Nursing Impact in Surviving Sepsis Campaign-Continued
Immediate Interventions
2. Initiate immediate interventions (Resuscitation Elements). Mobilize resources to the patient by calling the Rapid Response Team (RRT).
Resuscitation/Treatment
3. Anticipate MD orders for immediate resuscitation/treatment: an MD order set for severe sepsis/septic shock should be available at your hospital inclusive of the resuscitation and management bundle items. Please note, this is an order set for severe sepsis and septic shock, not for simple sepsis or bacteriemia patients. To provide ease of use, the order set can be started outside of critical care but call the Rapid Response Team (RRT) to get the experts to assist.
Resuscitation Elements
• Broad spectrum antibiotic administered within the first hour of recognizing severe sepsis/septic shock. In the presence of septic shock, each hour delay increases the risk of mortality. The preponerance of evidence suggests that this is also influential in those with severe sepsis.
• Blood cultures prior to antibiotic administration
• Serum lactate measured
• Initial fluid bolus 30 ml/kg IV fluid for hypotension (SBP < 90 mm Hg or MAP < 65 mmHg) or lactate > 4 mmol/L
• Vasopressors for hypotension not responding to initial fluid Levophed (norepinephrine) preferred
• Fluids to achieve a CVP 8 - 12mmHg - Insert central line if not responsive to initial fluid bolus and give adequate fluid
• Intervention to achieve a ScvO2 > 70% - after CVP pressure > 8 mmHg. This may include blood, oxygen, etc.
• Implementation of the fluids, antibiotics and lab specimens should begin ASAP and not wait for admission to a higher level of care.
Priority Interventions
1.Fluid resuscitation at 30ml/kg given as a bolus
2.Target time for fluid is 30ml/kg cm 3 hours of recognition
3.Antibiotic administration within the first hour of recognizing severe sepsis/septic shock
4.Blood cultures prior to antibiotic administration;
5.Lactate level obtained ASAP
6. These priority first interventions are believed to be more beneficial the earlier they are implemented. Delay in any could result in failure to rescue
Transfer
4. Prepare patient for transfer to higher level of care (Critical Care). Patients diagnosed by a physician with severe sepsis and septic shock generally benefit from being transferred to Critical Care for aggressive resuscitation therapy.
* Please note: A positive screen on the screening tool does NOT diagnose the patient for severe sepsis. A physician must make the diagnosis.
Communication
5. Handoff / Communication Tool
To facilitate timely intervention and to promote complete information at handoff, a communication tool was developed at a local Omaha medical center entitled: "Severe Sepsis/Septic Shock Checklist". It should be initiated for all patients with identified severe sepsis or septic shock. It assists the nurse with communication of the essential resuscitation bundle elements already instituted and reveals what still needs to be completed.
