Severe Sepsis and Septic Shock: Management Bundle (Composite Measure)

NQF ENDORSEMENT STATUS: Endorsed  |  NQF ID: 0500  |  MEASURE TYPE: Process  |  INFO AS OF: Not available  |  CMIT ID: 1017  |  REVISION: 1
This measure focuses on adults 18 years and older with a diagnosis of severe sepsis or septic shock. Consistent with Surviving Sepsis Campaign guidelines, the measure contains several elements, including measurement of lactate, obtaining blood cultures, administering broad spectrum antibiotics, fluid resuscitation, vasopressor administration, reassessment of volume status and tissue perfusion, and repeat lactate measurement. As reflected in the data elements and their definitions, these elements should be performed in the early management of severe sepsis and septic shock.
Info As Of Not available
Description This measure focuses on adults 18 years and older with a diagnosis of severe sepsis or septic shock. Consistent with Surviving Sepsis Campaign guidelines, the measure contains several elements, including measurement of lactate, obtaining blood cultures, administering broad spectrum antibiotics, fluid resuscitation, vasopressor administration, reassessment of volume status and tissue perfusion, and repeat lactate measurement. As reflected in the data elements and their definitions, these elements should be performed in the early management of severe sepsis and septic shock.
Numerator The number of patients in the denominator who received ALL of the following components (if applicable) for the early management of severe sepsis and septic shock: initial lactate levels, blood cultures, antibiotics, fluid resuscitation, repeat lactate level, vasopressors, and volume status and tissue perfusion reassessment.
Denominator Inpatients age 18 and over with an ICD-10-CM Principal or Other Diagnosis Code of Sepsis, Severe Sepsis, or Septic Shock.
Denominator Exclusions The following patients are excluded from the denominator: Severe sepsis is not present Patients Transferred in from another acute care facility Patients receiving IV antibiotics for more than 24 hours prior to presentation of severe sepsis. Patients with a Directive for Comfort Care or Palliative Care within 3 hours of presentation of severe sepsis Patients with an Administrative Contraindication to Care within 6 hours of presentation of severe sepsis Patients with an Administrative Contraindication to Care within 6 hours of presentation of septic shock Patients with a Directive for Comfort Care or Palliative Care within 6 hours of presentation of septic shock Patients with septic shock who are discharged within 6 hours of presentation Patients with severe sepsis who are discharged within 6 hours of presentation Patients with a Length of Stay >120 days Patients included in a Clinical Trial
Rationale The evidence cited for all components of this measure is directly related to decreases in organ failure, overall reductions in hospital mortality, length of stay, and costs of care. A principle of sepsis care is that clinicians must rapidly treat patients with an unknown causative organism and unknown antibiotic susceptibility. Since patients with severe sepsis have little margin for error regarding antimicrobial therapy, initial treatment should be broad spectrum to cover all likely pathogens. As soon as the causative organism is identified, based on subsequent culture and susceptibility testing, de-escalation is encouraged by selecting the most appropriate antimicrobial therapy to cover the identified pathogen, safely and cost effectively (Dellinger, 2012). Multicenter efforts to promote bundles of care for severe sepsis and septic shock were associated with improved guideline compliance and lower hospital mortality (Ferrer, 2008 and Rhodes, 2015). Even with compliance rates of less than 30%, absolute reductions in mortality of 4-6% have been noted (Levy, 2010 and Ferrer, 2008). Absolute reductions in mortality of over 20% have been seen with compliance rates of 52% (Levy, 2010). Coba et al. has shown that when all bundle elements are completed and compared to patients who do not have bundle completion, the mortality difference is 14% (2011). Thus, there is a direct association between bundle compliance and improved mortality. Without a continuous quality initiative (CQI), even these compliance rates will not improve and will decrease over time (Ferrer, 2008). Multiple studies have shown that, for patients with severe sepsis, standardized order sets, enhanced bedside monitor display, telemedicine, and comprehensive CQI feedback is feasible, modifies clinician behavior, and is associated with decreased hospital mortality (Thiel, 2009; Micek, 2006; Winterbottom, 2011; Schramm, 2011; Nguyen, 2007; Loyola, 2011).
Evidence Not available
Steward Centers for Medicare & Medicaid Services (CMS)
Contact MMSSupport@Battelle.org
Measure Developer Not specified
Development Stage Fully Developed
Measure Type Process
Meaningful Measure Area Preventable Healthcare Harm
Healthcare Priority Make Care Safer by Reducing Harm Caused in the Delivery of Care
eCQM Spec Available Not Available
NQF Endorsement Status Endorsed
NQF ID 0500  (NQF Website )
Last NQF Update 2017-07-13
Target Population Age 18+
Target Population Age (High) Not available
Target Population Age (Low) 18
Reporting Level Facility
Conditions Infection
Subconditions Sepsis
Care Settings Hospital Inpatient , Hospital/Acute Care Facility

  Core Measure Set  :   Not available


Measure Group Group Identifier Actions
SEP 01
SEP 1
SEP Not available
There are no relationships associated with the measure at this time.
Info As Of Not Available
Program / Model Notes
Data Sources Not available
Purposes Not available
Quality Domain Patient Safety
Reporting Frequency Not available
Impacts Payment Not available
Links
Links Actions
Current Measure Status
Status Effective Date Comments Links Other Data Actions
Implemented 2016-10-01 Not available

http://www.gpo.gov/fdsys/pkg/FR-2014-08-22/pdf/2014-18545.pdf

Upcoming Status Changes
Status Effective Date Comments Links Other Data Actions
Status Effective Date Comments Links Other Data Actions
Reference 1900-01-01 Not available

https://www.medicare.gov/hospitalcompare/search.html

http://www.qualitynet.org/dcs/ContentServer?c=Page&pagename=QnetPublic%2FPage%2FQnetTier4&cid=1228775436944

Finalized 2014-08-22 Not available

http://www.gpo.gov/fdsys/pkg/FR-2015-08-17/pdf/2015-19049.pdf

Info As Of Not Available
Program / Model Notes
Data Sources Other
Medical Record
Electronic Clinical Data: Electronic Health Record
Electronic Clinical Data
Paper Medical Records
Purposes Not available
Quality Domain Patient Safety
Reporting Frequency Not available
Impacts Payment Not available
Current Measure Status
Status Effective Date Comments Links Other Data Actions
Implemented 2016-10-01 Not available
Upcoming Status Changes
Status Effective Date Comments Links Other Data Actions
Status Effective Date Comments Links Other Data Actions
Finalized 2014-08-22 Not available
There are no links associated with the measure at this time.