Initial Care for Patients with Severe Sepsis and Septic Shock: The Next ICU Quality Measure

In 2001, the landmark trial of early goal-directed therapy versus standard care for the treatment of severe sepsis and septic shock was published. The marked decrease in mortality with early recognition of sepsis and quantitative resuscitation revolutionized the treatment of patients with these conditions. Specific pieces of the early goal-directed therapy protocol have not been routinely adopted into bedside care; however, early administration of antibiotics, resuscitation with intravenous fluids, and attainment of hemodynamic stability to achieve end-organ perfusion have become the standard of care. To help ensure all patients receive optimal therapy at the first signs of severe sepsis or septic shock, the Surviving Sepsis Campaign has developed a core set of initial process steps and treatment goals grouped into a care bundle. Recognizing the benefit of early quantitative resuscitation on patient care, the National Quality Forum adopted a severe sepsis and septic shock care bundle that is similar to the Surviving Sepsis Campaign bundle. This care bundle has been adopted by the US Centers for Medicare & Medicaid Services, with reimbursement to be influenced beginning in 2017. The purpose of this review is to summarize evidence supporting the sepsis quality measure and care bundle and simplify key components of the care bundle where pharmacists can be impactful in ensuring optimal patient care and bundle compliance.