Morning,

In our attempt to deliver a consistent approach to the sepsis patient,
we have implemented Sepsis boxes in many of the wards. This includes
everything (except antibiotics) to deliver Sepsis Six (O2 mask, IV
fluids, blood bottles, cannulation pack, cultures, ABG, documentation).
We have not done this in our admission units and Emergency Departments
due to the volume of sepsis patients they see (box would be constantly
empty) but one of them has pooled everything into one cupboard. The
feedback is great, though as ever, it is only as good as the team
keeping it stocked!

Hope that's useful.

Heather

-----Original Message-----
From: John Brady [mailto:[email protected]] 
Sent: 20 December 2012 18:15
To: Cormack, Patricia (WS); Heather McClelland; Steve Chabala;
[email protected]
Subject: RE: [Sepsis Groups] sepsis tool kit

I would like to ask if any of your hospitals have a sepsis toolkit. We
have had mentioned of it in the past, but had never pursed it. Our
thought would be order sets, antibiotics, IV fluids. We have even had
thought of a sepsis cart. What are your thoughts.

John Brady Quality Nurse Manager
St. Mary Medical Center
760 242 2311 ( 5369)

-----Original Message-----
From: [email protected]
[mailto:[email protected]] On Behalf Of
Cormack, Patricia (WS)
Sent: Tuesday, December 18, 2012 5:41 AM
To: Heather McClelland; Steve Chabala;
[email protected]
Subject: Re: [Sepsis Groups] flu and sepsis screening

Heather,

You hit the nail on the head. Early intervention can prevent progression
to shock which is more costly to manage.

-----Original Message-----
From: Heather McClelland [mailto:[email protected]]
Sent: Tuesday, December 18, 2012 7:27 AM
To: Cormack, Patricia (WS); Steve Chabala;
[email protected]
Subject: RE: [Sepsis Groups] flu and sepsis screening

Hi all,

Really interesting discussion. This is surely the age-old public health
debate about the cost of screening programmes. But for me, the
implication of missing something as life-threatening as a sepsis episode
warrants the extra cost involved. I am unsure of any health economic
data around this, but certainly evidence from other screening studies
would probably reflect this.

ED presentations are always challenging, and evidence from our work has
been that although many are sepsis positive on screening, they will
quickly settle following early intervention with our Sepsis 6 bundle of
care. Whether this is a sign that the patient did not have sepsis or
whether we prevented deterioration into severe sepsis due to our action,
is difficult to tell. Rather to err on the side of caution. Equally,
most of these patients will respond to basic intervention, and will not
need critical care support, and the added expense attached.

Heather McClelland
Nurse Consultant - Emergency Care

-----Original Message-----
From: [email protected]
[mailto:[email protected]] On Behalf Of
Cormack, Patricia (WS)
Sent: 17 December 2012 13:05
To: Steve Chabala; [email protected]
Subject: Re: [Sepsis Groups] flu and sepsis screening

If a young person has signs of organ dysfunction, despite the initial
insult, they need to be aggressively managed. SIRS alone does not
qualify anyone for EGDT. It's the organ dysfunction that should spring
us into action, no matter how young the patient. We had a 20 year old
who presented with what we thought was a viral illness- turned out to be
toxic shock syndrome. She lived. In an organization that did not perform
aggressive EGDT, that may not have been the outcome. She was already on
our radar before she crashed.
Patty

-----Original Message-----
From: [email protected]
[mailto:[email protected]] On Behalf Of Steve
Chabala
Sent: Friday, December 14, 2012 8:32 AM
To: [email protected]
Subject: [Sepsis Groups] flu and sepsis screening

I think Sue's question gets at the larger question of the need for
testing of ALL patients with SIRS criteria and evidence of infection.
All such patients should be directed by their primary care doctors to
come to the ER for sepsis evaluation?  Does the generally healthy
college kid with SIRS criteria and a strep throat really need a lactate
and blood cultures drawn?  Probably not.  I'm curious to know if there
is any literature to address this sort of issue.  When does sepsis
screening yield to common sense?

Steve Chabala D.O., F.A.C.E.P.
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