Ann, We do time of presentation at Santa Clara Valley Medical Center the exact way that Martie describes below as well. We have a 3 hour window from time of presentation for ABX administration in the ED and a 1 hour window for all adult inpatient units (excluding OB). We have no official protocol for checking Procalcitonin, that's up to the treating Physician if they want to use that test.
Kathy Kathy Madlem, RN, BSN Sepsis Quality Improvement Coordinator Santa Clara Valley Medical Center 2325 Enborg Lane, Suite 340 San Jose, California 95128 408-793-6556 [email protected] [cid:[email protected]] From: [email protected] [mailto:[email protected]] On Behalf Of Martie Mattson Sent: Tuesday, February 05, 2013 6:32 PM To: 'Ann Knight'; [email protected] Subject: Re: [Sepsis Groups] General Sepsis Questions Hello all, As Dr. Elkin frequently says, this is my $.02. The guidelines (2012) define severe sepsis as sepsis -induced tissue hypoperfusion or organ dysfunction and the 1 hour antibiotic recommendation is for severe sepsis and septic shock - not simple sepsis. So to meet the requirement to have an antibiotic within 1 hour severe sepsis would need to be diagnosed. So, for example, if a patient presented to triage with a confirmed or suspected infection and was hypotensive or had other obvious organ failure (acute respiratory failure, acute mental status change etc) thought related to the infection, that patient would meet the criteria for severe sepsis and time zero would be the time of triage. If the patient presented to triage with a confirmed or suspected infection, signs of SIRS, but no obvious signs of organ failure, then, in my opinion. time zero would be when severe sepsis was first obvious - patient developed obvious organ failure or lab work came back consistent with organ failure. Martie Martie Mattson, RN, MSN, CNS, CCRN(a) Critical Care Consultant and Educator (415) 412-2364 [email protected]<mailto:[email protected]> From: [email protected]<mailto:[email protected]> [mailto:[email protected]] On Behalf Of Ann Knight Sent: Monday, February 04, 2013 7:36 AM To: [email protected]<mailto:[email protected]> Subject: [Sepsis Groups] General Sepsis Questions To Whom It May Concern: After reviewing the new guidelines I have a few questions: 1. What are your experiences with Procalcitonin and the usefulness of it? It seems to be a pricey lab draw and I am wondering if it is worth the cost to the patient. 2. In the ABX recommendations it states giving antibiotics within one hour of identification of sepsis or septic shock. Does this mean one hour for both ED patients and in-patients who might develop sepsis on the med surg floors? In the bundle changes it simply states giving proper broad spectrum coverage within the first three hours. Simply want to clarify since this would be a process change for our ED 3. In regards to the ED patients, is the start of bundle time the triage time? I have heard many different things regarding this. Any advice would be much appreciated! Ann Knight Clinical Nurse Specialist, Critical Care Northside Hospital System [email protected]<mailto:[email protected]> 404-851-6514 CONFIDENTIALITY NOTICE: This electronic mail transmission has been sent by Northside Hospital. It may contain information that is confidential, privileged, proprietary, or otherwise legally exempt from disclosure. If you are not the intended recipient, you are hereby notified that you are not authorized to read, print, retain, copy or disseminate this message, any part of it, or any attachments. If you have received this message in error, please delete this message and any attachments from your system without reading the content and notify the sender immediately of the inadvertent transmission. There is no intent on the part of the sender to waive any privilege CONFIDENTIALITY NOTICE: This electronic mail transmission has been sent by Northside Hospital. It may contain information that is confidential, privileged, proprietary, or otherwise legally exempt from disclosure. If you are not the intended recipient, you are hereby notified that you are not authorized to read, print, retain, copy or disseminate this message, any part of it, or any attachments. If you have received this message in error, please delete this message and any attachments from your system without reading the content and notify the sender immediately of the inadvertent transmission. There is no intent on the part of the sender to waive any privilege. NOTICE: This email message and/or its attachments may contain information that is confidential or restricted. It is intended only for the individuals named as recipients in the message. If you are NOT an authorized recipient, you are prohibited from using, delivering, distributing, printing, copying, or disclosing the message or content to others and must delete the message from your computer. If you have received this message in error, please notify the sender by return email.
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