Re: [Sepsis Groups] [External] Sepsisgroups Digest, Vol 275, Issue 3

[Sandy Tobar]

We had a similar discussion so we have the provider order the initial lactate 
and a repeat x 1 in 180 minutes after the initial. The subsequent lactate is 
cancelled if the lactate is <2.0.  This eliminates the auto repeat order 
without a validation by providers because 2 are ordered initially. We have had 
success with this.

Sandy Tobar MSBA, BSN, RN, CPPS
Director, Clinical Transformation Sepsis, HAI & Patient Safety
Trinity Health
sandra.to...@trinity-health.org
W  734-343-1496
20555 Victor Parkway 
Livonia, MI 48152
trinity-health.org | Facebook | Twitter | LinkedIn



-Original Message-
From: Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On 
Behalf Of sepsisgroups-requ...@lists.sepsisgroups.org
Sent: Tuesday, January 09, 2018 9:43 AM
To: sepsisgroups@lists.sepsisgroups.org
Subject: [External] Sepsisgroups Digest, Vol 275, Issue 3

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Today's Topics:

   1. Automated Lactate Orders (Rutherford, Richard)
   2. Re: Antibiotics/ normal saline shortage
  (Hodge - Garrett, Sara Mical)


--

Message: 1
Date: Mon, 8 Jan 2018 22:53:36 +
From: "Rutherford, Richard" 
To: "sepsisgroups@lists.sepsisgroups.org"

Subject: [Sepsis Groups] Automated Lactate Orders
Message-ID:



Content-Type: text/plain; charset="iso-8859-1"

Hello All,


We are having a debate in our organization about whether automatic lactate 
orders violate nursing standard of practice.  Currently if a patient in ED or 
on floor screens in for sepsis, the nurse follows hospital protocol and orders 
a lactate which is then routed to the attending physician for cosignature 
(after drawn).   We also have an automated order to repeat lactate at 4 hours 
for admitted patients with an initial lactate>2.I believe our initial 
lactate order in ER is covered by Standardized Nursing Procedures.  We are 
having more debate around the initial lactate ordered on inpatients and the 
automated second lactate on all patients with lactate>2 without a prior 
physician order.


I am interested in knowing if other hospitals use our approach, and if so is 
nursing leadership feeling comfortable that nursing standards of practice are 
not being violated.


Thanks,


Rick Rutherford

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Message: 2
Date: Wed, 3 Jan 2018 17:41:33 +
From: "Hodge - Garrett, Sara Mical"

To: 'Angela Craig' , 'Tara Miller'
,
"sepsisgroups@lists.sepsisgroups.org"

Subject: Re: [Sepsis Groups] Antibiotics/ normal saline shortage
Message-ID: <246a1a4685bd471a8005998500912...@harrishealth.org>
Content-Type: text/plain; charset="utf-8"

In Houston, many of the hospitals are being affected by the saline shortage.  
In order to  be proactive, we are doing IVP medications as well.

Sara M. Hodge-Garrett, MSN, RN, MSCRN, CPHQ Quality Manager Ben Taub Hospital 
Quality Programs HARRIS HEALTH SYSTEM
1504 Taub Loop |  Houston, TX 77030 | phone 713.873.4452 
sara.hodge-garr...@harrishealth.org


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Re: [Sepsis Groups] Sepsisgroups Digest, Vol 275, Issue 3

[Pender . Linda]

Rick,
We are in the process of a Nursing Workflow change in response to the exact 
scenario you are facing. The way we are proposing to  handle the inpatient 
situation is to give nursing the ability to cancel the automatic order if there 
is no suspicion of new or worsening infection. This allows the nurse to stay 
within the nursing standards of practice.  We are also hoping to decrease 
excessive Lactic Acids that are unnecessary. Wish us luck!

Linda G. Pender RRT-NPS
Sepsis Coordinator
Patient Care Services  Administration
phone: 478-633-6806  pager: 
KNOW Sepsis: Inside & Out

Confidential Quality Improvement: Not for Disclosure
Email: pender.li...@navicenthealth.org


-Original Message-
From: Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On 
Behalf Of sepsisgroups-requ...@lists.sepsisgroups.org
Sent: Tuesday, January 09, 2018 9:43 AM
To: sepsisgroups@lists.sepsisgroups.org
Subject: Sepsisgroups Digest, Vol 275, Issue 3

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You can reach the person managing the list at
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When replying, please edit your Subject line so it is more specific than "Re: 
Contents of Sepsisgroups digest..."


Today's Topics:

   1. Automated Lactate Orders (Rutherford, Richard)
   2. Re: Antibiotics/ normal saline shortage
  (Hodge - Garrett, Sara Mical)


--

Message: 1
Date: Mon, 8 Jan 2018 22:53:36 +
From: "Rutherford, Richard" 
To: "sepsisgroups@lists.sepsisgroups.org"

Subject: [Sepsis Groups] Automated Lactate Orders
Message-ID:


Content-Type: text/plain; charset="iso-8859-1"

Hello All,


We are having a debate in our organization about whether automatic lactate 
orders violate nursing standard of practice.  Currently if a patient in ED or 
on floor screens in for sepsis, the nurse follows hospital protocol and orders 
a lactate which is then routed to the attending physician for cosignature 
(after drawn).   We also have an automated order to repeat lactate at 4 hours 
for admitted patients with an initial lactate>2.I believe our initial 
lactate order in ER is covered by Standardized Nursing Procedures.  We are 
having more debate around the initial lactate ordered on inpatients and the 
automated second lactate on all patients with lactate>2 without a prior 
physician order.


I am interested in knowing if other hospitals use our approach, and if so is 
nursing leadership feeling comfortable that nursing standards of practice are 
not being violated.


Thanks,


Rick Rutherford

-- next part --
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--

Message: 2
Date: Wed, 3 Jan 2018 17:41:33 +
From: "Hodge - Garrett, Sara Mical"

To: 'Angela Craig' , 'Tara Miller'
,
"sepsisgroups@lists.sepsisgroups.org"

Subject: Re: [Sepsis Groups] Antibiotics/ normal saline shortage
Message-ID: <246a1a4685bd471a8005998500912...@harrishealth.org>
Content-Type: text/plain; charset="utf-8"

In Houston, many of the hospitals are being affected by the saline shortage.  
In order to  be proactive, we are doing IVP medications as well.

Sara M. Hodge-Garrett, MSN, RN, MSCRN, CPHQ Quality Manager Ben Taub Hospital 
Quality Programs HARRIS HEALTH SYSTEM
1504 Taub Loop |  Houston, TX 77030 | phone 713.873.4452 
sara.hodge-garr...@harrishealth.org


CONFIDENTIALITY NOTICE:
If you have received this e-mail in error, please immediately notify the sender 
by return e-mail and delete this e-mail and any attachments from your computer 
system.
To the extent the information in this e-mail and any attachments contain  
protected health information as defined by the Health Insurance Portability  
and Accountability Act of 1996 ("HIPAA"), PL 104-191; 45 CFR Parts 160 and  
164; or Chapter 181, Texas Health and Safety Code, it is confidential and/or  
privileged.  This 

Re: [Sepsis Groups] Procalcitonin and Lactate Questions

[Pamela Green]

Sorry I was referring to initial Lactate on the second statement

From: Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On 
Behalf Of Pamela Green
Sent: Tuesday, January 09, 2018 8:43 AM
To: Robert Hattabaugh ; 
'sepsisgroups@lists.sepsisgroups.org' 
Subject: Re: [Sepsis Groups] Procalcitonin and Lactate Questions

We use it for ABX stewardship on all patients for Antibiotic effectiveness.  We 
count as meeting the compliance if it was attempted within the 3 and 6 hour 
time frame, however our expectation is  that we document a result if at all 
possible in presence of Sever or Septic Shock.

From: Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On 
Behalf Of Robert Hattabaugh
Sent: Wednesday, January 03, 2018 12:03 PMmeasured
To: 'sepsisgroups@lists.sepsisgroups.org' 
>
Subject: [Sepsis Groups] Procalcitonin and Lactate Questions


1.  Procalcitonin: is anyone using this in their sepsis protocol, as a 
routine lab with Sepsis patients or how is it being used in your facility 
overall; ABX stewardship...

2.  If the provider or nurse is unable to obtain blood for initial or 
repeat lab work, lactate, etc..., secondary to shock, etc... are you 
abstracting the cases as meeting the measure or falling out of the measure.  
CMS SEP-1 notes for Abstraction- "if a lactate level is ordered and there is an 
attempt to collect it, but the attempt results in failure to collect the 
specimen (too dehydrated to get a vein) or the specimen was contaminated during 
or after the draw."

Thanks in advance for your response
Robert Hattabaugh MSN, RN, ACNS-BC, CMSRN
Adult Health Clinical Nurse Specialist
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Re: [Sepsis Groups] Automated Lactate Orders

[Angela Craig]

At my hospital we have the repeat lactate as part of our sepsis protocol.  It 
is spelled out in our policy that nurses are to redraw an elevated lactate.  It 
is an automatic reflex order with our lab as well.  We have not had an issue.

Angela Craig APN,MS,CCNS
Clinical Nurse Specialist
Intensive Care Unit
Cookeville Regional Medical Center
931-783-5035


From: Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On 
Behalf Of Rutherford, Richard
Sent: Monday, January 08, 2018 4:54 PM
To: sepsisgroups@lists.sepsisgroups.org
Subject: [Sepsis Groups] Automated Lactate Orders


Hello All,



We are having a debate in our organization about whether automatic lactate 
orders violate nursing standard of practice.  Currently if a patient in ED or 
on floor screens in for sepsis, the nurse follows hospital protocol and orders 
a lactate which is then routed to the attending physician for cosignature 
(after drawn).   We also have an automated order to repeat lactate at 4 hours 
for admitted patients with an initial lactate>2.I believe our initial 
lactate order in ER is covered by Standardized Nursing Procedures.  We are 
having more debate around the initial lactate ordered on inpatients and the 
automated second lactate on all patients with lactate>2 without a prior 
physician order.



I am interested in knowing if other hospitals use our approach, and if so is 
nursing leadership feeling comfortable that nursing standards of practice are 
not being violated.



Thanks,



Rick Rutherford

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