Hello,

I want to thank Dr. Townsend for responding to my questions: thank you so much 
for your well-reasoned response. I have spoken with a few physicians using that 
line of thinking and it has been effective. Thank you again.

Re: critical values: Our facility is also adding Lactic acid >2 mmol/L as a 
critical value.

New Question: We have approved a nurse-driven protocol where, based on our 
severe sepsis screening tool, a rapid response ICU nurse may call Code Sepsis 
and order blood cultures, lactic acid, as well as loading doses of Vancomycin 
and either Zosyn or Merrem. What other facilities have added antibiotics to 
their nurse-driven protocols, and how have you provided parameters, education, 
and safety measures (anything beyond the usual)? Would you be willing to share 
any materials along those lines?

Thanks,
Gayle Porter RN BSN
Brownsville, TX
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