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Sepsis Protocol
Sepsis Protocol
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Created by Qualaris Staff
Emergency Department
Table of Contents
Audit Form
Audit Form
Sepsis Protocol
Description
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Required
Observed Date
Unit
ED
ICU
Med-Surg
PACU
Rehab
Shift
AM
PM
Night
Sepsis Protocol Checklist
Mark all as...
Pt screened for Sepsis upon admission?
Yes
No
If screen positive, was Pt diagnosed within 2 hours?
Yes
No
N/A
If Pt confirmed for Sepsis, was Sepsis Team notified immediately?
Yes
No
N/A
If Pt confirmed for Severe Sepsis, 3-hour Resuscitation Bundle completed within 3 hours?
Yes
No
N/A
1) Measured lactate level?
Yes
No
N/A
2) Obtained blood cultures prior to administration of antibiotics?
Yes
No
N/A
3) Administered broad spectrum antibiotics?
Yes
No
N/A
4) Administered 30 mL/kg Crystalloid for Hypotension or Lactate >= 4 mmol/L
Yes
No
N/A
If Pt confirmed for Severe Sepsis, was 6-hour Septic Shock Bundle completed within 6 hours?
Yes
No
N/A
1) Applied Vasopressors?
Yes
No
N/A
2) Measured Central Venous Pressure and Measured Central Venous Oxygen Saturation?
Yes
No
N/A
3) Remeasured Lactate If Initial Lactate Was Elevated?
Yes
No
N/A
All documentation correct per protocol?
Yes
No
N/A
