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Improving Sepsis Care

The quality council is focusing on improving early identification of patients who are at risk of developing sepsis and ensuring timely interventions for those patients. When evaluating patients for infection, especially those with suspicion for bacteremia, it’s important to consider the diagnosis of sepsis.

Best-practice guidelines recommend the following within three hours of the onset of suspicion of infection:

  1. Check lactic acid if sepsis is suspected. This measurement is an important component of managing sepsis to help gauge tissue ischemia. The lactic acid order is now paneled as an optional selection to the blood culture orders in CS-Link™ to facilitate ease of ordering.
  2. Obtain appropriate routine microbiologic cultures (including blood) before starting antimicrobial therapy in patients with suspected sepsis and septic shock if doing so results in no substantial delay in the start of antimicrobials.
  3. Administer broad-spectrum IV antibiotics as soon as possible after recognition of sepsis. Guidelines recommend empiric broad-spectrum therapy with one or more antimicrobials to cover all likely pathogens, and that empiric antimicrobial therapy be narrowed once pathogen identification and sensitivities are established and/or adequate clinical improvement is noted. They also recommend daily assessment for de-escalation of antimicrobial therapy in patients with sepsis and septic shock.

As part of an ongoing test of change, crisis nurses also are helping to provide rapid assessment and assist in early diagnosis of at-risk patients on two select units, 5-SE and 3-SPT.

Crisis nurses are using a patient list to assess patients who may be at risk of developing sepsis in partnership with the bedside nurse and notify the physician to initiate labs and antibiotics, if appropriate.

For additional information, please contact the executive sponsors of this project, Harry Sax, MD, or Sam Torbati, MD.