Re: [Sepsis Groups] severe sepsis presentation

[Pamela Green]

We use the initial Triage Vital Signs, Elevated Lactate etc... as Time zero if 
they meet criteria for Severe Sepsis or Septic Shock.  The Criteria for 
Screening is any of those Vitals that screen Sepsis is present or Labs etc.. 
that have a time stamp. If you are waiting until the doctor decides that it is 
final Diagnosis for admit you are already in a late presentation. Our policy is 
nurse driven protocol to initiate Code Sepsis if the patient Screens as at Risk 
of/or having Severe Sepsis/Septic Shock. That is time Zero and starts the 
clock.  The scenario that was used indicates that time from initial triage 
vital signs is outside of 3 hour window.  Are you waiting until the Physician 
final diagnosis of Sepsis documented to initiate EGDT when indicated?

From: Sepsisgroups  On Behalf Of 
Schrecengost, Lisa M.
Sent: Tuesday, June 26, 2018 9:00 AM
To: sepsisgroups@lists.sepsisgroups.org
Subject: [Sepsis Groups] severe sepsis presentation

Hello all.


Need help!!   We are having issues with figuring out severe sepsis presentation 
times.   We are having discrepancies at our facility understanding what times 
to use, especially when the physician has severe sepsis as the impression and 
there are other times within the note.


We have a patient that comes into the ED.  The note was opened at 16:37 by the 
physician. In the body of the report, it says "Time of sepsis diagnosis is 
19:50". Pulse of 104 at 16:19. Respirations of 24 at 16:19. Lactate 2.9 at 
17:50. He documents in the body of the note "the patient has severe sepsis but 
not septic shock".
Primary impression documented on the ED Physician Report is Pneumonia, 
additional impression is Severe Sepsis. What time should we collect as Time of 
Severe Sepsis?   Do we take the time the note was opened since he has an 
impression of severe sepsis or use the times within the body of the note?


Thanks for your time,
Lisa




Lisa Schrecengost RN BSN
Quality Management
ACMH Hospital
One Nolte Drive
Kittanning, PA 16201
Phone:  724-543-8871
email:  schrecengo...@acmh.org
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[Sepsis Groups] Septic Shock Documentation By Provider

[Doskotz, Margaret L.]

Hi,  The below documentation was found in a physician note.  Would you consider 
this documentation of septic shock?We are aware of the qualifier list in 
the data dictionary but wonder if the documentation below falls somewhere in 
between. Has anyone sent a query regarding similar documentation to CMS and 
received a response?
[cid:image003.png@01D411EE.F6A2CCA0]

Thank you,
Peg

Margaret Doskotz, RN
Quality Measures Data Manager
Quality Measurement and Analytics
31 Research Way, Suite 100, East Setauket, NY 11733
Internal Zip- 9297
Phone- 631-444-4709
Fax: (631) 444-5870
margaret.dosk...@stonybrookmedicine.edu

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Re: [Sepsis Groups] severe sepsis presentation [External]

[Cox, Debra M. (RN)]

Be aware: [This message came from outside of Spartanburg Regional Network]

Is there anything in the ED record or nursing documentation showing a source? 
This can even be "Sepsis ED order" or the triage impression of a code Sepsis. 
If so, what time is this documentation?

Get Outlook for iOS

From: Sepsisgroups  on behalf of 
Schrecengost, Lisa M. 
Sent: Tuesday, June 26, 2018 10:00:26 AM
To: sepsisgroups@lists.sepsisgroups.org
Subject: [Sepsis Groups] severe sepsis presentation [External]

Be aware: [This message came from outside of Spartanburg Regional Network]

Hello all…..


Need help!!   We are having issues with figuring out severe sepsis presentation 
times.   We are having discrepancies at our facility understanding what times 
to use, especially when the physician has severe sepsis as the impression and 
there are other times within the note.


We have a patient that comes into the ED.  The note was opened at 16:37 by the 
physician. In the body of the report, it says "Time of sepsis diagnosis is 
19:50". Pulse of 104 at 16:19. Respirations of 24 at 16:19. Lactate 2.9 at 
17:50. He documents in the body of the note “the patient has severe sepsis but 
not septic shock”.
Primary impression documented on the ED Physician Report is Pneumonia, 
additional impression is Severe Sepsis. What time should we collect as Time of 
Severe Sepsis?   Do we take the time the note was opened since he has an 
impression of severe sepsis or use the times within the body of the note?


Thanks for your time,
Lisa




Lisa Schrecengost RN BSN
Quality Management
ACMH Hospital
One Nolte Drive
Kittanning, PA 16201
Phone:  724-543-8871
email:  schrecengo...@acmh.org
Confidentiality Notice: This e-mail message, including any attachments, is for 
the sole use of the intended recipient(s) and may contain confidential and 
privileged information. Any unauthorized review, use, disclosure or 
distribution is prohibited. If you are not the intended recipient, please 
contact the sender by reply e-mail and destroy all copies of the original 
message.


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Re: [Sepsis Groups] Sepsisgroups Digest, Vol 294, Issue 3

[Carlson, Brenda L]

Lisa, 

The severe sepsis presentation time can be a confusing data element. I would 
use the earliest time that the patient met the criteria for severe sepsis which 
would be the lactate result time of 17:50 (already met infection in the note 
opened at 16:37 and the 2/4 SIRS at 16:19). 

Brenda

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Sent: Tuesday, June 26, 2018 4:05 PM
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Subject: Sepsisgroups Digest, Vol 294, Issue 3

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Date: Tue, 26 Jun 2018 14:00:26 +
From: "Schrecengost, Lisa M." 
To: "sepsisgroups@lists.sepsisgroups.org"

Subject: [Sepsis Groups] severe sepsis presentation
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Hello all.


Need help!!   We are having issues with figuring out severe sepsis presentation 
times.   We are having discrepancies at our facility understanding what times 
to use, especially when the physician has severe sepsis as the impression and 
there are other times within the note.


We have a patient that comes into the ED.  The note was opened at 16:37 by the 
physician. In the body of the report, it says "Time of sepsis diagnosis is 
19:50". Pulse of 104 at 16:19. Respirations of 24 at 16:19. Lactate 2.9 at 
17:50. He documents in the body of the note "the patient has severe sepsis but 
not septic shock".
Primary impression documented on the ED Physician Report is Pneumonia, 
additional impression is Severe Sepsis. What time should we collect as Time of 
Severe Sepsis?   Do we take the time the note was opened since he has an 
impression of severe sepsis or use the times within the body of the note?


Thanks for your time,
Lisa




Lisa Schrecengost RN BSN
Quality Management
ACMH Hospital
One Nolte Drive
Kittanning, PA 16201
Phone:  724-543-8871
email:  schrecengo...@acmh.org
Confidentiality Notice: This e-mail message, including any attachments, is for 
the sole use of the intended recipient(s) and may contain confidential and 
privileged information. Any unauthorized review, use, disclosure or 
distribution is prohibited. If you are not the intended recipient, please 
contact the sender by reply e-mail and destroy all copies of the original 
message.


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[Sepsis Groups] Questions re July spec manual

[Belfi, Karen]

I have a question regarding some of the additions to the spec manual for July.
Under Severe Sepsis, in the examples of acceptable/unacceptable documentation, 
there are a couple examples I'm questioning.




Examples of Acceptable physician/APN/PA documentation: o "Creatinine 
3.0, CKD, HD in am" Do not use value since the creatinine and the chronic 
condition are in the same sentence in the documentation.









We wouldn't use this anyway, correct, because of the HD? Elsewhere it states:
Creatinine >2.0 o If there is physician/APN/PA documentation the patient has 
end stage renal disease (ESRD) and is on hemodialysis or peritoneal dialysis 
all reported creatinine levels should be disregarded as signs of organ 
dysfunction. ESRD (on hemodialysis or peritoneal dialysis) and creatinine 
levels or reference to elevated creatinine levels do not need to be included in 
the same physician/APN/PA documentation.






Under Unacceptable documentation it states:

[cid:image001.png@01D40DEF.A13CD3D0]



However, we wouldn't use the INR because of the documentation of being on 
Warfarin, correct?

Because elsewhere there's a bullet that states:
If the suggested data source shows the patient was given an anticoagulant 
medication in Appendix C Table 5.3, an elevated INR or aPTT level should not be 
used as organ dysfunction. Physician/APN/PA documentation is not required.

Thanks,





Karen Belfi, RN, MSN
Quality Outcomes Coordinator
Lankenau Medical Center
(484)476-8092

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