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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