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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.