Hi Jessica, Yikes - as an ED nurse in my last life and a former ED manager, I cannot imagine having to tackle this with just "suspected infection + SIRS" as the trigger. Fortunately, the bundle is not directed at that population; it is directed at treating severe sepsis and septic shock...and those require more to trigger. So, the short answer is that I don't think you need to change your heart rate cut-off, you need to add "organ dysfunction" as a criterion.
See the attached - it is what we are using through Dignity Health within the Cerner EHR. You will see there is a third qualifier to designate "severe sepsis" and it is on these folks that the sepsis bundle is triggered. We also have a Code Sepsis and there was some push back from the ED that we were going to be casting too fine a net with this third criterion so we have met in the middle a bit. The screen has not changed and severe sepsis is managed the same way but now our highlight for Code Sepsis - to warrant the "all hands on deck" - is on patients with acute encephalopathy (AMS), respiratory compromise and hypotension. Hope this helps! -- Sam Farrell, RN CCRN Intensivist Program Manager West Coast Critical Care Specialists office: 805.988.7004 fax: 805.988.7101 cell: 805.444.3730 wccriticalcare.com *CONFIDENTIALITY NOTICE : This message and any included attachments are intended only for the addressee and may contain confidential information belonging to the sender that is legally protected. Unauthorized forwarding, printing, copying, distribution, or use of such information is strictly prohibited and may be unlawful. If you are not the addressee, please promptly delete this message and notify the sender of the delivery error by e-mail. Thank you.* On Thu, Apr 9, 2015 at 8:02 AM, Jessica Wonderly <[email protected]> wrote: > Good morning, > > At our facility we have been struggling with the sensitivity of our > screening tool, particularly in our ED. If there is an index of suspicion > and any two SIRS criteria nursing my protocol a septic work up. We are > finding that the low threshold for tachycardia (HR > 90) is causing over > triage and leading to increased spending and prolonged ED visits. Can > anyone point me towards the research that determined the heart rate of 90 > as standard SIRS? Also have any of you changed your criteria to heart rate > > 100? > > Jessica Wonderly, RN > Special Projects: > DSRIP Sepsis/CLABSI Facilitator > Hospital Staff Nurse II > Kern Medical Center > Phone: (661) 326-5637 > Pager: (661) 307-1098 > * * * * * * * * * CONFIDENTIALITY STATEMENT * * * * * * * * > * > > This message is intended only for the use of the individual or entity to > which it is addressed and may contain information that is privileged, > confidential and exempt from disclosure under applicable law. If the > reader of this message is not the intended recipient, you are hereby > notified that any dissemination, distribution or copying of the > communication is strictly prohibited. If you received this communication > in error, please notify us immediately by telephone and return the original > message to us at the e-mail address above. Thank you. > > OWNED AND OPERATED BY THE COUNTY OF KERN > 1830 Flower Street, Bakersfield California 93305-4197 > (661) 326-2416 > > _______________________________________________ > Sepsisgroups mailing list > [email protected] > http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org > >
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