Thank you for the opportunity to describe our study Sepsis in the Emergency Department
The main objective is to decrease the time between identification of patient with sepsis and the start of the sepsis protocol. ----- Meeting Notes (11/15/11 17:05) ----- as well as empowering nurses and physcians to use the protocol to manage these patients
The incidence of sepsis has steadily increased during the past several decades, the associated mortality rates have remained constant. As you can see from the graph the comparison of mortality in the US by cause severe sepsis is almost equal to the rate of acute myocardial infarction.
What we want to do is identify patient’s >18yr suspected of infection and treat them using the sepsis protocol. We want to identify and treat these suspected patient within one hour upon admission to a level one emergency room. To have them transported from the ER to an ICU with initiation of the protocol within 4hrs. Most patients will be admitted to the ICU due to the fact of being placed on vasoactive drips that require titration ----- Meeting Notes (11/15/11 17:05) ----- This type of titration can only be performed in an ICU setting.
How these patients will be identified. Suspected infection included PNA, meningitis, intra-abdominal infection, UTI. Serum lactate > 4mmol/L
Data Collection- using electronic medical record. Printing reports such as vital signs, CVP readings, lab results. Trained nurses will collect this information on a weekly basis and enter this data into a system that will provide statistical analysis of the data.
Serum lactate via iSTAT will be measured before initiation of sepsis protocol and 12 hrs after protocol. Each patient with suspected sepsis will automatically have blood cultures drawn. With this blood drawl, we can go ahead and obtain a serum lactate.
In service programs will be provided for nursing staff. These in-services will be held at various times to cover all shifts in the ER. Collaboration with the medical director in the ER to help education physicians during their ground rounds as well as online training. Placed in various placed on the ER will be poster size sepsis protocols for reference as well as on on call trained nurse on the sepsis protocol.
Outcome of interest is reducing the mortality rate of patients with sepsis within 24 hours. We would like to meet the above goals in 12 hrs. CVP….
We want to know if obtaining serum lactate levels on patients admitted to the ER meeting criteria for sepsis reduces mortality rate when using a specfic set of treament interventions. Thank You
Transcript of "Assign.4"
Develop an evidenced based protocol that will allow
rapid identification of sepsis and to educate and
empower nurses to use the protocol to manage patients
with severe sepsis
Sepsis is a complex condition that
is often life-threatening. It is
characterized by hematological
disorders and a pronounced
inflammatory response to an
infection or injury. Sepsis accounts
for 215, 00 deaths in the United
States each year at a cost of more
than $16 billion. Septic shock
remains the most frequent cause of
death in non-cardiac ICU’s
Cause of death
Picard, O'Donoghue, Young-Kershaw, & Russell, 2006
Identification of patient’s with suspected infection
Patients > 18 yrs.
Within one hour of admission
Level 1 emergency room
Patients > 18yrs or older with signs/symptoms of infection
Meets two or more of the following for systemic inflammatory
Temperature > 100.4 F or < 96.8 F
Heart rate > 90 beats/min
Respirations > 32.min or Paco2 <32 mm Hg
White blood count > 12,000 cells/mm3 or < 4,000 cells/mm3
Central line insertion
with continuous Scvo2
Broad Spectrum ABX
500 mL NS bolus
Repeated q 20-30min
until CVP >8 mm Hg
Monitor lungs sounds
for tolerance of
Titrate for a MAP > 65
< 30% Tranfuse 1 unit
Repeat Hgb and
Scv02 2hrs after blood
> 30% Initiate
dobutamine drip Titrate every 1 hr for
Scvo2 > 70%
300 patients >18yrs
24 months of data collection by trained nurses
In service programs
Poster size sepsis protocol
24hr on call nurse
Goals of therapy will be met within 12hrs
Central Venous Pressure (CVP) 8-12 mm Hg
Mean Arterial Pressure (MAP) 65-90 mm Hg
Mixed Venous Oxyhemoglobin (Scvo2) 70%-80%
Hematocrit > 30%
Serum lactate < 4mmol
Educating a large staff working various shifts.
Transferring patients treated by using the protocol in
a timely manner.
Expediting placement of central venous catheters.
Will obtaining serum lactate levels immediately on
emergency department (ED) patients, age 18 and older,
meeting certain sepsis high-risk prognostic criteria,
reduce mortality due to immediate treatment
Picard, K. M., O'Donoghue, S. C., Young-Kershaw, D. A., & Russell, K. J. (2006).
Development and implementation of a multidisciplinary sepsis protocol.
Critcal Care Nurse, 26(3), 43-54.
Shapire, N., Fisher, C., Donnino, M., Cataldo, L., Tang, A., Trzeciak, S., Horowitz, G., &
Wolfe, K. (2010) The feasibility and accuracy of point-of-care lactate measurement
in emergency department patients with suspected infection. Journal of
Emergency Medicine 39(1), 89-94.
Shapiro, N. I., Howell, M. D., Talmor, D., Lahey, D., Ngo, L., Buras, J., . . . Lisbon, A.
(2006). Implementation and outcomes of the Multiple Urgent Sepsis
Therapies (MUST) protocol. Critical Care Medicine, 34(4), 1025-1032.
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