The initial treatment for severe sepsis requires early administration of appropriate broad-spectrum antibiotic therapy based on local resistance patterns and organism prevalence, states the author of a commentary from the May 2015 edition of the Agency for Healthcare Research and Quality's (AHRQ) online case study review, WebM&M. In the spotlight case, a 72-year-old woman with pulmonary hypertension and chronic obstructive pulmonary disease presented to the emergency department with left-sided abdominal pain and shortness of breath. After a chest radiograph revealed an infiltrate in the left lower lobe of her lungs, she was diagnosed with pneumonia and admitted to the transitional care unit, where her condition slowly worsened. Twenty-four hours after admission, methicillin-resistant Staphylococcus aureus was identified in her blood cultures, so vancomycin was added to her antibiotic regimen. Despite the antibiotics, she continued to deteriorate, and the decision was made to withdraw life-sustaining therapies to allow her to die peacefully. According to the commentary's author, the case provides an opportunity to describe errors and pitfalls associated with sepsis management as well as best practices to reduce mortality. He emphasizes that the initial management of severe sepsis and septic shock should involve treatment with a resuscitation bundle, such as the one that was recently updated in 2013 by the Surviving Sepsis Campaign. In addition to the bundle, other key components of sepsis management discussed in the commentary include the use of low-tidal volume ventilation in patients with associated adult respiratory distress syndrome, corticosteroid for refractory shock, and red blood cell transfusion to maintain hemoglobin concentration of 7 to 9 g/dL once tissue hypoperfusion has resolved. The author concludes that institutions should create robust patient safety and quality improvement programs to ensure appropriate screening and severe sepsis/septic shock bundle compliance. To be successful, he notes that the program must have a multidisciplinary approach involving nurses, providers, and hospital administration. Other case studies in the May 2015 issue of WebM&M discuss retained guidewires from central venous catheterization and transitions of care in adolescent medicine.

HRC Recommends: Especially in light of recent study results finding that sepsis contributes to one out of every two or three deaths among hospitalized patients (see the May 21, 2014, HRC Alerts), risk managers may wish to examine sepsis prevention and treatment in their organizations. Adopting bundles and ensuring that they are used appropriately throughout the facility can be an effective way to improve detection, prevention, and treatment practices.