Table 1.

Sepsis nursing quality of care indicators

Sepsis care metric	Indicator
Time to perform blood culture sampling	Nursing quality indicator 1 (a) Blood culture (BC) sampling Proportion of sepsis cases in which BCs were sampled Measured: (n cases with BCs sampled/total number of sepsis cases) × 100 $\frac{n\text{cases with blood cultures sampled}}{\text{total}n\text{of sepsis cases}}\times 100$ 1 (b) Timing of blood culture sampling Proportion of sepsis cases in which BCs were sampled before starting antimicrobial Measured: (n cases with BCs sampled before start of antimicrobial therapy/total n of sepsis cases in which blood cultures could be sampled without substantially delaying the start of antimicrobial therapy) × 100 $\frac{\begin{array}{c}\hfill n\text{cases with blood cultures sampled}\\ \hfill \text{before start antimicrobial therapy}\\ \hfill \end{array}}{\begin{array}{c}\hfill \text{total}n\text{of sepsis cases in which blood cultures could be sampled}\\ \hfill \text{without substantially delaying the start of antimicrobial therapy}\\ \hfill \end{array}}\times 100$
Time to start antimicrobial therapy	2. Antimicrobial therapy (time to administration of antimicrobials once they have been prescribed by the physician or advanced practice provider) Proportion of cases in which antibiotic (AB) therapy was started within 30 min after prescription Measured: (n cases in which AB therapy was delivered with 30 min post prescription/total n of sepsis cases with a prescription of a new antimicrobial therapy or a switch in current therapy) × 100 $\frac{\begin{array}{c}\hfill n\text{cases in which antimicrobial therapy was started}\\ \hfill \text{<}30\text{min of prescription}\\ \hfill \end{array}}{\begin{array}{c}\hfill \text{total}n\text{of sepsis cases with a prescription of a new antimicrobial therapy}\\ \hfill \text{or a switch in current therapy}\\ \hfill \end{array}}\times 100$
Time to reach fluid bolus goals	3 (a) Time to fluid bolus goals (time to administration of fluids once they have been prescribed by the physician or advanced practice provider) Proportion of cases in which fluid therapy was started within 30 min after prescription Measured: (n cases in which fluid therapy was started within 30 min post prescription/total n of sepsis cases in which fluid therapy was prescribed) × 100 $\frac{\begin{array}{c}\hfill n\text{cases in which resuscitation fluids}\\ \hfill \text{were started}\text{<}30\text{min of prescription}\\ \hfill \end{array}}{\begin{array}{c}\hfill \text{total}n\text{of sepsis cases in which}\\ \hfill \text{resuscitation fluids were prescribed}\\ \hfill \end{array}}\times 100$ 3 (b) 30 mL/kg of crystalloid fluid be given within the first 3 h (unless contraindicated) Proportion of cases in which 30 mL/kg of crystalloid fluid was given within the first 3 h unless this was contraindicated Measured: (n cases in which 30 mL/kg of crystalloid fluid was administered < 3 h of prescription)/total n of sepsis cases in which resuscitation fluid was prescribed) × 100 $\frac{\begin{array}{c}\hfill n\text{cases in which 30mL/kg was administered}\\ \hfill \text{< 3h of prescription}\\ \hfill \end{array}}{\begin{array}{c}\hfill \text{total}n\text{of sepsis cases in which}\\ \hfill \text{resuscitation fluid were prescribed}\\ \hfill \end{array}}\times 100$
Time to perform blood lactate monitoring	4. Time to blood lactate monitoring (time to obtaining initial lactate level) Proportion of cases in which lactate level was drawn within 30 min after prescription Measured: (n cases in which lactate level was drawn < 1 h of sepsis onset/total n of sepsis cases in which blood lactate level can be monitored*) × 100 $\frac{\begin{array}{c}\hfill n\text{cases in which blood lactate was monitored}\\ \hfill \text{< 1h of sepsis onset}\\ \hfill \end{array}}{\begin{array}{c}\hfill \text{total}n\text{of sepsis cases in which}\\ \hfill \text{blood lactate level can be monitored}\\ \hfill \end{array}}\times 100$
Maintaining glucose control	5. Glucose blood value levels < 180 mg/dL Proportion of cases in which glycemia was < 180 mg/dL within 6 h of onset of hyperglycemia Measured: (n cases in which glucose blood value levels were (< 180 mg/dL) < 6 h/total n of sepsis cases presenting with hyperglycemia) × 100 $\frac{\begin{array}{c}\hfill n\text{cases in which glucose was normalized}\left(<180\text{mg/dL}\right)\\ \hfill <6\text{h of onset hyperglycemia}\\ \hfill \end{array}}{\text{total}n\text{of sepsis cases presenting with hyperglycemia}}\times 100$
Family care conference to address goals of care	6. Patients receiving family care conference to address goals of care within 72 h of ICU admission Proportion of cases in which patients received family care conference to address goals of care within 72 h of ICU admission Measured: (n cases in which a family care conference was held to address goals of care within 72 h of ICU admission/total n of sepsis cases with an ICU admission of > 72 h) × 100 $\frac{n\text{cases in which a family care conference was provided}}{\text{total}n\text{of sepsis cases with an ICU stay > 72h}}\times 100$
Total sepsis bundle performance	7. Compliance to all aforementioned quality indicators Proportion of cases in which all elements of the sepsis bundle were implemented Measured: (n cases in which all elements of the sepsis bundle were implemented/total n of sepsis cases) × 100

*In settings where blood lactate monitoring is not readily available (low resource countries), this indicator can be omitted from the quality control