Sepsis Protocol

Audit Form

Required

Observed Date

Unit

Shift

Pt screened for Sepsis upon admission?

If screen positive, was Pt diagnosed within 2 hours?

If Pt confirmed for Sepsis, was Sepsis Team notified immediately?

If Pt confirmed for Severe Sepsis, 3-hour Resuscitation Bundle completed within 3 hours?

1) Measured lactate level?

2) Obtained blood cultures prior to administration of antibiotics?

3) Administered broad spectrum antibiotics?

4) Administered 30 mL/kg Crystalloid for Hypotension or Lactate >= 4 mmol/L

If Pt confirmed for Severe Sepsis, was 6-hour Septic Shock Bundle completed within 6 hours?

1) Applied Vasopressors?

2) Measured Central Venous Pressure and Measured Central Venous Oxygen Saturation?

3) Remeasured Lactate If Initial Lactate Was Elevated?

All documentation correct per protocol?