Sepsis Management Bundle

Evidence-based goals that must be completed within 24 hours for patients with severe sepsis, septic shock and/or lactate > 4 mmol/L (36 mg/dl).

For patients with severe sepsis, as many as four bundle elements must be accomplished within the first 24 hours of presentation. Some items may not be completed if the clinical conditions described in the bundle do not prevail, but clinicians must assess for them. The goal is to perform all indicated tasks 100 percent of the time within the first 24 hours from presentation. Please note that efforts to accomplish these goals should begin immediately, but may be completed within 24 hours to qualify in the database.

Changes for Improvement

Bundle Element 1: Administer low-dose steroids for septic shock in accordance with a standardized ICU policy. If not administered, document why the patient did not qualify for low-dose steroids based upon the standardized protocol.

• Administer Low-Dose Steroids by a Standard Policy

Bundle Element 2: Administer recombinant human activated protein C (rhAPC) in accordance with a standardized ICU policy. If not administered, document why the patient did not qualify for rhAPC.

Bundle Element 3: Maintain glucose control >70, but <150 mg/dL.

• Maintain Adequate Glycemic Control

Bundle Element 4: Maintain a median inspiratory plateau pressure (IPP) <30 size="1">20 for mechanically ventilated patients.

• Prevent Excessive Inspiratory Plateau Pressures