About the STOP Sepsis Bundle Toolkit
What is a bundle?
A bundle is a group of interventions related to a disease that when performed together result in better outcome than when individually done. It increases the use of evidence-based science in clinical practice and provides a mechanism to enforce teamwork. A bundle is not guidelines, but a method to implement the guidelines. In creating a bundle, several rules have to be met: 1) the components of the bundle are solid and accepted into clinical practice, 2) the components must be completed in the same space and time interval, 3) the completion of each component can be answered by a "Yes" or "No", 4) the delivery of the whole bundle can be answered by a "Yes" or "No", and 5) the function of the bundle or the disease process it targets needs to be frequently occurring1.
What is the STOP Sepsis Bundle?
The STOP Sepsis Bundle is an implementation of an early sepsis treatment model specific toLoma Linda University. It focuses on the timely initiation of carefor severe sepsis or septic shock in the emergency department and then in the intensive care unit. While it was designed for the emergency department setting, the bundle can beinitiated in any location where care is being given to patients with severe sepsis or septic shock; e.g. the medical ward or the recovery room.
What is the evidence and support for the STOP Sepsis Bundle?
The Surviving Sepsis Campaign guidelines for the management of severe sepsis and septic shock2 serve as framework for the bundle. The advances in therapy behind the bundle are early goal-directed therapy (EGDT)3, corticosteroids4, and activated protein C5. Most important in the first 6 hours of therapy for severe sepsis or septic shock is the implementation of EGDT as originally presented by Rivers et al3. The STOP Sepsis Bundle was not conceived to replace or modify EGDT, but is presented as an adaptation of the original EGDT research, and with the hope of making EGDT as widely implemented as possible. This suggested bundle is also an adaptation of the sepsis bundles provided by the Institute for Health Care Improvement1 to the clinical environment at our institution.
H. Bryant Nguyen, MD, MS
for the STOP Sepsis Working Group
1. Sepsis Bundle.http://www.ihi.org/IHI/Topics/CriticalCare/Sepsis. 2005
2. Dellinger RP, Carlet JM, Masur H, Gerlach H, al. e. Surviving sepsis campaign guidelines for management of severe sepsis and septic shock. Crit Care Med 2004; 32:858-72.
3. Rivers E, Nguyen B, Havstad S, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 2001; 345:1368-77.
4. Annane D, Sebille V, Charpentier C, et al. Effect of treatment with low doses of hydrocortisone and fludrocortisone on mortality in patients with septic shock. Jama 2002; 288:862-71.
5. Bernard GR, Vincent JL, Laterre PF, et al. Efficacy and safety of recombinant human activated protein C for severe sepsis. N Engl J Med 2001; 344:699-709.