Critical Care Research and Practice

Clinical Study

The Use of an Early Alert System to Improve Compliance with Sepsis Bundles and to Assess Impact on Mortality

Table 8

Sepsis patient daily progress note.
Date of Admission:_____________________________    Admitting Diagnosis:______________________________________________
Sepsis Information
 Was sepsis present on admission (including ED stay)?: yes   no
 If no, date/time noted to be present: _________________________________________________________________________________________________________
 Source of sepsis:______________________________________________________________________________________________________________________________
  Evidence of infection (CXR, U/A, etc.): ___________________________________________________________________________________________________
  Positive blood cultures and date: ________________________________________________________________________________________________________
 End-organ damage:___________________________________________________________________________________________________________________________
Antibiotic and Other Treatment
 Initial antibiotic therapy:____________________________________________________________________________________________________________________
 Current antibiotic therapy and start date:__________________________________________________________________________________________________
 Anticipated duration of antibiotic therapy: _________________________________________________________________________________________________
 Route of administration and need for long-term access: ___________________________________________________________________________________
 Steroids considered/ Why given or not: _____________________________________________________________________________________________________
 Xigris considered/Why given or not:________________________________________________________________________________________________________
Please provide a brief summary of why the patient needs to remain in the hospital and cannot receive further treatment as an outpatient.
____________________________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________________________
Signature/Title       Date /Time