1
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กก CQI
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1. &'( : ก
ก Sepsis/Septic shock
2. * : Sepsis, Septic shock , Severe Sepsis ,Care process
3. : ก Sepsis/Septic shock &'()*++,
4. &'(/0( 12#ก : PCT */ก0 1,)*,2
5. &ก0 : .456 /&57ก809+6 2:
6. 56 : *++;ก<
Severe Sepsis/Septic shock
7. 8*6/6" :
Sepsis7=97)+/)ก>*,ก79?@?A+ BCD,0?Mortality Rate7AD00ก>CI+0
20/,
,?I 20 %( Sepsis , 40 % ( Severe Sepsis
0กกN 60 % (&?D7= Septic Shock ;ก9PA+A
ก79?@?A+>*,(1,)*,2 N97)+/ก79?@?A+*ก*), 3 R2S* sepsis
*+ก79?@?A+R 48 = 2.59,R 49 = 3.90,R 50 = 3.5 ,R 51 = 4.73
;กกA72
)697)+/&?D&'()*+ก79?@?A+>*, Sepsis /Septic shock 9, 7SD*,;ก
1.
, 7ก:Z6AA;[\0N@7; &,กก8)ก) >
&Cก
7ก]>*0
2./2ก >20 &ก8
ก7^_
, Sepsis/Septic shock 3.72SD*,0S**/ก:6ก&6
\0N*0/\0N*7?, ;กกReview chart Sepsis R 51 (N = 400)N *
31 +*,ก8(
ICU &'()0?2N(@;N9, LOS = 5.43 ICU 1.13 +*,*. > 7 *
28.57 N
*
42 7=7i@ *
58 7=7i)jA, *
65 0?*/0กกN 60 R 9N()jN0?127A0 7=
7)*
26 1220*
20 12\+7SI*,*
16 7<&>*,7@SI*&?D7=ก0
20.45 % ก0ก 8.16 % 7@SI* 0.26 % 7@SI*&?D0ก&?D9/2S* E. coli 10.45 % *,,07=
Burkhoderia Pseudomallei 3.57 % Klebseilla Pneumonia 1.80 % sA@?
&?D(@N*\กN Ceftriaxone
(Single = 32.65 %,Combine = 23.98 % ) Cefpirome (Single = 9.94 %,Combine = 4.59 % ) Ceftazidime
(Single = 6.63 %,Combine = 10.20 % ) 9N()jN7=&?D9N,+N*0;ก1,@/0@PC,*
68 BCD,0ก;
0*ก&?D/, ),;ก()9I'7?,* &?D*ก/,
2
79?@?A+0ก;
N0? organ failure )S*shock &?D0ก\กN Hypotension,Azotemia,Thrombocytopenia
Leukopenia ,I<
&?D0?+N*ก79?@?A+2S* severe sepsis septic shock BCD,0ก*
38.19 >*, Sepsis &I,)0 7SD*,;ก sepsis 7=97)+/ก79?@?A+&?D9'2j 0&?D+*,\ก
*N,(ก@A +*,(@72SD*,@N)(; 34.18 % +*,(@ Vasopressure drug 51.28 % 9PA+Aก79?@?A+(
Sepsis Sepsis 79?@?A+ 45 % 7=7i@ 50 % 7i)jA, 41 % *N(7>+*.70S*, 22 % *ก *.
70S*, 78 % ,Iกก&?D7=
;C,0?209'2j +I,+N
9N,+N* ก
ก8 ก_*,กก7กA12 กAA;[ กก8 ก22/012 ;
@N7AD0
2/:<(กก8Sepsis
*+ก79?@?A+\ &?0,;C,\
,กN>CI7SD**++(,()\0ก&?D9/
8. ก0( / :
8.1 ก&&
ก Sepsis /Septic shock
8.2 ก/,&,ก Sepsis /Septic shock
8.3 ก9SD*9&'207>(;ก/2ก กก')A@*
8.4 ก/,
, : ;กกA72
)697)+/&?D&'()*+ก79?@?A+>*, Sepsis
/Septic shock 9, 7SD*,;ก
1) , 7ก:Z6AA;[\0N@7; &,กก8)ก) >
&Cก
7ก]>*0
2) /2ก >20 &ก8
ก7^_
, Sepsis/Septic shock
3) 72SD*,0S**/ก:6ก&6\0N*0/\0N*7?,
ก2/:<กSepsis
&?D1
7AD0'7Aก7S* ก.2.51 1
1) ก')&?0Sepsis
ก'))&?DA@*
2) &&7@
7?Sepsis
3) ก')7_)0/+@?I/&,ก7ก]>*0
4) ;&'&,กSepsis/Severe Sepsis 1N0ก99;.;
@/0A@ก
17@Aj*;6;ก0>.0()20
>&,ก\,@.
3
&,กsevere sepsis,septic shock (1,)*,2
70SD*0?AA;[ sepsis +07ก:Z6กAA;[())N,sA+A,?I
1) +A(CPG )chart 7;
lab+0&,\กN CBC, BUN,Cr, Electrolyte, LFT, UA,
H/C x 2 ,CXR,ABG(7[
(Severe Sepsis) 9N,+;*SD~ +0
&?D9,9
2) ()ATB <( 1 @0.),กAA;[
3) ()0.9 NSS 500-1,000 cc.</@0. P\0N0?12)(; ก:?&?D SBP < 90 ,MAP < 65 A;:()
Vasopressure drug
4) severe sepsis,septic shock ()9I'()7?,*( 6 @0.ก17_)02S* CVP
8-12 B0I' )S* 12-15 B0.I' P(@72SD*,@N)(; ,Systolic BP>90 )S* MAP>65 00.
*& ,99
0กกN 30 B?B?/@D10,
5) record I/O Septic shock &/ก
6) record V/S &/ก15-30 &?;Stable
7) &Cก>*0(+;9*2/:<กSepsis
7]&?D;กก&& 2I,&?D2
1) ก9SD*9()7;)&?D7ก?D>*,&,\0N2*2/0sA+A
2) ก7ก]>*0ก\9I' 0.9 NSS 500 -1,000 cc. 0?20272SD*7SD*,;ก07*
&?D7= ESRD,CKD
12)(;7>0
,\0N\&'I/O
3) ก,7[?\0N7=;;/N,7+0Routine
4) &6\0NOrder7;
Lab+0&,&?Dก')&'()\0N\ก+;Lab+0&,
ก2/:<กSepsis
&?D 2(>*+ก,()0N)
1) ก9SD*9()7;)&?D7ก?D>*,&
sA+A+0&,ก Sepsis/Severe
Sepsis
2) /,&Cกก+;9*2/:<กSepsis
3) ( CPG Sepsis )chart
4) ก')&,ก&Cก>*0+@?I
5) ก,7ก\2I,ก ATB (),7&?D[?;A,Real time),&6AA;[
ก7\0N(&?D7=Sepsis NI
6) ก7ก]>*0ก\9I' 0.9 % NSS 500-1,000 cc/hr ()ก7\0N&?D7=
ESRD,CKD,12)(;
7) ก7;
Lab7SD*Investigate)<
&กB*+0&,()7;
9N,\7
8) 7AD0'7Aก7S*..51
4
ก2/:<กSepsis
&?D 3
1) ก')&,ก7^_
,Septic shock
2) ก')&,ก,&6()@7;
3) ก&CกNurse note()&Cก
9N,7(
7]9
&?D+*,7^_
,72079?D,&,2?Aก
7[
4) ก')&&)&?D9)A@@?&?D7ก?D>*,กก()@7;(ER,Lab,Pharmacy, Ward)
ก9SD*9()&
&,ก7^_
,Septic shock
1) +A CPG Sepsis)chart
sA+A+0&,&?Dก')
2) &Cก+;9*2/:<กSepsis
3) ()\9I'7?,*+07ก:Z6&?Dก')
4) Record V/S &/ก 15-30 &?; Stable
5) Record I/O
6) Monitor HAD +0&,20*<
7) ,&670SD*0?>*N,@?I+N*\?I
-Urine **ก*กN 30 cc./hr
- CVP < 8 B0I' )S* > 15 B0.I'
- Systolic BP < 90 )S* MAP < 65 00.*&
- BS < 60 )S* > 300
- ABG
-O2 Sat. < 92
- ()Dopamine 2: 1 tritate PC, 30 µd BP ,\0N>CI
9. ก;/2ก0( / :
กReview chartกN*ก
+@?I
7_
1.*
Sepsis\ Antibiotic <( 1 @0. ≥ 80 %
0A..51
44 %
ก.2.51
38 %
9.2.51
47 %
0
43 %
≥ 80 %
56 %
64 %
52 %
51.32 %
≥ 80 %
53.3 %
50 %
56.6 % 56.64 %
),กAA;[
2.*
Septic shock \9I'7?,*
+0&,(ก712)(;/\+
9/&)
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Sepsis\ก
70A
<
&กB*
5
5 100 %
ก
ก
6
ก
5 > 80 %
6
ก
ก
ก
5 > 80 %
6
ก
ก
ก
6
5 > 80 %
ก
ก
6
ก
5 > 80 %
ก
ก
6
ก
7
10. !0 0(?@! :
-ก&&
ก Sepsis &'()7)]1*ก9(ก
-ก+N*7SD*,2S*ก>
ก Sepsis \, PCT *SD~ ก7@SD*01,ก
@. 0?ก22/0ก(@ Antibiotic
11. ก""0 : PCT */ก0 1,)*,2
8
Incidence F case Sepsis/Septic shock
8*6
Case Septic shock 79?@?A+
-\ 2B?\>) 2009 79?@?A+
+N\0N\9N,+;H/C 7SD*,;ก arrest
กN* &'()\0N0? Lab S97)+/ก
+
Case Septic shock 79?@?A+
-**ก\*
7?,+N*0&/,
79?@?A+
/;/ก@?2
-;&'&,ก9N,+;ก:?0PC,
+*,CPR 79?@?A+1()9N,Lab
investigate +0 Order &/ก*N,
-P\0NN(;()9*P0&6กN*N;
9N,
+;+0order 7A0)S*\0N
-&,ก27S*กกN*\*
7?, \0N2ก:?,+N*\?I\
*
7?,
-12)(; 12* ),off
ET.Tube()7S*ก7=*9/& ก:?\0N
N(;()9*P0207)]&6กN*A;:
-;
7^_
,
-&,กก
7<& 1ก;
Zoning 7+?,
P#
;'*/+Aก:6 Septic
shock 79?@?A+1\0N\9N,Lab
+0order
0?.2.53 = 1 2I,
70..53- 0A..53 = 0 2I,
;'*/+Aก:6 Septic
shock \*
?,&/
,79?@?A+
0?.2.53 = 1 2I,
70..53- 0A..53 = 0 2I,

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