1. Sepsis Surgeon Champions Talking Points
October 3, 2017

2. Patient Safety Indicators
PSI 13 Sepsis Incidence in Elective Surgery Patients:
Based on provider diagnosis
PSI 13 cases would likely decrease if we use the new Sepsis 3 Definitions since sepsis diagnosis now requires organ dysfunction
PSI 4 Death among surgical inpatients with Serious Treatable Complications:
PSI 4 cases would likely decrease with prevention of DVT, HAI’s, and prompt treatment of complications including sepsis – using code sepsis process tailored to your patient population/location
PSI 4 cases would decrease with accurate documentation of infections present at admission or sepsis present at admission

3. 2016
Sepsis-3
REDUNDANT
RETIRED

4. What is Sepsis as of 2017?
Sepsis (with organ dysfunction) – now defined as life-threatening organ dysfunction caused by a dysregulated host response to infection. This is a clinical diagnosis. Note that “Severe sepsis” (previously used for sepsis with organ dysfunction) is no longer recognized since it would be redundant.
Septic Shock – a subset of Sepsis with circulatory and cellular/metabolic dysfunction associated with a higher risk of mortality. This is a clinical diagnosis.
Sepsis (with organ dysfunction) and Septic Shock are medical emergencies and it is recommended that treatment and resuscitation begin immediately (Best Practice Statement).

7. Evidence Based Sepsis Treatment to Meet the CMS Sepsis Core Measure Patients > 18 Years of Age: Meeting the Measure is ALL OR NONE
Sepsis (with organ dysfunction) and Treatment
Suspected/documented infection and Life Threatening Organ Dysfunction
(Creatinine >2, Lactate > 2, oliguria, new oxygen demand - respiratory distress/failure, AMS, SBP<90, RR>20)
list is not all inclusive
In first 3 hours: Lactate, Blood Cultures, broad spectrum Antibiotics
In first 6 hours: repeat Lactate if initial > 2
Septic Shock and Treatment
(Sepsis + SBP <90 not responsive to 30mL/kg IV fluid given + requires vasopressors for SBP <90 or MAP <65 + lactate >4)
In first 3 hours: Lactate, Blood Cultures, broad spectrum Antibiotics, and Fluid resuscitation with 30 mL/kg crystalloid fluids
In first 6 hours: repeat Lactate, complete .SEPSISEXAM, and start Norepinephrine if hypotension persists after 30 mL/kg Fluid resuscitation**
Renal Failure, Heart Failure, Liver Failure & Surgical patients are NOT exempt from this measure. VAD patients ARE exempt
**We realize that even though CMS requires 30 mL/kg fluid resuscitation to meet measure that not all patients would tolerate this amount of fluid. The provider still directs the amount of fluid resuscitation given to their patients. Please document reasons to help the sepsis review team.

8. Don’t set it and Forget it!
Newest Evidence-Based Guidelines Published in 2017
Remember Septic Shock is a Clinical Diagnosis!
Don’t set it and Forget it!
Data Source: A Users Guide to the 2016 Surviving Sepsis Guidelines. Society of Critical care Medicine. March 2017 Volume 45 Number 3.

9. Sepsis Monitor
This will show a continuum of patient care even if part of time period was in the Emergency Department

10. Take Home Points Suspect Sepsis Early
Evaluate Patients Promptly – Diagnose Sepsis and Septic Shock per new criteria
Treat as a team event and if determine patient is septic treat as a “code sepsis”
Empower nurses to call for help, calling a “code sepsis” does not mean the patient will receive the sepsis bundle therapies – a provider still needs to write the orders as part of the response
Providers Use the Sepsis Bundle order sets
Providers Use .SEPSISEXAM to document response to fluids
Use your clinical judgment as you fluid resuscitate
Tell us what is not working well
Find resources at UNC Code Sepsis Website (Google it)