e-cPR #24:

INITIATION OF THE SEPSIS BUNDLE

E-CPR #24: initiation of sepsis bundle

• Sepsis Mortality Rate is estimated between 20-50%

• Early Intervention with the 3 hour sepsis bundle can significantly reduce mortality rates

E-CPR #24Numerator: Initiation of the 3 Hour Sepsis Bundle ordered:• Lactic Acid/Lactate• 2 Blood Cultures• IV Fluid Bolus• IV Antibiotics

Denominator:• Patients ≥ 18 years old• Diagnosis of Severe Sepsis or Septic Shock

#24:exclusion

• Patients documented to desire limited intervention (Hospice patient with limited IV access or other documented reason)

• Patients refusal (Refuses blood draws, refuses IV access)

• Medical reason (while not excluded from core measure SEP-1, a patient for thismeasure may be excluded with documentation of CHF or end stage renal disease).

#24:notes

Although we still need to meet the core measure SEP-1, this measure is not as strict:

1. Any IV fluid bolus will meet measure.2. Only 3 hour bundle portion is required

(not the 6 hour bundle)3. Medical exclusions of CHF/RF are allowed.4. No time requirement.

Best PracticesRemember to document/order all 4 parts of sepsis 3 hour bundle.

Best practice:1. “Patient with severe sepsis, 3 hour sepsis bundle initiated.”

2. Acceptable is ordering all 4 parts without specific statement.

3. “Patient refuses PICC line/CVC, no IV access.” (exclusion)

4. “Patient with signs of fluid overload, clinically fluid resuscitated and IVF deferred.” (exclusion)

Not Acceptable:1. Any of 4 elements not ordered without specified reason.