Protocols and Checklists

Colleagues share the tools they have developed in their own institutions as they implement the Surviving Sepsis Campaign. Here you’ll find locally created protocols, checklists, policies, and similar documents so you don’t have to start from scratch.​ If you have items to share based on the 2016 guidelines and guidelines and bundles, please email PDFs to info@survivingsepsis.org. Permission from your institution may be required.

Campaign Screening Tool Sample
The Surviving Sepsis Campaign provides a paper screening tool to assist when evaluating patients in the hospital emergency department; medical, surgical, or telemetry wards; or ICU.

 

Pediatric Treat Before Transfer Sepsis Screening Tool
Colleagues share the tools they have developed in their own institutions as they implement the Surviving Sepsis Campaign. These Transferring Facility Sepsis Recommendations are from Wesley Children's Hospital.


Adult Treat Before Transfer Sepsis Screening Tool - Wesley Healthcare
Colleagues share the tools they have developed in their own institutions as they implement the Surviving Sepsis Campaign. The Sepsis Screening Tool and Clinical Pathway is from Wesley Children's Hospital.


Severe Sepsis/Septic Shock Clinical Pathway - Cookeville Regional Medical Center
Colleagues share the tools they have developed in their own institutions as they implement the Surviving Sepsis Campaign. The SEVERE SEPSIS/SEPTIC SHOCK CLINICAL PATHWAY is from Cookeville Regional Medical Center.


Pediatric Sepsis Alert Checklist - Wesley Healthcare
Colleagues share the tools they have developed in their own institutions as they implement the Surviving Sepsis Campaign. The Sepsis Alert Checklist is from Wesley Healthcare.


ICU Severe Sepsis Screening Tool - Saint Joseph Mercy Health System
Colleagues share the tools they have developed in their own institutions as they implement the Surviving Sepsis Campaign. The ICU Severe Sepsis Screening Tool is from  Saint Joseph Mercy Health System.


Patient Units Severe Sepsis Screening Tool - Saint Joseph Mercy Health System
Colleagues share the tools they have developed in their own institutions as they implement the Surviving Sepsis Campaign. The Patient Units Severe Sepsis Screening Tool is from  Saint Joseph Mercy Health System.


Sepsis Recognition and Treatment Protocols - Stony Brook
Colleagues share the tools they have developed in their own institutions as they implement the Surviving Sepsis Campaign. The Severe Sepsis/Septic Shock Recognition and Treatment Protocols are from Stony Brook Medicine.


Perinatal Screening Tool​ - Dignity Health
Colleagues share the tools they have developed in their own institutions as they implement the Surviving Sepsis Campaign. The MATERNAL ASSESSMENT OF SEPSIS tool is from Dignity Health.