In July 2009 I was appointed to be the hospital lead of the Clinical Application in Research and Education (CARE) project to initiate the Surviving Sepsis Campaign in our small, acute care hospital. The goal for this project is to reduce sepsis mortality by 25% and to train nurses at the bedside to be leaders in change project.
We are now screening all adult patients 18 years-old and older for sepsis.
If they are tested positive with two signs of Systemic Inflammatory Response Syndrome (SIRS) — like temperature > 100.4, HR > 100, SBP < 90 mmHg, lactate level > 4 — we initiate Sepsis Resuscitation Bundle (to be completed within six hours of the time of presentation), which includes Early Goal Directed Therapy (EGDT), such as fluid resuscitation, blood cultures, lactate level and antibiotic therapy within one hour of diagnosis of severe sepsis or septic shock.
If all the interventions mentioned were done and the patient continues to deteriorate, we activate Sepsis Management bundle that includes tight glycemic control, Xigris, steroid therapy, etc.