Hour-1 Bundle Audit
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Osman, Faadumo -- Sepsis bundle review
The Hour-1 Sepsis Bundle requires all components to be completed within 60 minutes of sepsis recognition. Review what happened in this case and reflect on the timeline.
Case timeline
07:20Pre-alert
Nurse begins assessment -- Room 412
Faadumo confused and attempting egress. Cabdilaahi at bedside.
07:45Alert -- clock starts
SIRS criteria identified -- sepsis alert activated
Temp 38.4 C, HR 102 bpm. Hour-1 window now open.
07:483 min -- I complete
NS 0.9% rate verified and documented
IV fluids already running on admission. Bundle step I confirmed.
08:0520 min -- D complete
Blood cultures x2 drawn + serum lactate sent on ice
Extra time required -- patient combative, required support from Cabdilaahi for positioning. Lactate transported to lab immediately.
08:1227 min -- R complete
Provider notified -- Ceftriaxone on hold, CKD clarification requested
Hold documented. Awaiting provider callback.
08:1631 min -- while waiting
Urine specimen collected by straight catheterization
Provider callback was not yet received. Nurse used the wait time productively. FGM/C Type II required careful technique and additional positioning. Specimen sent to lab at 08:19.
08:2843 min -- callback delay
Provider callback received -- Ceftriaxone confirmed safe to give as ordered
16-minute wait for callback. Dual biliary and renal clearance confirmed -- no dose adjustment required. Charge nurse notified of delay at 08:20. Barrier documented.
08:3449 min -- A complete, in window
Ceftriaxone 1g IV administered
Antibiotic given with 11 minutes to spare. Bundle step A complete.
08:4257 min -- I confirmed in window
Urine output monitoring initiated and documented
Catheter already in place from specimen collection. Hourly output monitoring confirmed and charted. Bundle step N initiated.
08:5166 min -- 6 min over
Full bundle documentation completed
All five bundle steps confirmed and timestamped. Bundle step N fully documented. Six minutes outside the window -- barrier noted as provider callback delay.
Antibiotic in window at 49 min -- urine output in window at 57 min -- full documentation 6 minutes over
The two most time-sensitive steps -- antibiotic administration at 49 minutes and urine output monitoring at 57 minutes -- were both completed within the one-hour window. That is a meaningful achievement given the provider callback delay and the additional steps required for safe specimen collection.
Full bundle documentation closed six minutes outside the window. The primary barrier was the 16-minute wait for a provider callback to confirm Ceftriaxone dosing. That delay was documented, escalated to the charge nurse, and was outside direct nursing control. These were not errors -- they were the right decisions made in a genuinely complex situation.
Reflect with your group
1. Which step in the timeline created the longest delay, and what caused it?
2. Which factors were specific to Faadumo -- her history, her presentation, or her identity -- that made this bundle more complex to complete than a straightforward sepsis case?
3. Name one change at the system level -- a hospital policy, unit workflow, or staffing decision -- that could help nurses complete the bundle faster for patients like Faadumo.
4. Name one thing you would carry into your own practice from this case.
Bundle audited.
You made it through. Take the final card.
Take card #9
9