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Severe Sepsis and Septic Shock in Adults
Clinical scenario
The in-hospital mortality from severe sepsis (30%) and septic shock (50%) remains extremely high. Sepsis is a complex syndrome that is difficult to define, diagnose, and treat. It is a range of clinical conditions caused by the body's systemic response to infection, and is one of the leading causes of death in hospital. Rapid and timely intervention is critical to successful treatment.
Audit question
Are patients presenting with sepsis currently managed appropriately according to best practice guidelines?
Method
Retrospective audit
Sample: 50 consecutive Emergency Department patient records
Criteria
Inclusion: Patients over 18 years old coded as Sepsis, Infection or shock (Including Hypotension and Infection.)
The internationally agreed definitions of Severe Sepsis/ Septic Shock should be used (see attached documentation).
Audits
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1st August 2008
Results
| Date | Patients | Measured | Results | Standard | Regional avg. |
|---|---|---|---|---|---|
| 01st August 2008 | Patients with infection OR sepsis as their primary diagnosis | Management of the patients according to the criteria | Documented evidence that blood cultures were obtained prior to antibiotics being administered in the ED | 100 % | 69.667 % |
| Documented evidence that serum lactate measurement obtained prior to leaving the ED | 100 % | 10 % | |||
| Documented evidence that first intravenous fluid bolus (up to 20mls/kg) was given in 75% of cases within 1 hour of arrival | 100 % | 33.333 % | |||
| Documented evidence that antibiotics were administered in 90% of cases within 2 hours of arrival | 100 % | 58.667 % |
Comments
These results show quite a rapid decline in standards since the last audit, in all but one criteria. The timeliness of antibiotics administration has improved by just under 5%, but all other criteria have declined significantly. All are substantially under the target threshold.
Audit Bottom Line
Significant scope for improvement across the board, in particular the application of goal directed therapy, and serum lactate measurements.