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Table 2 Composite example of steps involved in Sepsis Six, observed in fieldwork

From: A complex endeavour: an ethnographic study of the implementation of the Sepsis Six clinical care bundle

1. Administer high flow oxygen

 • Find a doctor, get oxygen prescribed

 • Assess for COPD

 • Gather together equipment

 • Wash hands

 • Explain the reason for the procedure & gain consent

 • Administer O2 and check for comfort

 • Document

2. Take blood cultures

 • Find a doctor/nurse/phlebotomist who can take the bloods

 • Gather the equipment

 • Explain the procedure to the patient & gain consent

 • Wash hands/gloves

 • Carry out the procedure

 • Leave the patient comfortable

 • Send off the samples

 • Document

3. Give IV antibiotics

 • Find a doctor—get the antibiotics prescribed and check for any allergies

 • Find a nurse with IV certificate, wash hands and prepare the medication

 • Ensure the medication is checked by two nurses

 • Gloves

 • Take the medication to the patient with the drug record

 • Explain the procedure and gain consent

 • Check the patient’s identity at point of administration

 • Administer the medication and observe for any adverse effects

 • Document

4. Start IV fluid resuscitation

 • Find a doctor/nurse who can cannulate, get IV access

 • Gather equipment

 • Wash hands

 • Check the prescription and the fluids and set up the infusion

 • Explain the procedure to the patient and gain consent

 • Gloves

 • Connect and commence the fluids

 • Ensure patient comfort

 • Remember the PVC care bundle

5. Measure serum lactate

 • Find a doctor or a nurse who can take a venous lactate

 • Gather equipment

 • Wash hands/ Gloves

 • Explain the procedure and gain consent

 • Obtain the sample

 • Ensure patient comfort

 • Find a lactate machine

 • Get the result, inform the doctor and document

6. Monitor urine output

 • Explain why and ask the patient to pass urine

 • Wash hands

 • Assist them to the toilet/commode

 • Help the patient back to bed, remember to save the sample!

 • Wash hands/gloves

 • Go back and get sample, measure it, test it and send off sample

 • Find a fluid balance chart and record