Hamad Medical Corporation Adult Sepsis Care Pathway PDF

APENDIX B-3 CLINICAL PATHWAYS ORIGINAL DATE: TITLE: ADULT SEPSIS CARE PATHWAY May 2017 IDENTIFICATION LAST REVISI...

APENDIX B-3 CLINICAL PATHWAYS ORIGINAL DATE: TITLE: ADULT SEPSIS CARE PATHWAY May 2017 IDENTIFICATION LAST REVISION DATE: CPW 10311 May 2022 NUMBER: NEXT REVIEW DATE: HOSPITAL(S): All HMC Hospitals May 2025 Sheet No. 1 of 18 1.0 PURPOSE (AIM): This guideline provides directives for a standardized approach to diagnosing, managing, and escalating the care of adult patients with sepsis across Hamad Medical Corporation (HMC) hospitals. 2.0 DEFINITIONS: 2.1 Infection - the invasion of normally sterile tissue by pathogenic organisms. 2.2 Bacteremia - the presence of viable bacteria in the blood. 2.3 Sepsis – is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection 8.1. Sepsis and septic shock (see below) are medical emergencies that require immediate treatment and resuscitation 8.2. 2.4 Organ Dysfunction - described by an increase in the Sequential [Sepsis-related] Organ Failure Assessment (SOFA) score of 2 points or more, which is associated with in- hospital mortality greater than 10%. 8.1 (Refer to Appendix 3) 2.5 Septic Shock - a subset of sepsis in which profound circulatory, cellular, and metabolic abnormalities after adequate fluid resuscitation are associated with a greater risk of mortality than with sepsis alone. Patients with septic shock can be clinically identified by: 2.5.1 A vasopressor requirement to maintain a mean arterial pressure (MAP) of 65mmHg or greater, and 2.5.2 A serum lactate level greater than 2 mmol/L (>18mg/dL) in the absence of hypovolemia. 5.13 2.6 Attending Team – the clinical team primarily caring for the patient. 3.0 APPLIES TO: 3.1 All Physicians, Nurses, and Allied Health Practitioners across HMC hospitals including the ENAYA Healthcare complexes under the Rumailah Group of hospitals. 3.2 Refer to Appendix 1 for specific Staff Roles and Responsibilities 4.0 PATIENT GROUP: Patients aged 14 years and above in any clinical service. 5.0 EXCEPTIONS: Maternity patients at any stage of gestation. 6.0 TARGET AREAS: All clinical services across HMC. 7.0 PATHWAY: Governance, Leadership & Direction Corporate Clinical Practice Guidelines Committee APENDIX B-3 CLINICAL PATHWAYS ORIGINAL DATE: TITLE: ADULT SEPSIS CARE PATHWAY May 2017 IDENTIFICATION LAST REVISION DATE: CPW 10311 May 2022 NUMBER: NEXT REVIEW DATE: HOSPITAL(S): All HMC Hospitals May 2025 Sheet No. 2 of 18 7.1 Detection and Diagnosis 7.1.1 The Sepsis Care Algorithm (Refer to Appendix 2) shall be initiated in all patient settings as soon as a patient is identified to have: 7.1.1.1 a suspected or identified focus of infection and 7.1.1.2 signs of new, or worsening, organ dysfunction: 7.1.1.2.1 scored 2 or more in the qSOFA / SOFA (see appendix 3) or 7.1.1.2.2 lactate level of ≥ 2 or 7.1.1.2.3 any other clinical, laboratory, biochemical and/or radiological marker indicating new or worsening organ-specific dysfunction. 7.1.2 Should the SIRS/Sepsis alert get triggered in the electronic health records system (EHRS), the assigned nurse must call for an urgent clinical review or Rapid Response Team (RRT) activation (as required) for the patient. The clinical review or RRT must then assess the patient’s overall condition and confirm the diagnosis of sepsis and activate the sepsis pathway. 7.1.3 The Sepsis Pathway may also be initiated based on strong clinical suspicion of sepsis (alone or in addition to criteria above), particularly in those patient populations with: 7.1.3.1 Poor host response to infection (e.g. immunocompromised, hematologic malignancy, malnourished, elderly, or other vulnerable patient populations) 7.1.3.2 Altered baseline clinical parameters (e.g. medication-induced, or due to chronic illness) 7.2 Intervention 7.2.1 Ensure all elements of the Sepsis Six Care Bundle are specified in the Sepsis Order Set, unless otherwise indicated: 7.2.1.1 If a certain, or all, element(s) of the Sepsis Six Care Bundle was (were) not ordered: 7.2.1.1.1 The Physician must clearly document in the patient’s medical records the justification for this clinical decision. 7.2.1.1.2 This decision must be authorized and countersigned by the most senior Physician directly involved in the patient’s care. 7.2.2 Interventions within the Sepsis Six Care Bundle that must be delivered within 1 hour of sepsis identification include: Governance, Leadership & Direction Corporate Clinical Practice Guidelines Committee APENDIX B-3 CLINICAL PATHWAYS ORIGINAL DATE: TITLE: ADULT SEPSIS CARE PATHWAY May 2017 IDENTIFICATION LAST REVISION DATE: CPW 10311 May 2022 NUMBER: NEXT REVIEW DATE: HOSPITAL(S): All HMC Hospitals May 2025 Sheet No. 3 of 18 7.2.2.1 Give Oxygen: 7.2.2.1.1 Administer humidified oxygen via case-appropriate ventilatory route and mode. 7.2.2.1.2 Titrate oxygen delivery to keep peripheral arterial oxygen saturation (SpO2) at 94-98%, unless clinically contraindicated (e.g. advanced COPD where target SpO2 is 88-92%). 7.2.2.1.3 Take baseline arterial blood gas (ABG) to confirm oxygenation levels and identify acid-base status. 7.2.2.1.4 Oxygen supplementation is not required if the patient is maintaining an SpO2 of greater than 98% on room air and is without evidence of: 7.2.2.1.4.1 labored breathing efforts, 7.2.2.1.4.2 cyanosis, or 7.2.2.1.4.3 deranged arterial oxygenation or tissue perfusion. 7.2.2.2 Obtain Blood for Investigation: 7.2.2.2.1 Establish peripheral large-bore venous access immediately; unless otherwise specified or required. 7.2.2.2.2 Obtain and send blood for the following investigations: 7.2.2.2.2.1 complete blood count (CBC), 7.2.2.2.2.2 complete metabolic panel (CMP) (electrolytes, renal and liver function tests, glucose), 7.2.2.2.2.3 clotting profile (PT, PTT, INR), and 7.2.2.2.2.4 lactate. 7.2.2.2.3 Repeat measurement of serum lactate every 4 hours thereafter to monitor response to treatment through lactate clearance, and at least 2 hours after IV fluid challenges. 7.2.2.2.4 Obtain blood for other relevant and clinically indicated investigations as required (e.g. procalcitonin, CRP, etc.). 7.2.2.2.5 Avoid multiple and unnecessary venipunctures and procedures. 7.2.2.3 Obtain Cultures: 7.2.2.3.1 Obtain cultures with full aseptic technique and following relevant HMC guidelines. 7.2.2.3.2 Two (2) sets of blood culture (aerobic and anaerobic) MUST be taken PRIOR to the administration of antibiotics, ensuring that these are completed within the first hour of sepsis identification. 7.2.2.3.2.1 Should it prove to be difficult to extract 2 sets of blood culture Governance, Leadership & Direction Corporate Clinical Practice Guidelines Committee APENDIX B-3 CLINICAL PATHWAYS ORIGINAL DATE: TITLE: ADULT SEPSIS CARE PATHWAY May 2017 IDENTIFICATION LAST REVISION DATE: CPW 10311 May 2022 NUMBER: NEXT REVIEW DATE: HOSPITAL(S): All HMC Hospitals May 2025 Sheet No. 4 of 18 prior to administration of antibiotics within the golden hour, at least one (1) set of blood culture must be sent. Clear justification of this MUST be documented in the patient’s medical record by both the Primary Nurse and Physician assigned to the patient. 7.2.2.3.3 Ensure adequate blood volumes are extracted for each blood culture sample: 7.2.2.3.3.1 Minimum blood cultures volume for adults is 10mL 7.2.2.3.3.2 Minimum blood cultures volume for neonate and pediatric patients is 1mL to 4 mL. 7.2.2.3.4 Two (2) sets of blood culture can be taken within minutes and preferably from different sites. 7.2.2.3.5 Take other cultures (e.g. urine, sputum, wound swabs) as clinically indicated and as ordered by the Attending Physician. 7.2.3 Give IV Antibiotics: 7.2.3.1 Prescribe 'stat' empiric IV broad spectrum antibiotics as per case requirements and according to relevant HMC guidelines. (see Section 7.4), ensuring that blood cultures (as well as other cultures ordered) have been obtained prior to administration. 7.2.3.2 Ensure initial antimicrobial administration within 60 minutes of sepsis recognition. 7.2.3.3 Ensure adequate and appropriate frequency, dosing, route, and duration of succeeding doses of antimicrobial therapy is ordered following the stat dose. 7.2.4 Give fluids 7.2.4.1 Prescribe fluids to all patients with sepsis-induced hypoperfusion (i.e. high lactate and/or SBP 18mg/dL) in the absence of hypovolemia; or 7.6.1.4 The patient’s clinical or biochemical parameters trigger QEWS response (at both Clinical Review and Rapid Response Team (RRT) levels). Governance, Leadership & Direction Corporate Clinical Practice Guidelines Committee APENDIX B-3 CLINICAL PATHWAYS ORIGINAL DATE: TITLE: ADULT SEPSIS CARE PATHWAY May 2017 IDENTIFICATION LAST REVISION DATE: CPW 10311 May 2022 NUMBER: NEXT REVIEW DATE: HOSPITAL(S): All HMC Hospitals May 2025 Sheet No. 8 of 18 7.7 Patients with a Do Not Attempt Resuscitation (DNAR) Order in Place 7.7.1 ALL clauses within this policy apply to patients who have been clinically agreed not for cardio-pulmonary resuscitation (i.e. those who have a DNAR order in place), and those with a DNAR advance directive, unless otherwise specified. 7.7.2 It is recommended that the primary clinical teams caring for patients with DNAR order in place and diagnosed with sepsis (suspected or proven) to conduct a multidisciplinary team (MDT) discussion(s) with the patient/patient’s family on the most appropriate approach to their care on a case-by-case basis. 7.7.3 If the consensus of the MDT discussion with the patient/patient’s family is not to provide part, or all, of the recommended sepsis care and management as stated in this policy, then there must be clear documentation in the patient’s medical records of: 7.7.3.1 The reason(s) for non-provision of recommended care (e.g. futility of care, patient/family requests); and 7.7.3.2 The specific elements of care that will not be provided as recommended in this policy; and 7.7.3.3 The tailored sepsis care and management agreed by the MDT for the patient; and 7.7.3.4 Members of the team who made the consensus agreement; and 7.7.3.5 Authorization and counter-signature of the most senior medical staff in charge of the patient’s care (at least at consultant level) Monitoring Tools: - The following key performance indicators (KPIs) shall be used for performance monitoring and shall be reported through the corporate dashboard: Compliance to Sepsis Six Care Bundle (Process Measure) Sepsis case to death ratio (Outcome Measure) Proportionate sepsis mortality (Outcome Measure) Transfer to higher level of care (e.g. HDU, ICU, specialty facility) (Process Measure) 7.8 ATTACHMENTS: 7.8.1 Appendix 1. Staff Roles and Responsibilities 7.8.2 Appendix 2. Sepsis Pathway 7.8.3 Appendix 3. SOFA Scoring 7.8.4 Appendix 4. Sepsis Kits 7.8.5 Appendix 5. Recommended Sepsis ISBAR Script 8.0 EVIDENCE-BASED REFERENCES: Governance, Leadership & Direction Corporate Clinical Practice Guidelines Committee APENDIX B-3 CLINICAL PATHWAYS ORIGINAL DATE: TITLE: ADULT SEPSIS CARE PATHWAY May 2017 IDENTIFICATION LAST REVISION DATE: CPW 10311 May 2022 NUMBER: NEXT REVIEW DATE: HOSPITAL(S): All HMC Hospitals May 2025 Sheet No. 9 of 18 8.1 International Guidelines for Management of Sepsis and Septic Shock 2021. Critical Care Medicine: October 4, 2021 8.2 The Sepsis Trust Manual. 2019 United Kingdom Sepsis Trust 8.3 Singer M, Deutschmann C, Seymour C, et al – The Sepsis Definitions Task Force. (2016). The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315(8):801-810. doi:10.1001/jama.2016.0287 8.4 Rhodes, A., Evans, L.E., Alhazzani, W., Levy, M.M., Antonelli, M., Ferrer, R., Kumar, A., Sevransky, J.E., Sprung, C.L., Nunnally, M.E. and Rochwerg, B., 2017. Surviving Sepsis Campaign: International guidelines for management of sepsis and septic shock: 2016. Intensive Care Medicine, pp.1-74. 8.5 ARISE Investigators; ANZICS Clinical Trials Group, Peake SL, Delaney A, Bailey M, Bellomo R, et al. Goal-directed re¬suscitation for patients with early septic shock. New England Journal of Medicine 2014;371:1496-506. 8.6 ProCESS Investigators, Yealy DM, Kellum JA, Huang DT, Bar¬nato AE, Weissfeld LA, et al. A randomized trial of protocol-based care for early septic shock. New England Journal of Medicine 2014; 370:1683-93. 8.7 ProMISe Investigators, Mouncey P, Osborn T, Power S, Harrison D, et al. Trial of Early, Goal- Directed Resuscitation for Septic Shock.. New England Journal of Medicine 2015; 372:1301-11. 8.8 Rhodes A, Phillips G, Beale R, Cecconi M, Chiche JD, et al. The Surviving Sepsis Campaign bundles and outcome: results from the International Multicentre Prevalence Study on Sepsis (the IMPreSS study). Intensive Care Medicine. 2015 Sep;41(9):1620-8 8.9 Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. New England Journal of Medicine 2001; 345:1368-77. 8.10 Surviving Sepsis Campaign Executive Committee. Updates on the Surviving Sepsis Campaign Bundle. April 2015. http://www.survivingsepsis.org/SiteCollectionDocuments/SSC_Bundle.pdf Author: HMC Sepsis Program Team Reviewed by: Dr. Abdulsalam Saif, Head of ICU’s Dr. Mohammad Faisal Malmstrom, Director of SICU Mr. Emad Mustafa, Director of Nursing/Midwifery - ICU Governance, Leadership & Direction Corporate Clinical Practice Guidelines Committee APENDIX B-3 CLINICAL PATHWAYS ORIGINAL DATE: TITLE: ADULT SEPSIS CARE PATHWAY May 2017 IDENTIFICATION LAST REVISION DATE: CPW 10311 May 2022 NUMBER: NEXT REVIEW DATE: HOSPITAL(S): All HMC Hospitals May 2025 Sheet No. 10 of 18 Appendix 1: Staff Roles and Responsibilities 1. Nurse Assigned to the Patient a. Call for a clinical review whenever a patient with possible or proven infection is having: i. QEWS criterion(a) in the yellow zone; ii. SIRS or Sepsis alert; iii.2 or more of the qSOFA criteria (if aware) iv.Abnormal laboratory values or positive blood culture(s) v. Or whenever there is clinical suspicion of sepsis or deterioration of the patient. Governance, Leadership & Direction Corporate Clinical Practice Guidelines Committee APENDIX B-3 CLINICAL PATHWAYS ORIGINAL DATE: TITLE: ADULT SEPSIS CARE PATHWAY May 2017 IDENTIFICATION LAST REVISION DATE: CPW 10311 May 2022 NUMBER: NEXT REVIEW DATE: HOSPITAL(S): All HMC Hospitals May 2025 Sheet No. 11 of 18 b. Call for the rapid response team (RRT) whenever a patient’s QEWS criterion(a) is(are) in the red zone. c. Stay with the attending team and/or RRT throughout the patient encounter(s) and carry out the patient care plan as advised by the team. d. Once the patient is considered as having sepsis (preliminary or confirmed), the following must be completed within 1 hour: i. Work in close collaboration with the team managing sepsis for the patient ii. Take complete vital signs of the patient if not done so within the last 30 minutes iii.If oxygen saturation is below 98% or if the patient is having difficulty breathing, initiate supplemental humidified oxygen via appropriate ventilation mode. iv.Immediately carry out the physician orders, as they are entered into the sepsis order set: 1. Adjust humidified oxygen delivery mode as per physician order and titrate flow to keep SpO2 94-98%. 2. Insert large bore peripheral cannula (if not in place), unless otherwise specified 3. Keep Sepsis Diagnostic Kit (Refer to Appendix 7.1) at bedside and extract blood for investigations. 4. Prepare and infuse IV fluids as ordered 5. Override Pyxis system (if available in unit) and take the ordered antibiotic from the Sepsis Antibiotic Kit. 6. Prepare the first antibiotic dose following aseptic techniques and administer immediately. Succeeding doses shall be prepared and supplied by the Pharmacy Department. 7. If the antibiotic is not in the Sepsis Antibiotic Kit notify the pharmacy by phone of the requirement and inform them that a nursing aide will pick up the formulated first dose of the antibiotic in 15 minutes. 8. Monitor and document the patient’s input and output v. Closely monitor the patient and increase vital sign observations from baseline. vi.Escalate patient care according to local protocol as recommended in the policy. e. Restock Sepsis Diagnostic Kit after every use. Contents defined in Appendix 7.1. f. Restock used antibiotic vial/ampoule from Sepsis Antibiotic Kit as supplied by the Pharmacy Department. g. Communicate using the ISBAR format at all times. 2. Charge Nurse a. Support the assigned nurse from the time of clinical review or RRT activation. b. Ensure all physician orders are carried out within 1 hour of sepsis identification. c. Ensure deteriorating patient is closely monitored and managed. Governance, Leadership & Direction Corporate Clinical Practice Guidelines Committee APENDIX B-3 CLINICAL PATHWAYS ORIGINAL DATE: TITLE: ADULT SEPSIS CARE PATHWAY May 2017 IDENTIFICATION LAST REVISION DATE: CPW 10311 May 2022 NUMBER: NEXT REVIEW DATE: HOSPITAL(S): All HMC Hospitals May 2025 Sheet No. 12 of 18 d. Allocate additional staffing to support the primary staff nurse in carrying out the physician orders and in managing the patient, if required. e. Redistribute the assigned nurse’s other patients to other capable staff nurses while the assigned nurse is providing initial care to the sepsis patient, if required. f. Coordinate transfer of care/services (when necessary). g. Ensure the unit is equipped with sufficient sets of the Sepsis Diagnostic Kit and that the Sepsis Antibiotic Kit is always completely stocked for every shift. h. Communicate using the ISBAR format at all times. 3. Attending Team a. Attend promptly to all clinical reviews and RRT calls as per the QEWS policy. b. Review and assess the patient for signs and symptoms of organ dysfunction, and decide whether the patient possibly has sepsis. c. Once the patient is considered as having sepsis (preliminary or confirmed), complete the Sepsis Order Set and ensure completion of orders within 1 hour of sepsis identification. d. Identify and apply infection control precautions required for the patient. e. Identify source of infection (if not known); and arrange for source control URGENTLY, if indicated. i. Order/perform relevant diagnostic examinations/procedures as required. (eg, lumbar puncture, change of catheters and tip cultures, etc) ii. Consult relevant services as required. (e.g., Surgery, Orthopedics, Interventional Radiology, etc) f. Review and update of antibiotics prescription within 72 hours of initial prescription in the order set. g. At least 1 member of the team must stay with the patient until s/he has stabilized, or is not showing signs of further deterioration, or has been transferred to a higher level of care. h. Escalate the care of the patient to a higher level of care, as recommended in the sepsis and QEWS policies, and according to local protocols. i. Ensure timely, complete and accurate documentation of events are entered in the patient’s medical records. j. Communicate using the ISBAR format at all times. 4. Rapid Response Team a. Attend promptly to all RRT calls as per the QEWS Policy. b. Review and assess the patient for signs and symptoms of organ dysfunction, and decide whether the patient possibly has sepsis. c. Once the patient is considered as having sepsis (preliminary or confirmed), complete the Sepsis Order Set and ensure completion of orders within 1 hour of sepsis identification. Governance, Leadership & Direction Corporate Clinical Practice Guidelines Committee APENDIX B-3 CLINICAL PATHWAYS ORIGINAL DATE: TITLE: ADULT SEPSIS CARE PATHWAY May 2017 IDENTIFICATION LAST REVISION DATE: CPW 10311 May 2022 NUMBER: NEXT REVIEW DATE: HOSPITAL(S): All HMC Hospitals May 2025 Sheet No. 13 of 18 d. Follow the patient up and collaborate with the Attending Team until s/he has stabilized, or is not showing signs of further deterioration, or has been transferred to a higher level of care. e. Escalate the care of the patient to a higher level of care, as recommended in the sepsis and QEWS policies and according to local protocols. f. Ensure timely, complete and accurate documentation of events are entered in the patient’s medical records. g. Communicate using the ISBAR format at all times. 5. Critical Care Team a. Attend to all calls for escalation of care of sepsis patients and provide required support. b. Arrange for ICU transfer as required. c. Take handover of the patient, assume care, and continue management of sepsis and septic shock as per local protocols. d. Communicate using the ISBAR format at all times. 6. Pharmacy Department a. Review dosing, route, frequency and duration of antibiotic prescription as ordered in the sepsis order set. i. Alert primary physician IMMEDIATELY for any recommendations of adjustment. b. Ensure physician review and update of antibiotic prescription within 72 hours of initial prescription in the order set. c. Send succeeding doses pre-formulated as per the Pharmacy department’s medication provision policies and guidelines. d. Facilitate preparation and delivery of antibiotics not kept in the Sepsis Antibiotic Kit, particularly the first dose, as required. e. Ensure all clinical units are supplied with the Sepsis Antibiotic Kits; and that: i. Contents are standardized as described in Appendix 7.2. ii. Antibiotics are regularly checked for expiry dates and defects. iii.Antibiotics are restocked as they are used to ensure continuous availability in the units. 7. Laboratory a. Ensure all relevant sepsis laboratory investigations are processed, analyzed, and reported STAT or as quickly as possible. b. Relay abnormal laboratory values immediately to the requesting or on-call physician according to policy. Governance, Leadership & Direction Corporate Clinical Practice Guidelines Committee APENDIX B-3 CLINICAL PATHWAYS ORIGINAL DATE: TITLE: ADULT SEPSIS CARE PATHWAY May 2017 IDENTIFICATION LAST REVISION DATE: CPW 10311 May 2022 NUMBER: NEXT REVIEW DATE: HOSPITAL(S): All HMC Hospitals May 2025 Sheet No. 14 of 18 c. Relay preliminary and final findings of cultures immediately to the requesting or on-call physician according to policy. Governance, Leadership & Direction Corporate Clinical Practice Guidelines Committee APENDIX B-3 CLINICAL PATHWAYS ORIGINAL DATE: TITLE: ADULT SEPSIS CARE PATHWAY May 2017 IDENTIFICATION LAST REVISION DATE: CPW 10311 May 2022 NUMBER: NEXT REVIEW DATE: HOSPITAL(S): All HMC Hospitals May 2025 Sheet No. 15 of 18 Appendix 2. Adult Sepsis Care Pathway Governance, Leadership & Direction Corporate Clinical Practice Guidelines Committee APENDIX B-3 CLINICAL PATHWAYS ORIGINAL DATE: TITLE: ADULT SEPSIS CARE PATHWAY May 2017 IDENTIFICATION LAST REVISION DATE: CPW 10311 May 2022 NUMBER: NEXT REVIEW DATE: HOSPITAL(S): All HMC Hospitals May 2025 Sheet No. 16 of 18 Appendix 3: Sepsis-related Organ Failure Assessment (SOFA) Scoring 1. qSOFA (quick SOFA) Score 2. Full SOFA score Governance, Leadership & Direction Corporate Clinical Practice Guidelines Committee APENDIX B-3 CLINICAL PATHWAYS ORIGINAL DATE: TITLE: ADULT SEPSIS CARE PATHWAY May 2017 IDENTIFICATION LAST REVISION DATE: CPW 10311 May 2022 NUMBER: NEXT REVIEW DATE: HOSPITAL(S): All HMC Hospitals May 2025 Sheet No. 17 of 18 Adopted from Singer M, Deutschman CS, Seymour CW, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis- 3). JAMA. 2016;315(8):801-810. doi:10.1001/jama.2016.0287 Appendix 4. Sepsis Kits 1. Sepsis Diagnostic Kit a. Contents: i. Blood culture aerobic bottle ii. Blood culture anaerobic bottle iii. Sterile specimen containers (at least 2): For urinalysis Specimen culture iv. Yellow top tubes (at least 2): Complete metabolic panel Other tests v. Purple top tube Complete blood count vi. Green top tube Lactic acid vii. Blue top tube Coagulation profile viii. ABG kit 2. Sepsis Antibiotic Kit Governance, Leadership & Direction Corporate Clinical Practice Guidelines Committee APENDIX B-3 CLINICAL PATHWAYS ORIGINAL DATE: TITLE: ADULT SEPSIS CARE PATHWAY May 2017 IDENTIFICATION LAST REVISION DATE: CPW 10311 May 2022 NUMBER: NEXT REVIEW DATE: HOSPITAL(S): All HMC Hospitals May 2025 Sheet No. 18 of 18 a. Contents: Drug Name Dose Meropenem 2g Piperacillin/tazobactam( Tazocin) 4.5 g Ceftriaxone 2g Vancomycin 1.5 g Ciprofloxacin 400 mg Metronidazole 500 mg Clindamycin 800 mg Eratpenem 1g Amikacin 1000 mg Aztreonam 2g Appendix 5. Recommended Sepsis ISBAR Script - May I speak with Dr. (state receiver’s name) I - This is (state caller’s name) Introduction - I am calling about our patient (name, HC number, bed number) - I am calling because state situation (including alerts fired) S - My latest clinical observations are: state significant observations Situation - The patient also has: state pertinent laboratory findings - This patient is years old, B - admitted for diagnosis, who underwent procedure (if any), Background - with previous history of relevant past medical history, - and is currently on: significant ongoing management - Given the patient’s condition, background infection, and A the rest of the information I shared with you, should we Assessment consider sepsis/septic shock? R - Could you please come and assess the patient? Recommendation - Is there anything you would like me to do until you get here? - Read back a summary of the conversation Governance, Leadership & Direction Corporate Clinical Practice Guidelines Committee