Situation: As of 0800 Feb 1, 2016 we have a new two stage early warning system for *SIRS/Sepsis for our 5E/5P pilot unit.

Background:  Sepsis is now a Core Measure (publicly reported compliance measure) and requires early recognition and treatment.  The St. John’s Sepsis Alert uses vital sign and laboratory data to trigger “Discern Alerts” in Orchid.  “SIRS” is the first level alert and “Sepsis”  the more serious alert.

“SIRS” Must meet 3 of the St. John Criteria “SEPSIS” Must meet 2 “SIRS” and 1 organ dysfunction
Temp <36oC or >38.3oC Lactate . 2.0 mmol/L
HR >95 bpm SBP<90 mmHg
                RR > 22 b/min MAP<65 mmHg
                Glucose level <  50 mg/dL or >180 ml/dL Creatinine Level (0.5mg/dL increase
                 WBC <4 or >12K/CMM Bilirubin <10 mg/dL or >2 mg/dL
                 Bands >10%

*These are the definitions built into the tool, and differ from the more commonly used guideline definitions

Assessment/Recommendation: If called for a SIRS alert, please assess the patient and determine whether or not an untreated infection is the  likely cause of the abnormal parameters.  If infection is likely, please use the sepsis order sets in Orchid to initiate therapy.  If called for a Sepsis alert, please assess the patient and determine whether or not an untreated infection is the  likely cause of the abnormal parameters.  If infection is likely, please use any of the (soon to be revised) sepsis order sets in Orchid to initiate therapy.  In order to meet the Core Measure, the fluid bolus is now 30 cc/kg completed over 3 hours.  There are also .sepsis phrases that will assist with documentation.