Low-dose steroids* have been shown to prolong survival in patients with refractory shock in some 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. In that case, simply assign credit for the steroid policy as if it had been followed.

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 200–300 mg of hydrocortisone or equivalent.

Increase administration of low-dose steroids in accordance with a standardized ICU policy to 100 percent of indicated septic shock cases.

Data may be collected concurrently — that is, once a patient is placed on the hospital’s severe sepsis protocol, data can be abstracted from the patient chart in real time — or retrospectively using a chart review, a method generally recommended for more experienced improvement teams.