Severe sepsis is a common cause of admission to the intensive care unit and is associated with a high hospital mortality.  This audit explored the current use of, and attitudes towards, recombinant activated protein C therapy across Scotland, and compared these with current guidance.  Patients with severe sepsis were followed for 3 days.  Consideration and/or usage of recombinant activated protein C were compared with two different guidelines.  97 patients were admitted to the intensive care unit over the audit period.  Recombinant activated protein C was used in 9 of these patients.  Depending on the criteria used, between 50% and 81% of the patients who qualified for recombinant activated protein C therapy did not receive it.  Subsequent to the audit, a survey was performed to study intensive care unit consultants' attitudes to recombinant activated protein C therapy.  A total of 125 consultants responded to the survey (77%).  Of these, 104 (83%) stated that they used recombinant activated protein C in their clinical practice, 56 (52%) of whom prescribed it to patients with two-organ failures and an Acute Physiology and Chronic Health Evaluation II score of 25 or higher.  39 respondents (38%) stated that two-organ failures alone would be an adequate trigger for therapy.  We conclude that recombinant activated protein C is potentially under-used to treat severe sepsis.  Many consultants seem to reserve the drug for the most severely ill sub group of patients.