Sepsis intervention protocol

ED physicians, nurses, CNA, pharmacists and lab technician were educated regarding implementation of time sensitive measures of sepsis bundles through lectures and monthly nursing orientation at the end of September through October of 2018 (Figure 2). Sepsis posters highlighting time sensitive measures were posted throughout the emergency department. Time sensitive measures in the 3-hour bundle include obtaining timely initial lactate level, administration of IV fluids at a rate of 30 ml/kg of body weight within 2 hours, and timely blood cultures draw prior to administration of antibiotics. In the 6-hour bundle, time sensitive measures include obtaining repeat lactate within 4 hours if initial lactate >2, assessing patient responsiveness to fluid resuscitation and prompt administration of vasopressors within 4 hours if patient is not responsive to fluid resuscitation.

Swim-lane diagram for emergency department process for sepsis intervention protocol (SIP).

An ED sepsis kit which included two liters of crystalloids, and a timer as reminder for timely re-measurement of lactate was created. Patients presenting to the ED who demonstrated clinical deterioration and met two or more criteria on the sepsis screening guide (thereby demonstrating that they were likely to have severe sepsis or septic shock) were intended to trigger a sepsis code (SIP=sepsis intervention protocol). Sepsis resuscitation and management bundle elements were implemented using a sepsis checklist to capture the above time sensitive measures to be completed by nurses and physicians (Figure 3). Checklist review process by Quality Assurance and Performance Improvement department along with ED leadership allowed for real time feedback.

Sepsis checklist for implementation of time sensitive measures in the sepsis resuscitation and management bundles.