Sepsis Bundle Tracking in Nigeria: What ICU Software Should Record

Night shift, MAP 58, lactate 4.6. The registrar knows the Surviving Sepsis Campaign Hour-1 list. The question is whether anyone can later show which items were done, by whom, on this admission. A sepsis bundle is that record. It is not a red NEWS2 banner, and it is not the software deciding the patient has sepsis.

This guide is for medical directors, intensivists, ICU charge nurses, and administrators buying EMR or HMS in Nigeria. Pair it with NEWS2, SOFA, and critical lab alerts. Score the bundle on a named ICU admission, not a slide titled "AI sepsis."

What is a sepsis Hour-1 bundle in a Nigerian ICU?

The Hour-1 bundle is a Surviving Sepsis Campaign sequence. Begin at recognition. The published elements are:

1. Measure lactate. Repeat within 2-4 hours if the first value is above 2 mmol/L.
2. Draw blood cultures before antibiotics.
3. Give broad-spectrum antibiotics.
4. Start rapid crystalloid 30 mL/kg for hypotension or lactate at or above 4 mmol/L.
5. Apply vasopressors if still hypotensive during or after fluid, targeting MAP at or above 65 mmHg.

That list is a clinical standard (Levy 2018 Hour-1; Evans 2021 guidelines). It is not a software certificate. Buying an HMS does not make the hospital "SSC certified," and a vendor should not say it does.

What the software should do is make the list visible on the admission, tickable, and auditable. Paper round sheets lose the night the unit is slammed. WhatsApp groups mix the MAP with family numbers. A checklist in the chart is the middle path: the clinician still decides; the record stays with the patient.

DawaHQ puts this on the ICU admission as a Sepsis Bundle tab (ICU module, enable-per-clinic, on an ICU-placed bed). It is a clinician checklist, not a national registry submit. See critical care.

How is a sepsis bundle different from NEWS2 or SOFA?

Medical directors already know the split. Vendors mash them because all three sit in the ICU brochure.

NEWS2 aggregates ward vitals. A total of 5 or more is a medium trigger in the RCP standard, often worded as urgent response, consider sepsis. That is an early-warning score. It is not proof of infection, and it is not a bundle. See NEWS2.

SOFA scores organ failure. An acute rise of 2 or more points with suspected infection is part of the Sepsis-3 definition. Without the infection judgement, a rising SOFA is a prompt, not a label. DawaHQ's SOFA-delta notice is locked that way: assess for sepsis, pending infection suspicion. It does not write "this patient has sepsis" onto the chart. See SOFA.

The bundle is the work after recognition: lactate, cultures, antibiotics, fluids, vasopressors. You can have a high NEWS2 and no bundle. You can complete a bundle and still be arguing about the source. Buy both. Do not let a vendor substitute a score for a checklist.

qSOFA (0-3) is a screening score some units still write down. SSC 2021 does not recommend qSOFA as the single screen. DawaHQ stores a qSOFA field on the bundle if you enter it. It does not compute qSOFA from vitals, and it does not diagnose from that number.

What should Hour-1 software actually record?

At minimum you should see, on one named admission:

| Item | Why it matters | |------|----------------| | Lactate ordered | The clock starts with a number, not a guess | | Blood cultures drawn | Before antibiotics, or you lose the culture | | Antibiotics given, with the name | "Covered" is not a drug | | Fluid bolus started, with volume | 30 mL/kg is a dose, not a vibe | | Vasopressors if fluids did not restore MAP | Name the agent | | Repeat lactate if the first was above 2 mmol/L | Hour-1 is not finished after the first draw |

DawaHQ's ICU tab shows those five Hour-1 checks, antibiotic and vasopressor names, fluid volume in mL, initial and repeat lactate in mmol/L, a repeat-lactate checkbox, qSOFA 0-3, and notes. A progress pill shows % Complete.

Read the percentage before you buy the brochure. DawaHQ computes that percentage from four items: lactate, cultures, antibiotics, and fluids. Vasopressors and the lactate repeat are recorded; they are not in the four-item percentage. Bundle-complete follows those four. If a vendor says "100% Hour-1," ask which items are in the denominator.

Some product pages say Hour-1 and Hour-3 with time-to-completion. Ask to see the clock. DawaHQ can store per-item timestamps on the row if they are supplied. The day-to-day ICU tab does not stamp a time when you tick a box, and it does not flag items still open at 60 minutes. The lactate-repeat checkbox is the follow-up (the older Hour-3 repeat-lactate idea), not a second timed protocol screen. That is the honest demo. A countdown you cannot open is a slide.

The checklist is not closed-loop. Ticking "antibiotics given" does not dispense from pharmacy or write a MAR dose. Ticking "lactate ordered" does not create a lab request. Those are separate laboratory and MAR paths. You want them in the same HMS. You should not be told they are the same click.

Does the EMR diagnose sepsis or start the bundle for you?

No product that a Nigerian board should trust auto-diagnoses sepsis. Infection is a clinician judgement. Software can prompt.

DawaHQ does not auto-create a sepsis bundle row from NEWS2, from SOFA, or from a high lactate. The intensivist (or another consult-capable clinician) starts it on the ICU admission and updates it.

A separate ICU escalation exists when a lab reading named lactate is at or above 4 mmol/L on an admission. That is a red prompt: begin 30 mL/kg crystalloid; re-measure within 2-4 hours. It is not the bundle tab filling itself in. It also will not fire on LDH (the detector requires the parameter name lactate). Outpatient labs without an admission stay on the critical lab path, not this ICU event.

Do not buy "AI sepsis detection." DawaHQ's checks are rule-based scores and a checklist. There is no model labelling Sepsis-3.

Do not buy "NHIA integrated sepsis" or "NDHI / FHIR bundle submit." Prefer HMO claim workflows if the stay will be billed to a panel. See HMO claims. Minimise identifiable values in group chats. Prefer NDPA-oriented consent logging and a patient-access audit trail. We do not sell "NDPA certified" or "SSC certified EMR."

Who should be allowed to start and update the bundle?

The person who owns the recognition, not the cashier, and not a shared ward login.

On DawaHQ:

• The Sepsis Bundle tab shows on ICU-placed admissions (ICU bed type, or ICU ward when bed type is empty). General ward beds do not grow a fake ICU tab. The ICU module is still enable-per-clinic; the API blocks saves if the module is off.
• Nurses who can view the nurse chart can see the bundle.
• Starting and saving requires a consult capability. The server returns 403 otherwise. A cashier cannot write it.
• A locum should use their own login. See staff roles and handover.

The bundle does not replace FASTHUG-BID. De-escalation of antibiotics is a daily ICU safety item; Hour-1 is the first hour. Keep both. See FASTHUG-BID.

Paediatric and neonatal sepsis pathways differ (fluids, antibiotics, lactate interpretation). DawaHQ's checklist copy is the adult SSC Hour-1 wording. Do not run a paediatric demo and assume the same 30 mL/kg adult bolus is the product making the clinical call. The clinician still owns the dose.

What should we test in a sepsis-bundle demo?

Bring the medical director or the ICU consultant, not only the cashier.

1. Confirm the ICU module is on. Open an ICU-placed admission. Confirm a Sepsis Bundle tab. A general ward admission should not pretend to be ICU.
2. Log in as a nurse. Confirm the tab is visible and the ticks do not save. Log in as a doctor. Start the bundle.
3. Tick lactate, cultures, antibiotics, and fluids. Confirm the percentage reaches 100% from those four. Tick vasopressors. Confirm the percentage does not silently become a fifth item.
4. Enter antibiotic name, fluid volume, initial lactate 4.6, and a repeat. Save. Reload. Confirm the values persist.
5. Ask to see a 60-minute countdown from recognition time. If the vendor cannot show a clock, write that down. DawaHQ's tab will not invent one.
6. Chart a NEWS2 of 7. Confirm escalation. Confirm it did not auto-open a bundle. Rise SOFA by 2. Confirm the notice is "assess for sepsis," not a diagnosis.
7. If you have a lactate result on the admission, ask whether a value at or above 4 mmol/L raises an ICU prompt. Ask whether it also creates the checklist. In DawaHQ it prompts; it does not fill the ticks.
8. Ask for "AI sepsis," "Hour-3 timer," "SEP-1 certified," "NDHI / FHIR," or "NHIA integrated bundle." DawaHQ does not ship those claims.

If step 3 has no denominator you can name, you do not have a bundle. If step 6 auto-diagnoses, walk out.

What to do next

This week, write down who in your ICU is allowed to declare recognition after 16:00, and where today's Hour-1 list actually lives (paper, WhatsApp, or the chart).

Then book a demo or request access. Walk one ICU admission, one Hour-1 checklist, one nurse-cannot-save check, and one NEWS2 that does not auto-diagnose. Explore critical care, HMS for Nigeria, and EMR for Nigeria. Pricing is sales-led from ₦25,000/month, then a scoped quote. If the product cannot show the five Hour-1 items on a named bed, it will not help you in the morbidity meeting.