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Top Prevention Highlights

Sepsis evidence-based practice and top prevention techniques

Preparation

  • All patients screened on emergency department or care unit admission with sepsis screening tool.
  • Early alert or warning system in place for prompt escalation and action if patient meets sepsis/sepsis shock criteria; automated systems are ideal:
    • establish multidisciplinary rapid response sepsis team, including members from ED, critical care and medical-surgical unit;
    • activate sepsis rapid response teams (even in ED); and
    • assign “owner” of the process for at least the first six hours of care, regardless of where the patient is located.

Bundle implementation

  • Recommended Hour-1 Bundle of Care elements:
    • measure lactate level. Re-measure lactate if initial lactate is elevated (> 2 mmol/L);
    • obtain blood cultures before administering antibiotics;
    • administer broad-spectrum antibiotics;
    • begin rapid administration of 30mL/kg crystalloid for hypotension or lactate level ≥ 4 mmol/L; and
    • apply vasopressors if hypotensive during or after fluid resuscitation to maintain MAP ≥ 65 mm Hg.

Ongoing prevention tips

  • Timeliness standards may need Plan-Do-Study-Act cycles: between ED [unit]/lab for lactate levels, between ED [unit]/pharmacy for antibiotics, for new rapid-response process, etc.
  • Frequent reassessment of hemodynamic status with use of standardized order sets for sepsis.
  • Handoffs of care readily incorporate status (time date stamps) of bundle element treatment.
  • Daily assessment for de-escalation of antimicrobial therapy.
  • Patient/family goals of care are incorporated into treatment and end-of-life planning.