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NSF #0500 Severe Sepsis and Septic Shock: Management Bundle, Last Updated Date: Oct 05, 2012 NATIONAL QUALITY FORUM Measure Submission and Evaluation Worksheet 5.0 This form contains the information

How to fill out sepsis worksheet form

How to fill out a sepsis worksheet:

1. Begin by gathering all relevant patient information, including their name, age, medical history, and any current medications they are taking.
2. Assess the patient's vital signs, such as their temperature, heart rate, and blood pressure. Record these measurements accurately onto the worksheet.
3. Document the specific signs and symptoms of sepsis that the patient is experiencing, such as fever, rapid breathing, confusion, or decreased urine output.
4. Perform a thorough physical examination of the patient, paying attention to any areas of infection or potential sources of sepsis. Include these findings on the worksheet.
5. Collect and analyze any laboratory test results that are available, including blood cultures, complete blood count, and inflammatory markers. Write down the results and interpretations on the worksheet.
6. Identify any risk factors or underlying conditions that may contribute to the development of sepsis, such as recent surgery, immunosuppression, or chronic illnesses. Note these factors on the worksheet.
7. Determine the severity of the sepsis by utilizing established scoring systems, such as the Sepsis-Related Organ Failure Assessment (SOFA) or the Quick Sequential Organ Failure Assessment (qSOFA). Calculate and record these scores on the worksheet.
8. Make sure to document any interventions or treatments that have been initiated for the patient's sepsis, such as antimicrobial therapy, fluid resuscitation, or vasopressors. Note the specifics on the worksheet.
9. Continuously monitor the patient's response to treatment and document any changes in their condition over time. Adjust the management plan accordingly and update the worksheet accordingly.
10. Regularly communicate and collaborate with the healthcare team involved in the patient's care to ensure accurate and up-to-date information is recorded on the sepsis worksheet.

Who needs a sepsis worksheet:

1. Healthcare professionals, specifically those involved in the management and treatment of patients with sepsis, such as doctors, nurses, or intensivists, can benefit from using a sepsis worksheet.
2. Hospitals or healthcare facilities that have implemented sepsis protocols or quality improvement initiatives may require the use of a sepsis worksheet as part of their standardized documentation process.
3. Researchers or medical educators who are studying sepsis or teaching others about sepsis management may find a sepsis worksheet useful for organizing and analyzing patient data.

For pdfFiller’s FAQs

What is sepsis worksheet?

A sepsis worksheet is a tool used in healthcare settings to track and document information related to sepsis cases.

Who is required to file sepsis worksheet?

Healthcare providers and facilities are required to file sepsis worksheets when treating sepsis cases.

How to fill out sepsis worksheet?

Sepsis worksheets are typically filled out by healthcare providers and include important information such as patient demographics, clinical symptoms, and treatment provided.

What is the purpose of sepsis worksheet?

The purpose of sepsis worksheet is to help healthcare providers track and monitor sepsis cases, improve patient outcomes, and identify opportunities for quality improvement.

What information must be reported on sepsis worksheet?

Information that must be reported on sepsis worksheet includes patient demographics, clinical presentation, laboratory results, treatment administered, and outcome.

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