Download SIRS: Meets 2 or more of the criteria • HR greater than 90 bpm

Patient Label Here
ADULT SEPSIS GUIDELINES/PLAN
1. Attending Physician:_________________________________________ Resident/Fellow________________________________
2.  Consult: ______________________________________________________________________________________________
 Consult Dietary
3.  Stable
 Fair
 Serious
4.  Admit to________
 Critical
 Transfer to_________
5. Code Status:  Full Code  DNR/DNI Comfort Care  Other______________________________________________
 NKDA
6. Allergies:
 Allergic to: _____________________________________________________________________
7. Notify physician if patient meets any of the following criteria:
 SIRS: Meets 2 or more of the criteria
 HR greater than 90 bpm
 Temperature greater than 100.4 F (38 C) or less than 96.8 F (36 C)
 WBC greater than 12, 000 or less than 4,000
 RR greater than 20 per min or PaCO2 less than 32 mmhg
 SEPSIS: SIRS + Infection
 Confirmed infection
 Suspected infection
Call Rapid Response for assistance in completing orders
8.
NURSING:
 Insert Foley Catheter if possible with temp probe
 Diet:
 NPO
 Clear Liquids
 Full Liquids
 Mechanical Soft
 Regular
 Renal
 ADA
 Other______________________________________________________________________________________
 Activity:  Bedrest
 Vital signs every_______
 Cardiac monitor with pulse ox continuous
 Obtain consent for Central line or ScvO2 catheter for placement
 Obtain consent for arterial line placement and set up room for art line and Flow Track
 CVP monitoring every_____hourrs
 ScvO2 monitoring every_____hours
 Notify physician if MAP <65, UO <0.5 ml/kg/hr, ScvO2 < 70% or CVP <_______or more than __________
 TO  Read back
Order taken by Signature: ________________________________________Date/Time: _____________________________
Physician Signature__________________________________________ Date/Time_____________________________
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 Glucose Management
 Accuchecks every hour
 Accuchecks every 2 hours
 Accuchecks every 4 hours
9.

Cover blood sugars with the UMC Adult SSI orders using the moderate scale

Utilize Insulin Drip orders if Blood sugar greater than 180 X 2
LABORATORY/DIAGNOSTICS:
 CBC with differential, CMP, MG, Phos, PT/INR, PTT, CKMB, CK, Trop-T, Cortisol level
 Type and Screen
 ABG with lactate
Obtain all cultures prior to starting antibiotics
 Blood Cultures X 2 from 2 separate sites
 Sputum C&S and gram stain,
 Urinalysis and culture
 Wound culture if applicable
 Stat portable Chest X-ray
 Stat EKG
 ________________________________________________________
10. RESPIRATORY THERAPY:
 Respiratory Care Plan
 SaO2 Monitoring
 O2 @ ____ liters per _____________________________
 Vent Settings: ______ Settings ________ FIO2
 ABG
 NOW
 Every AM
__________ Rate
__________ TV _______Peep
 Every 8 hours
 1 hour after Vent changes
11. IV:
 Bolus patient with 20 ml/kg of NS or ______________________ over 30 minutes (notify MD if initial bolus did not
improve fluid resuscitation)
 Continuous IV fluids________________________________ to run at ________________________ml/hr
 Routine central line care and flushes
If patient has not received adequate fluid resuscitation as evidenced by: SBP <90, MAP<65, Urine
output < 0.5 ml/kg/hr., ScvO2 < 70%, and/or lactate level > 4—Notify physician of SEVERE SEPSIS
+ Refractory Hypotension
 TO  Read back
Order taken by Signature: ________________________________________Date/Time: _____________________________
Physician Signature__________________________________________ Date/Time_____________________________
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Patient Label Here
12. MEDICATIONS: Refer also to Admission Medication Reconciliation Form and Discomfort Orders
 INITIATE ANTIBIOTICS WITHIN 3 HOURS OF AN EC ADMISSION OR 1 HOUR OF AN ICU TRANSFER
 FOR SICU PATIENTS ONLY: NOTIFY PHYSICIAN UPON ARRIVAL TO FLOOR TO INITIATE
ROTATION ANTIBIOTIC OF THE MONTH
 FOLLOWUP WITH CULTURES AND SENSITIVITY RESULTS AND ADJUST ANTIBIOTICS
ACCORDINGLY
 ANTIBIOTICS AS FOLLOWS: (CONSULT PHARMACY FOR APPROPRIATE DOSING
BASED ON AGE, WEIGHT, AND RENAL FUNCTION)
 UNKNOWN SOURCE WITH SEPSIS:
 Cefepime 2 g IV now and every 8 hours or  Zosyn 3.375 grams every 6 hrs
X_____ days
PLUS
 Levaquin 750 mg IV now and every 24 hours
PLUS
 Vancomycin 15 mg/kg= ______mg IV now and every _____ hours (round to the
nearest 100 mg) X 7 days
*draw trough levels with 4th dose
 OTHER:______________________________________________________________
 PNEUMONIA WITH SEPSIS: (for suspected pseudomonas and /or multi drug resistant
organism)
 Zosyn 4.5 g IV now and every 6 hours X________days
PLUS
 Vancomycin 15 mg/kg= _____mg IV now and every _____ hours (round to the
nearest 100 mg) X _____days *draw trough levels with 4th dose
 Levofloxacin (Levaquin) 750 mg IV every 24 hrs X 5 days
 Azithromycin (Zithromax) 500 mg IV Q24 hrs
 OTHER:______________________________________________________________
 URINARY TRACT INFECTION WITH SEPSIS:
 Zosyn 3.375 g IV now and every 6 hours
 OTHER______________________________________________________________

INTRA-ABDOMINAL/PELVIC INFECTION WITH SEPSIS

Meropenem 1 g IV now and every 8 hours PLUS
 Vancomycin 15 mg/kg= _____ mg IV now and every _____ hours (round to the
nearest 100 mg) X _____days *draw trough levels with 4th dose
 OTHER: _____________________________________________________________
 TO  Read back
Order taken by Signature: ________________________________________Date/Time: _____________________________
Physician Signature__________________________________________ Date/Time_____________________________
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Patient Label Here

SKIN AND SOFT TISSUE INFECTIONS/ NECROTIZING INFECTIONS:
 Zosyn 3.375 g IV now and every 6 hours
PLUS
 Vancomycin 15 mg/kg= _____mg IV now and every _____ hours (round to the
nearest 100 mg) X ____days
*draw trough levels with 4th dose
 For necrotizing infections add: Clindamycin 900 mg IV now and every 8 hours
X ____days
 OTHER:____________________________________________________________
 PENICILLIN ALLERGIES:
 Azactam 1 g IV now and every 8 hours X______ days PLUS
Flagyl 500 mg IV now every 8 hours X _____ days
 Meropenem 1 g IV now and every 8 hours X_____ days
STRESS ULCER PROPHYLAXIS:
Nexium 40 mg daily  PO  IV  Per Feeding Tube
DVT PROPHYLAXIS
SCD’s
Lovenox  30 mg  40 mg  SQ daily  SQ BID
Heparin 5000 units sq every 12 hours
VASOPRESSOR: (To be infused only through a central line)
Norepinephrine (Levophed) 5 mcg/min. Titrate 1-2 mcg/min every 5 min to keep MAP 65-75
Notify physician if needing to add another vasopressor such as:

Vasopressin 0.01 units/min. Titrate by 0.01 units every 15 min to keep MAP 65-75
( Max. 0.04 units per min.)

Dopamine 5 mcg/kg/min. Titrate by 1-2 mcg/kg to keep MAP 65-75
( Max. 20 mcg/kg/min.)
 TO  Read back
Order taken by Signature: ________________________________________Date/Time: _____________________________
Physician Signature__________________________________________ Date/Time_____________________________
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Patient Label Here
PATIENT DISCOMFORT
MEDICATION PLAN
Indicate desired medications by checking appropriate box. If more than one box is checked for an indication, then use the ordered
medications in the descending order.
PAIN MANAGEMENT: (TARGET MAXIMUM OF 3000 MG OF ACETAMINOPHEN PER 24 HOURS FROM ALL SOURCES)
(DO NOT EXCEED 4000MG OF ACETAMINOPHEN PER 24 HOURS)
MILD PAIN (Pain Scale 1-3):
Acetaminophen (Tylenol) 500–1000 mg PO every 4 hours PRN mild pain (Do not exceed 4,000 mg in 24 hours), if
NPO use:
Acetaminophen (Tylenol) 650 mg suppository PR every 4 hours PRN mild pain (Do not exceed 4,000 mg in 24 hours), if
acetaminophen is ineffective/contraindicated use:
Ibuprofen (Motrin) 400 mg PO every 6 hours PRN mild pain (Do not exceed 3,200 mg in 24 hours)
Other___________________________________________________________________________________________
MODERATE PAIN (Pain Scale 4-7):
Hydrocodone/acetaminophen (Lortab) 5/500 mg 1–2 tabs PO every 4 hours PRN moderate pain (Do not exceed 4
grams of acetaminophen in 24 hours), if ineffective/contraindicated or NPO use:
Ketorolac (Toradol) 15–30 mg IV every 6 hours PRN moderate pain x 48 hours (May give IM if no IV access)
 Other___________________________________________________________________________________________
SEVERE PAIN (Pain Scale 8-10):
Morphine 2–4 mg slow IV push every 4 hours PRN severe pain, if ineffective/contraindicated use:
Hydromorphone (Dilaudid) 1 mg slow IV push every 4 hours PRN severe pain
Other___________________________________________________________________________________________
NAUSEA/VOMITING:
Promethazine (Phenergan) 25 mg PO every 4 hours PRN nausea/vomiting, if ineffective/contraindicated or NPO use:
 Ondansetron (Zofran) 4 mg IV every 8 hours PRN nausea/vomiting
Other___________________________________________________________________________________________
BOWEL MANAGEMENT:

Docusate (Colace) 100 mg PO at bedtime PRN for constipation, if contraindicated or ineffective after 12 hours use:
Bisacodyl (Dulcolax) 10 mg suppository PR daily PRN constipation, if contraindicated or ineffective after 6 hours use:
Sodium phosphate enema (Fleet enema) PR daily PRN constipation (Do not use in renal patients)
Other___________________________________________________________________________________________
INDIGESTION/GAS:
Aluminum hydroxide/magnesium hydroxide (Maalox) 30 ml PO every 4 hours PRN indigestion
 Simethicone (Mylicon) 80–160 mg PO every 4 hours PRN gas/bloating
Other___________________________________________________________________________________________
DIARRHEA:
Loperamide (Imodium) 4 mg PO initially then 2 mg PO with each loose stool (Max 16 mg hours)
Other___________________________________________________________________________________________
 TO  Read back
Order taken by Signature: ________________________________________Date/Time: _____________________________
Physician Signature__________________________________________ Date/Time_____________________________
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Patient Label Here
Indicate desired medications by checking appropriate box. If more than one box is checked for an indication, then use the ordered
medications in the descending order.
ANXIETY:
Alprazolam (Xanax) 0.25 mg PO three times a day PRN anxiety, if ineffective/contraindicated or NPO use:
Lorazepam (Ativan) 0.5 – 1 mg IV every 6 hours PRN anxiety
Other____________________________________________________________________________________________
SLEEPLESSNESS:
Zolpidem (Ambien) 5 mg PO at bedtime PRN sleeplessness, may repeat x 1 in one hour if ineffective
Other____________________________________________________________________________________________
ALLERGIC REACTIONS:
Diphenhydramine (Benadryl) 25 mg PO every 4 hours PRN itching, if ineffective or NPO use:
Diphenhydramine (Benadryl) 25 mg IV every 4 hours PRN itching
Other____________________________________________________________________________________________
COUGH / SORE THROAT:
Phenol-menthol (Cepastat) 1 lozenge PO PRN sore throat (Do not exceed 6 lozenges in 24 hours)
Guaifenesin/dextromethorphan (Robitussin DM) 10 ml PO every 4 hours PRN cough
Other____________________________________________________________________________________________
TEMPERATURE:
Acetaminophen (Tylenol) 500–1000 mg PO every 4 hours PRN fever (Do not exceed 4,000 mg in 24 hours), if
ineffective/contraindicated use:
 Ibuprofen (Motrin) 200–400 mg PO every 4 hours PRN fever (Do not exceed 3,200 mg in 24 hours)
Other____________________________________________________________________________________________
HEMORRHOIDS:
 Witch hazel/glycerin (Tucks) pads at bedside wipe affected area as PRN, if ineffective use:
 Mineral oil/petrolatum/phenylephrine (Preparation H) ointment apply to affected area every 6 hours PRN. If
ineffective/contraindicated use:
 Pramoxine/hydrocortisone (Proctofoam HC) at bedside apply to affected area every 8 hours PRN
MUCOSITIS:
 Dexamethasone/diphenhydramine/nystatin/NS (Fred’s Brew) 15 ml swish and spit every 2 hours while awake PRN
mucositis. If ineffective/contraindicated use:
 Viscous lidocaine (Xylocaine) 15 ml swish and spit every 4 hours PRN mucositis
BLADDER SCAN:
 Bladder scan as needed for patients complaining of urinary discomfort and/or bladder distention present OR 6 hours postFoley removal and patient has not voided. If bladder scan volume is >250 ml please notify the physician.
OTHER:
____________________________________________________________________________________________________
____________________________________________________________________________________________________
 TO  Read back
Order taken by Signature: ________________________________________Date/Time: _____________________________
Physician Signature__________________________________________ Date/Time_____________________________
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