteria and suspected infection. The only measure they won't have in the field is WBC. 2. If sepsis criteria met - EMS will obtain a LA (point of care) in patients meeting sepsis criteria - looking to obtain in the field to help in identification of severe sepsis (esp. those who may not look that sick) 3. We have met with lab and will get the first blood culture in the field. EMS to do training bi-annually to assure proper technique. Would only do this for patients who are stable enough to take the extra few minutes to initiate this process. 4. Initiate fluids - simplifying protocol for 2 L for patients under 80 kg and 3L for > 80 kg. 5. We have also met with pharmacy and have worked out a process to have Zosyn and Rocephin available and part of the protocol to initiate in the field. EMS feels pretty confident with suspicion of pneumonia and UTI and will focus primarily on those patients with Rocephin for pneumonia and Zosyn for UTI and other suspicious sources. Once arrives to ED, the physician can fine tune abx. EMS will hold abx for patients with PCN allergy or if unsure and let ED physician make decision. 6. On arrival to ED - blood culture will be sent to lab and second culture drawn. Will continue with usual sepsis care then. One of our concerns is the pneumonia measure for antibiotic and eventual sepsis measure for abx. We plan to use arrival time for our internal abx time given. * Not sure what this will do to pneumonia measures. Quality says as long as all appropriate antibiotics are given within 24 hours, the patient will not fall out of the measure. Concern is for abx ordered every 24 hours or renal patient - how to meet the measure. We are going to work on making this process work for us. We are also finding an issue with this at our MD360 offices where they can start antibiotics and how this in impacting measures. * We've just started looking at participating in the surviving sepsis data base and will probably enter time of abx as time of arrival?? Not sure yet how that will work. Anyone have any thoughts or ideas that we haven't thought of? Sue Sue Beswick APRN, MS, CCNS, CCRN CNS Critical Care Greenville Health System 701 Grove Road l Greenville, SC 29605 Office: 864-455-4884
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