DEFINITIONS MANAGEMENT BUNDLE
Suspicion of Infection Plus: USE YOUR SEPSIS BUNDLE ORDER SET. (Automatic antibiotic
≥2 SIRS Criteria (More Sensitive) approval for the first dose — communicates urgency and facilitates bundle completion.)
• Temp > 38˚C (100.4˚F) or < 36˚C (96.8˚F) Use Sepsis Navigator to evaluate and manage the patient
1 Hour Goals
• Resp > 20/min B — Blood Cultures
• HR > 90/min • Draw blood cultures before giving antibiotics.
• WBC > 12 or < 4 K/cu mm or > 10% bands • If significant delay (>30 mins), with provider approval, administer
OR antibiotics, document failed attempt(s) and continue attempts after
antibiotics given, if appropriate.
≥2 qSOFA Criteria (More Specific)
• GCS ≤ 14 (acute change in mental status) L — Lactate
• Resp ≥ 22/min • Repeat lactate if initial lactate is > 2 mmol/L.
• SBP ≤ 100 mmHg A — Antibiotics Within 1 hour of Starting Timer
(within 30 min of STAT order)
SEPSIS
Infection + Dysregulated Systemic Host
Response Causing Acute Organ Dysfunction: S — Saline or LR: Administer 30 mL/kg for patients with
• Objective Criteria: Hypotension < 90 mmHg or Lactate ≥ 4 mmol/L
• Lactate > 2 mmol/L • Calculate target fluid volume using Ideal Body Weight (IBW) for obese
• SBP < 90 mmHg, drop in SBP > 40 mm Hg from patients (BMI>30)
3 Hour Goals
last recorded SBP “normal” or MAP < 65 mmHg • Target 20 mL/kg during pregnancy.
• Urine < 0.5 mL/kg/hr x 2 hrs • Document any contraindication to aggressive fluid resuscitation
• Acute respiratory failure (vent, NPPV) (e.g., severe CHF, ESRD, severe anemia) and the planned
• *Total bilirubin > 2 mg/dL alternative volume.
• *Creatinine > 2 mg/dL • Document repeat BP within 60 minutes of fluid bolus, and recheck if low.
• *Platelet < 100 K/cu mm T — Timing Is Everything.
• *INR > 1.5 or aPTT > 60 seconds • Early recognition and antibiotics within 60 minutes
Scan the
*If increased from baseline
QR code to
Documentation Tip: Please indicate organ failure associated/linked
download
— e.g.., ARF due to sepsis
to your
Sepsis with Either: If Hypotension Persists After Fluid Administration of 30 mL/kg
smartphone.
or Lactate ≥ 4 mmol/L:
• Elevated lactate ≥ 4 mmol/L SEPTIC SHOCK
6 Hour Goals
OR • Start Vasopressors and Initiate Transfer to ICU.
• Provider Will Conduct/Document Reassessment of Volume
• Persistent hypotension requiring vasopressors Status and Tissue Perfusion in Their Note:
to maintain MAP ≥ 65 mmHg despite adequate 1) Access via Sepsis Navigator Checklist OR consider using a dot phrase
volume resuscitation “.perfu…” OR a smart phrase “perfusion…”, “sepsis…”.
Documentation Tip: Please record if sepsis or septic shock diagnosis is ruled out
or doubtful.
ARM2203015
