Re: [Sepsis Groups] [**External**] Sepsis Alert

[Mary Draper]

Thanks Ron good analysis.

Mary Draper RN BSN
QI Coordinator
Quality Management
Office (925) 674-2045
Cell (925) 451-8792
Fax (925) 674-2373
mary.dra...@johnmuirhealth.com

On May 18, 2017, at 7:42 PM, Ron Elkin 
> wrote:

Attached is a study showing a 38% incidence of bacteremia in ED patients 
presenting with out of hospital cardiac arrest. It is often unclear if the 
bacteremia was a contributing cause, or a result of the arrest, but the study 
suggests we should have a low threshold for instituting immediate empirical 
antimicrobial therapy in these patients.

Such patients will certainly complicate diagnosis, treatment, and outcomes if 
included in analysis of severe sepsis or septic shock unassociated with arrest.

Ron Elkin MD
San Francisco



On Wed, May 17, 2017 at 10:56 AM, Townsend, Sean, M.D. 
>
 wrote:
I would agree this is a confounder. You could delete from your local focus 
study, but they will still hit the metric for purposes of SEP-1.  I'm not sure 
how often you see this to justify a change to SEP-1, but if common I'd take a 
look.

On May 17, 2017, at 10:52 AM, Mary Draper 
>
 wrote:

Hi Dr. Townsend, I have been looking through the Severe Sepsis guidelines with 
regards to patient who present in cardiac arrest to the ED. I have not found 
any information specific to this issue.  Most of them have an elevated lactate. 
It is difficult to determine what was the cause of the arrest.  We are 
proposing to our Sepsis committee that we delete these patients from the focus 
study.
What are your thoughts on this subject?
Thanks

Mary Draper RN BSN
Coordinator Quality Improvement
Peer Review Support CV/CT
Quality Management JMH
Office (925) 674-2045
Cell (925) 451-8792
Fax (925) 674-2373
mary.dra...@johnmuirhealth.com

"O, let us always have a mountain within our soul,  with a peak so high that we 
never quite reach the top...
For then we will always strive for greater things and will not be content  with 
merely climbing hills." Ardath Rodale

-Original Message-
From: Sepsisgroups 
[mailto:sepsisgroups-boun...@lists.sepsisgroups.org]
 On Behalf Of Gwen S. Schneider
Sent: Saturday, May 13, 2017 10:20 AM
To: Townsend, Sean, M.D. 
>;
 Parker, Erin 
>
Cc: 
sepsisgroups@lists.sepsisgroups.org
Subject: Re: [Sepsis Groups] [**External**] Sepsis Alert

Hello,
I am interested in the responses you might receive from your question. We use 
EPIC, and we have for LA a value of >2.0 a call from lab as a critical. I am 
wondering if other hospitals are doing the same. And what does MS have to say 
about it?

Sierra Schneider
Salem Oregon

From: Sepsisgroups 
[sepsisgroups-boun...@lists.sepsisgroups.org]
 On Behalf Of Townsend, Sean, M.D. 
[towns...@sutterhealth.org]
Sent: Thursday, May 11, 2017 9:36 PM
To: Parker, Erin
Cc: 
sepsisgroups@lists.sepsisgroups.org
Subject: Re: [Sepsis Groups] [**External**]  Sepsis Alert

Erin,

I'm sorry you received an inflammatory and obtuse response to your question.  
Such posts have earned the name "troll" or having been "trolled" for  for a 
reason.

Maybe to get a real answer to your question, you could share with us which EHR 
you use?

Sean



On May 5, 2017, at 7:05 AM, Parker, Erin 
>>
 wrote:


WARNING: This email originated outside of the Sutter Health email system!
DO NOT CLICK links if the sender is unknown and never provide your User ID or 
Password.




Would any one like to share EHR sepsis alert criteria, and also be willing to 
share how it is working?
Thanks,
Erin

Erin Parker RN, BSN, ACM
Infection Preventionist, Epidemiology
Ascension  |  Genesys
One Genesys Parkway
Grand Blanc, MI 48439

Re: [Sepsis Groups] [**External**] Sepsis Alert

[Maggie.Macias]

I have had this occur as well. 

Maggie Macias, RN
Sepsis Program Coordinator
Valley Regional Medical Center
Brownsville, TX 
(956) 350-7179 (O)
maggie.mac...@hcahealthcare.com 


-Original Message-
From: Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On 
Behalf Of Townsend, Sean, M.D.
Sent: Wednesday, May 17, 2017 12:57 PM
To: Mary Draper 
Cc: sepsisgroups@lists.sepsisgroups.org
Subject: [EXTERNAL] Re: [Sepsis Groups] [**External**] Sepsis Alert

I would agree this is a confounder. You could delete from your local focus 
study, but they will still hit the metric for purposes of SEP-1.  I'm not sure 
how often you see this to justify a change to SEP-1, but if common I'd take a 
look.

On May 17, 2017, at 10:52 AM, Mary Draper  
wrote:

Hi Dr. Townsend, I have been looking through the Severe Sepsis guidelines with 
regards to patient who present in cardiac arrest to the ED. I have not found 
any information specific to this issue.  Most of them have an elevated lactate. 
It is difficult to determine what was the cause of the arrest.  We are 
proposing to our Sepsis committee that we delete these patients from the focus 
study.
What are your thoughts on this subject?
Thanks 

Mary Draper RN BSN
Coordinator Quality Improvement
Peer Review Support CV/CT
Quality Management JMH
Office (925) 674-2045
Cell (925) 451-8792
Fax (925) 674-2373
mary.dra...@johnmuirhealth.com

"O, let us always have a mountain within our soul,  with a peak so high that we 
never quite reach the top...
 For then we will always strive for greater things and will not be content  
with merely climbing hills." Ardath Rodale

-Original Message-
From: Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On 
Behalf Of Gwen S. Schneider
Sent: Saturday, May 13, 2017 10:20 AM
To: Townsend, Sean, M.D. ; Parker, Erin 

Cc: sepsisgroups@lists.sepsisgroups.org
Subject: Re: [Sepsis Groups] [**External**] Sepsis Alert

Hello,
I am interested in the responses you might receive from your question. We use 
EPIC, and we have for LA a value of >2.0 a call from lab as a critical. I am 
wondering if other hospitals are doing the same. And what does MS have to say 
about it?

Sierra Schneider
Salem Oregon

From: Sepsisgroups [sepsisgroups-boun...@lists.sepsisgroups.org] On Behalf Of 
Townsend, Sean, M.D. [towns...@sutterhealth.org]
Sent: Thursday, May 11, 2017 9:36 PM
To: Parker, Erin
Cc: sepsisgroups@lists.sepsisgroups.org
Subject: Re: [Sepsis Groups] [**External**]  Sepsis Alert

Erin,

I'm sorry you received an inflammatory and obtuse response to your question.  
Such posts have earned the name "troll" or having been "trolled" for  for a 
reason.

Maybe to get a real answer to your question, you could share with us which EHR 
you use?

Sean



On May 5, 2017, at 7:05 AM, Parker, Erin 
> wrote:


WARNING: This email originated outside of the Sutter Health email system!
DO NOT CLICK links if the sender is unknown and never provide your User ID or 
Password.




Would any one like to share EHR sepsis alert criteria, and also be willing to 
share how it is working?
Thanks,
Erin

Erin Parker RN, BSN, ACM
Infection Preventionist, Epidemiology
Ascension  |  Genesys
One Genesys Parkway
Grand Blanc, MI 48439
Ascension.org/Michigan
T: 810.606.5093
F: 810-606-5495
M: erin.par...@ascension.org


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[Sepsis Groups] Narrative documentation

[Belfi, Karen]

Can we get some clarification on this bullet point in the spec manual, under 
Broad Spectrum Antibiotic Administration:

Do not abstract antibiotics from narrative charting unless there is no other 
documentation that reflects that the same antibiotic was given during the 
specified timeframe.



I've seen some differing opinions in what is meant by this.

Thank you,



Karen Belfi, RN, MSN

Quality Outcomes Coordinator

Lankenau Medical Center

(484)476-8092
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