/clinical/,/clinical/cckm-tools/,/clinical/cckm-tools/content/,/clinical/cckm-tools/content/delegationpractice-protocols/,/clinical/cckm-tools/content/delegationpractice-protocols/inpatient-delegation-protocols/,

/clinical/cckm-tools/content/delegationpractice-protocols/inpatient-delegation-protocols/name-97310-en.cckm

201711331

page

100

UWHC,UWMF,

Tools,

Clinical Hub,UW Health Clinical Tool Search,UW Health Clinical Tool Search,Delegation/Practice Protocols,Inpatient Delegation Protocols

Sepsis Treatment Initiation - Adult - Emergency Department [101]

Sepsis Treatment Initiation - Adult - Emergency Department [101] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Delegation/Practice Protocols, Inpatient Delegation Protocols



Delegation Protocol Number: 101

Delegation Protocol Title:
Sepsis Treatment Initiation – Adult – Emergency Department

Delegation Protocol Applies To:
UWHC Emergency Department

Target Patient Population:
Adult patients in the Emergency Department (ED) with signs and symptoms indicative of potential
sepsis

Delegation Protocol Champion:
Brian Sharp, MD – Department of Medicine ‐ Emergency Medical Services

Delegation Protocol Reviewer:
Anne Rikkers – Department of Emergency Services

Responsible Department:
Department of Emergency Medicine

Purpose Statement:
To delegate authority from the Emergency Department Provider to Registered Nurses (RNs) to place
orders for initial care of patients who have screened positive for potential sepsis.

Who May Carry Out This Delegation Protocol:
Registered Nurses in the Emergency Department trained in the use of this delegation protocol

Guidelines for Implementation:
1. The protocol is initiated when a patient in the Emergency Department presents with signs and
symptoms suggesting potential sepsis. Patients qualify as potentially septic if 2 or more vital
signs are outside of predefined thresholds (below) plus the answer is “Yes” to one or more of
the nursing assessment questions OR a patient has 2 or more vital signs outside of predefined
thresholds (below) with one being elevated temperature.
1.1. Vital sign thresholds
• Pulse > 90 bpm
• Respiratory rate > 20
• Mean arterial pressure < 65 mmHg
• Temperature > 38 C
1.2. Nursing assessment questions
• Rigors
• Signs of infection
2. When a patient meets the criteria the RN will be notified by a Best Practice Advisory (BPA, see
Appendix 1) in Health Link to initiate the protocol. The alert will contain a list of orders to be
entered for the patient. The orders are: IV insertion and maintenance, Normal Saline Bolus and
Vital Signs every 30 Minutes with the following lab tests: CBC with differential, Electrolytes, BUN,
Creatinine, Glucose, Calcium and Lactate.

Order Mode: Cosign Required, Protocol/Policy

Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org


References:
1. Dellinger RP, Levy MM, Carlet JM, et al. Surviving Sepsis Campaign international guidelines for
management of severe sepsis and septic shock:2012. Crit Care Med. 2013;41(2):580‐
637. http://www.sccm.org/Documents/SSC‐Guidelines.pdf. Accessed May 2017
2. Barochia AV, Cui X, Vitberg D, et al. Bundled care for septic shock: An analysis of clinical trials. Crit Care Med
2010;38:66‐78.
3. Shapiro N, Howell MD, Bates DW, et al. The association of sepsis syndrome and organ dysfunction
with mortality in emergency department patients with suspected infection. Ann Emerg Med.
2006;48(5):583–590.
4. Shapiro N, Howell MD, Talmor D, et al. Serum lactate as a predictor of mortality in emergency
department patients with infection. Ann Emerg Med. 2006;48(5):524–528

Collateral Documents/Tools:
1. Nursing Level Suspected Sepsis Best Practice Advisory

Approved By:
UW Health Lab Practice Committee: April 2014, *August 2017
UWHC Nursing Practice Council: April 2014; *August 2017
UW Health Clinical Knowledge Council: April 2014; *August 2017
UWHC Medical Board: May 2014; *August 2017

Effective Date: August 2017

Scheduled for Review: August 2020
*Expedited Review Process








Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org