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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 2006

1st April 2007

1st August 2007

1st December 2007

1st April 2008

1st August 2008

1st December 2008

1st April 2009

1st August 2009

1st December 2009

1st April 2010

1st August 2010

1st December 2010

1st April 2011

1st August 2011

1st December 2011

1st April 2012

1st August 2012

1st December 2012

Show Results Over Time

Results

 
Date Patients Measured Results Standard Regional avg.
01st December 2008 Patients with infection OR sepsis as their primary diagnosis Management of the pateints according to the criteria Documented evidence that blood cultures were obtained prior to antibiotics being administered in the ED 100 % 65 %
Documented evidence that serum lactate measurement obtained prior to leaving the ED 100 % 87 %
Documented evidence that first intravenous fluid bolus (up to 20mls/kg) was given in 75% of cases within 1 hour of arrival 100 % 58 %
Documented evidence that antibiotics were administered in 90% of cases within 2 hours of arrival 100 % 71 %

Comments

Improvements in most criteria, but still significant scope for improvement to achieve target. However, huge improvement in the use of goal directed therapy, which almost achieves target.

Audit Bottom Line

Significant scope for improvement across the board.

Record created on 31st December 2005 by