Code Sepsis Code Sepsis Nursing ReviewNursing Review

WHOWHO is involved? is involved?eLink monitoring teamCCM Medical TeamICU/ED/Floor nursesPharmacyLabOther medical professionals

WHATWHAT is the nurses role in code is the nurses role in code sepsis?sepsis?

Placement of IV linesAdministration of IV fluids,

pressors, and IV antibioticsMonitoring patient’s statusEnsuring labs are ordered and

taken appropriatelyMeeting specified goals within an

appropriate amount of time…but most importantly overall patient safety & care…

STATSTATWithin 1 hour of patient ID (3 hours Within 1 hour of patient ID (3 hours to ID and initiate for ED pts)to ID and initiate for ED pts)

Blood CulturesAntibiotic administration

Sepsis Resuscitation BundleSepsis Resuscitation BundleWithin 6 hours of patient identificationWithin 6 hours of patient identification

SBP > 100mmHgMAP > 65 mmHgCVP 8-12 mmHgCI > 2.5 L/min/m2

PCWP 8-12 mmHgUrine Output > 0.5mL/kg/hrScVO2 >70%

Sepsis Management BundleSepsis Management BundleWithin 24 hours of patient identificationWithin 24 hours of patient identification

Administer low-dose steroids (if applicable)

Maintain glucose levels <180mg/dL

Maintain IPP <30cm H2O for mechanically ventilated patients

HOWHOW should antibiotics be should antibiotics be administered?administered?

Within 1 hour of patient identification for non-ED patients and 3 hours to identify septic patients and administer antibiotics in the ED setting

Compatibilities should be checked – more antibiotics are compatible than you may realize

A broad spectrum of antibiotic should always be administered first

Spectrum of Activity for Selected Antimicrobial Spectrum of Activity for Selected Antimicrobial AgentsAgents

Gram (+) Antibiotics (+/- Anaerobes)Gram (+) Antibiotics (+/- Anaerobes)Vancomycin (Vancocin®), Linezolid

(Zyvox®), Daptomycin (Cubicin®), Clindamycin (Cleocin®)

Gram (-) Antibiotics (+/- Anaerobes)

Gentamicin, Tobramycin, Aztreonam (Azactam®)

AntifungalFluconazole (Diflucan®), Caspofungin

(Cancidas®), Micafungin (Mycamine®), Amphotericin B

Broad Spectrum AntibioticsBroad Spectrum AntibioticsPenicillinsPiperacillin/Tazobactam (Zosyn®),

Ampicillin/Sublactam (Unasyn®)CephalosporinsCeftriazone (Rocephin®), Ceftazidine

(Fortaz®), Cefipime (Maxipime®)FluoroquinolonesCiprofloxin (Cipro®), Moxifloxacin (Avelox®),

Levofloxacin (Levaquin®)Carbapenem Imipenem/Cilastin (Primaxin®), Meropenem

(Merrem®)

WHYWHY does this matter? does this matter?Sepsis is a range of clinical conditions caused

by the body’s systemic response to an infection, which can be accompanied by single or multiple organ dysfunction or failure, leading to death

Sepsis kills approximately 1,400 people worldwide every day and is a leading cause of death in ICU patients

Patients who do not receive prompt antibiotic therapy have a 10-15% increased risk of mortality – therefore early administration of antibiotics have proven to improve mortality

Nurses play a huge role in patient care and ensuring that antibiotics are given correctly and in a timely manner

That’s all for now!That’s all for now!

Now you can take the post test and see what you have learned.

Information provided by Elizabeth Jennings Martin, PharmD

Email: elizabeth.jennings@conehealth.com with any questions or comments