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