We obtain an initial lactate on all patients who are suspected and screen for risk of severe sepsis. We felt that if initial blood draws are being done with placement of saline lock access we go ahead and draw blood cultures and lactate at that time since we will drawing for CBC and CMP most likely. Our practice is to not miss these tests and to try to save patient as many additional sticks as possible. We have been drawing blood cultures this way for quite a while. We just added the initial lactate as part of any and all sepsis workup with screening. I heard a lot about costly tests but doing a lactate in our facility is reasonably cheap according to the lab director. From: Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On Behalf Of Rutherford, Richard Sent: Monday, January 08, 2018 4:54 PM To: sepsisgroups@lists.sepsisgroups.org Subject: [Sepsis Groups] Automated Lactate Orders
Hello All, We are having a debate in our organization about whether automatic lactate orders violate nursing standard of practice. Currently if a patient in ED or on floor screens in for sepsis, the nurse follows hospital protocol and orders a lactate which is then routed to the attending physician for cosignature (after drawn). We also have an automated order to repeat lactate at 4 hours for admitted patients with an initial lactate>2. I believe our initial lactate order in ER is covered by Standardized Nursing Procedures. We are having more debate around the initial lactate ordered on inpatients and the automated second lactate on all patients with lactate>2 without a prior physician order. I am interested in knowing if other hospitals use our approach, and if so is nursing leadership feeling comfortable that nursing standards of practice are not being violated. Thanks, Rick Rutherford
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