Low-Dose Steroid Administration
Low-Dose Steroid Administration
Definition
Low-dose steroids* have been shown to prolong survival in severely septic patients in clinical trials. There may also be a mortality benefit to low-dose steroid administration.
Compliance with this management bundle element is defined as the percent of patients with septic shock for whom low-dose steroids were administered in accordance with a standardized ICU policy within 24 hours following the time of presentation.
Note: it is possible that the standardized ICU policy that governs steroid administration concludes that steroids should not be given in a particular case. The structure of the data collection tools assigns credit for this indicator in that case, as long as there is annotation in the chart concluding that steroids were not indicated by protocol.
Numerator: The number of patients with septic shock for whom low-dose steroids were administered in accordance with a standardized ICU policy within 24 hours following time of presentation
Denominator: The total number of patients with septic shock
*Low-dose steroids refer to a daily dose of 200 to 300 mg of hydrocortisone or equivalent. A steroid equivalency chart is provided in the Individual Chart Measurement Tool.
Goal
Increase administration of low-dose steroids in accordance with a standardized ICU policy to 100 percent of indicated septic shock cases.
Data Collection Plan
Data is collected for this measure on each individual patient using the Individual Chart Measurement Tool. This can be done concurrently or retrospectively as detailed here.
Once all the Individual Chart Measurement Tools have been collected for the month, the Monthly Measurement Worksheet integrates the data by combining the results of all the Individual Chart Measurement Tools.
At the end of each section on the Monthly Measurement Worksheet you will find a line designated “Numerator” and a line designated “Denominator,” which are ready for input into the pre-configured Improvement Tracker for the measure.
