Sepsis screening

Sepsis is the body’s extreme response to an infection the patient already has, triggering a chain-reaction throughout the body, resulting in a medical emergency. Infections that lead to sepsis most often start in the lung, urinary tract, skin, or gastrointestinal tract. Without timely treatment, sepsis can rapidly lead to tissue damage, organ failure, and death.

1. (If you have not done so already) Access the EHR module in the ESO Suite.

   1. Do one of the following.

      • (If you are already working in the ESO Suite) Click the Home icon in the upper left corner of the screen.

        

      • (If you have not yet logged in) Log in to the ESO Suite.

        1. In a web browser, go to https://www.esosuite.net/EsoSuite.

           The ESO Suite login screen appears.

        2. Enter your user name, password, and agency name, then click Let's Go.

           If MFA multi-factor authentication is enabled, the Multi-factor authentication dialog box appears, displaying one or more methods you can use to verify your login credentials. The number of methods that appear in the dialog box depends on what MFA methods your ESO Suite administrators enabled in the Admin module.

           Click graphics to open them.

           Information on enabling MFA and specific MFA methods is available in the Admin module online help, in Configure multiple-factor authentication.

           Note: If your ESO Suite administrators have disabled MFA ("opted-out"), this dialog does not appear.

        3. (If the Multi-factor authentication dialog box appears) Depending on which buttons appear in the dialog box, verify your login in one of the following ways.

           With an authenticator application.

           1. Click MFA verification via authenticator app.

              The dialog box updates with boxes for entering the numbers of the authentication code, and the ESO Suite sends an authentication code to the authenticator application installed on your device.

              

           2. Open your authenticator application and note the authentication code currently displayed.

           3. Enter the authentication code displayed in the authenticator application.

           4. Click Log In.

           With a text message (SMS short message service).

           1. Click MFA verification via SMS.

              The dialog box updates with boxes for entering the numbers of the authentication code, and the ESO Suite sends an authentication code to the phone number recorded in your PM records and identified with MFA codes.

              

           2. Enter the authentication code sent to your MFA-registered phone number.

           3. Click Log In.

           With an email message.

           1. Click MFA verification via email.

              The dialog box updates with boxes for entering the numbers of the authentication code, and the ESO Suite sends an authentication code to your agency or department email address, recorded in your PM records.

              

           2. Enter the authentication code sent to your agency or department email address.

           3. Click Log In.

      The ESO Suite landing screen appears.

      Click graphics to open them.

      Note: If MFA multi-factor authentication is enabled, you can access and manage your MFA options through the PM module, on the Settings > Account page, as described in Manage a user account. If your agency or department has enabled MFA but has not purchased the full-featured version of the PM module, you can access your own MFA settings by clicking Change my Multi-Factor Authentication settings on the landing screen, then using the Settings > Account page that appears. If your agency has not enabled MFA, the Change my Multi-Factor Authentication settings link does not appear on the landing screen.

   2. On the top side of the home screen, click EHR.

      Tip: If your screen or browser window is too narrow to display all your agency's ESO Suite module icons, an options icon appears on the right side of the icon bar. If you click the options icon, a menu appears containing additional module icons.

      The EHR screen appears, displaying a list of patient records in the EHR module. The most-recent records appear at the top of the list.

      

      Different record status icons can appear in the list.

      Icon	Status
      	Unlocked/Draft The patient record exists in the ESO Suite database, and all crew members listed in the patient record may edit all fields in the record. ESO Suite administrators and personnel with security roles of either EHR Supervisor or EHR Manager can edit non-clinical fields.
      	Mobile The patient record exists on the mobile device, and has not been synchronized with the ESO Suite database. ESO Suite administrators, personnel with security roles of either EHR Supervisor or EHR Manager, and all crew members listed in the patient record can only access a print view of the record. Once the Mobile record synchronizes with the ESO Suite database. the record reflects its current status.
      	Locked The patient record exists in the ESO Suite database, and is locked. Only non-clinical fields can be edited by crew members listed in the patient record, ESO Suite administrators and personnel with security roles of either EHR Supervisor or EHR Manager.

2. (If you have not done so already) Add a new patient record, or search for the existing patient record you want to work with.

   Information on adding or opening a patient record is available in Add a patient record and Search for a patient record.

   The patient record opens and displays the Incident tab, with the Response bookmark selected in the left pane. Fields appear in the right pane for specifying basic information about the incident

   

   If you manually created a new patient record, the Incident Number and State Tracking Number fields populate automatically with ESO Suite-assigned values. You must enter data in all other required fields.

   If you imported data from a CAD Computer Aided Dispatch system, the Incident Number field populates with the data from that source. Other fields in the EHR module may also populate from these sources, depending on what data was recorded in them before the data was imported into the EHR module.

3. At the top of the page, click the Forms tab.

   The contents of the Forms tab appear, listing all the forms your ESO Suite administrator has enabled in the Admin module.

   

4. Click Sepsis Screening.

   The Sepsis Screening dialog box appears, with the Prerequisites bookmark selected in the left pane.

   

5. Record the sepsis screening findings in one of these ways.

   Indicate that you could not obtain the data.

   • In the upper right corner of the dialog box, click UTO, then select the appropriate single option from the menu that appears.

     Most sections of the Sepsis Screening dialog box update to remove fields and buttons for data collection, and display the reason you were unable to obtain the data.

     

   Record the sepsis screening data.

   1. For Time Performed, click the number pad icon to the right of the field, then enter the appropriate numerical values from the number pad dialog box that appears for the time you did the sepsis screening for the patient.

   2. For Date, click the calendar icon on the right end of the field and select the appropriate date from the calendar that appears for the date you did the sepsis screening for the patient.

   3. Record screening pre-requisite information.

      As you select options for the prerequisites, the indicator in the Prerequisites Met box in the section updates to a red circle with No in it, or to a green circle with Yes in it, accordingly.

          

      • For the following fields, click Yes or No to determine if the patient meets the prerequisites for having sepsis.

        Field	Information needed
        Infection Suspected or Documented	Confirmation that the provider suspects the patient has an infection, or documentation from a previous exam diagnosing the patient with an infection.
        EtCO2 ≤ 25 mmHg	Verification that the patient's end-tidal carbon dioxide level is less-than or equal-to 25 mmHg. A normal value is to 35-45 mmHg. End-tidal carbon dioxide (ETCO2) is the level of carbon dioxide that is released at the end of an exhaled breath, reflecting the adequacy with which carbon dioxide (CO2) is carried in the blood back to the lungs and exhaled.
        Lactate Level > 4 mmol/L	Confirmation that high levels of lactate is accumulating in the patient's blood, which may be an indication of lack of oxygen (hypoxia) or the presence of other conditions that cause the accumulation. A normal lactate range is less than 2.3 mmol/L.

   4. Note the results of the qSOFA Quick Sepsis Organ Failure Assessment exam.

      qSOFA Quick Sepsis Organ Failure Assessment is a bedside prompt for detection of patients with suspected infection, who are at risk of death outside of ICU intensive care unit.

      1. In the left pane, click the QSOFA bookmark.

         The right pane scrolls down to the top of the section of the page.

         

         As you select options in this section, the indicator in the Criteria Met box in the section updates to a red circle with No in it, or to a green circle with Yes in it, accordingly.

             

      2. For the following fields, click Yes or No to determine if the patient is experiencing organ failure.

         Field	Information needed
         Systolic Blood Pressure ≤ 100 mmHg	Verification that the patient's blood pressure is less-than or equal-to 100 mmHg. Systolic blood pressure (the top number) is the pressure inside the artery when the heart pumps blood to the body. Normal systolic blood pressure is less than 120.
         Respiratory Rate ≥ 22 breaths/min	Confirmation that the patient's respiratory rate is greater-than or equal-to 22 breaths per minute. Normal respiration rates for adults range from 12 to 20 breaths a minute. Breathing, or respiration, is the process of drawing into the body oxygen and expelling carbon dioxide from the body. The respiration rate is the number of breaths a person takes per minute.
         Glasgow Coma Scale < 15	Verification that the patient's Glasgow coma scale score is less-than 15. A normal score is 15. The GCS Glasgow Coma Scale describes the extent of impaired consciousness in all types of acute medical and trauma patients, according to three aspects of responsiveness: eye-opening, motor, and verbal responses.

   5. Note the results of the SIRS Systemic Inflammatory Response Syndrome exam.

      SIRS Systemic Inflammatory Response Syndrome is the serious condition of inflammation throughout the whole body. SIRS may be caused by an infection, trauma, surgery, ischemia (lack of blood supply to a part of the body), or certain conditions, such as an autoimmune disorder or pancreatitis. When SIRS occurs as a result of a known infection, it may be called sepsis. Sepsis can be severe or life threatening and lead to shock and multiple organ failure.

      1. In the left pane, click the SIRS bookmark.

         The right pane scrolls down to the top of the Quick Systemic Inflammatory Response Syndrome (SIRS) section of the page.

         

         As you select options in this section, the indicator in the Criteria Met box in the section updates to a red circle with No in it, or to a green circle with Yes in it, accordingly.

             

      2. For the following fields, click Yes or No to determine if the patient is experiencing SIRS Systemic Inflammatory Response Syndrome.

         Field	Information needed
         Temperature < 96.8 F (36 C) or > 100.4 F (38 )	Confirmation that the patient's temperature is outside the normal healthy range. The average body temperature is 98.6 F (37 C), but can range between 97 F (36.1 C) and 99 F (37.2 C) or more. Older people generally have lower body temperatures than younger people have.
         Heart Rate> 90 bpm	Verification that the patient's heart rate is greater-than 90 beats per minute. A healthy resting heart rate is between 60 and 100 beats per minute.
         Respiratory Rate > 20 breaths/min	Confirmation that the patient's respiratory rate is greater-than 20 breaths per minute. Normal respiration rates for adults range from 12 to 20 breaths a minute. Breathing, or respiration, is the process of drawing into the body oxygen and expelling carbon dioxide from the body. The respiration rate is the number of breaths a person takes per minute.
         White Blood Cell Count < 4,000 or >12,000 cellsMM3	Confirmation that the patient's WBC white blood cell is outside the normal healthy range of these cells. When you get sick, your body makes more white blood cells to fight the bacteria, viruses, or other foreign substances causing your illness. The WBC count measures the number of white cells, also called leukocytes, in the blood. WBCs are part of the immune system and help fight infections. The normal number of WBCs in the blood is 4,500 to 11,000 WBCs per microlite.)

6. Click OK.

   The dialog box closes, and a green triangle appears in the upper right corner of the form button, to indicate that data exists in this form.