Background, Rationale, and Suggested Implementation Strategies
Early Identification (HMS Bundle Measures)
- Initial lactate resulted within 3 hours of arrival to hospital/emergency department
- Repeat lactate resulted within 4 hours of first lactate(if elevated)
- Blood culture collected within 3 hours of arrival(non-viral sepsis only)
- Blood culture collected before antibiotic administration
Initial Treatment (HMS Bundle Measures)
- Antibiotic delivered within 5 hours(if not hypotensive) for non-viral sepsis
- Antibiotic delivered within 3 hours of arrival if hypotensive for non-viral sepsis(HMS 2024 Performance Measure)
Fluid Management (HMS Bundle Measures)
- ≥30 ml/kg ideal body weight(IBW) fluid within 6 hours, if indicated
- If not indicated, documentation as why this decision was made.
- ≥30 ml/kg IBW fluid within 2 hours of vasopressor initiation
Steps to Achieve Above Measures
- Sepsis team to review current performance with each component, review opportunities for improvement, identify gaps and understand root causes for gaps. Implement action items to mitigate root causes identified.
- Educate providers(attending, residents, APP, and nursing staff) on sepsis and evidenced based interventions. Develop ongoing education plan for each discipline.
- Provide audit and feedback directly to teams regarding compliance with bundles.
- Consider implementing a“Code Sepsis” or sepsis huddle to facilitate early sepsis recognition and treatment.
- To improve time to antibiotic consider stocking common antimicrobials in non-pharmacy locations(ED, floor, ICU); make first antibiotic STAT on all order sets and engage pharmacy in the sepsis response.
- Walk your process in ED, floor, and ICUs to identify areas of opportunity, understand issues and barriers
- Educate providers and nurses on the importance of early fluids and its impact on outcomes.