Re: [Sepsis Groups] Sepsis & COVID

[Shimandle, Ruth [UCH]]

Specifications Manual 5.7 states:
Choose Value “2” if within 6 hours after documentation meeting clinical 
criteria or physician/APN/PA documentation of Severe Sepsis there is additional 
physician/APN/PA documentation indicating: ….
o Severe Sepsis or Septic Shock is due to a viral, fungal, or parasitic 
infection.

My understanding of the abstraction notes is:
If there is documentation within 6 hours of meeting severe sepsis criteria, 
stating severe sepsis or septic shock is related to COVID (even if it could 
also have a bacterial component) we should answer “no” to Severe Sepsis Present.
If however there is only documentation stating infection or sepsis is related 
to COVID, then you would ignore documentation of viral infection, but accept 
documentation of that may also be associated with bacterial infection. For 
example, “Infection: Covid vs bacterial”, you would accept that as 
documentation of infection, based on the documentation that it could be a 
bacterial infection. “Septic Shock: Covid with superimposed bacterial pna”, you 
would answer “no” to Severe Sepsis present, based on the documentation that 
septic shock is due to a viral infection.


RUTH SHIMANDLE, RN, MPH, CPHQ
Clinical Documentation Nurse
Data and Analytics
UChicago Medicine
5700 S. Maryland Ave. | CCD 1192, MC2009 | Chicago, IL 60637
Office: 773-702-3192
AT THE FOREFRONT®
uchospitals.edu
uchicagokidshospital.org
facebook.com/UChicagoMed
Twitter: @UChicagoMed

From: Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On 
Behalf Of Roney, Jamie K
Sent: Thursday, June 11, 2020 10:29 AM
To: Deffenbaugh, Amy M ; Merwin, Courtney C. 
; 'sepsisgroups@lists.sepsisgroups.org' 

Subject: Re: [Sepsis Groups] [EXTERNAL] Re: Sepsis & COVID

Good morning,

Any organism, whether viral, fungal, parasitic, bacterial, etc., has always had 
the possibility of triggering the systemic sepsis response and has never 
changed the treatment recommendations of EGDT by experts. Viral infection is 
not an exclusionary criteria for abstraction and both co-owners of the CMS 
Sepsis Core Measure are a part of this forum (one being Dr. Rivers who 
introduced us to EGDT), thus I should not speak for them. Known bacterial 
infection or not does not impact our treatment or abstraction of these patients.

Respectfully,

Dr. Roney


Jamie Roney, DNP, RN, BSHCM, NPD-BC, CCRN-K
Regional sepsis coordinator/Nursing Professional Development Specialist IV
"Be a yardstick of quality. Some people aren't used to an environment where 
excellence is expected." ~Steve Jobs

3615 19th Street, Lubbock, TX 79410
T: (806) 725-4689C: (806) 773-1914
www.covenanthealth.org
..
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Re: [Sepsis Groups] [EXTERNAL] Re: Sepsis & COVID

[Jessica Harkey]

Amy is correct about SEP-1 spec manual directing abstractors to use 
documentation of viral infections to exclude that in the time of presentation 
criteria as suspicion of infection. We are dealing with this issue and 
providers looking for a “workaround” to avoid a SEP-1 failure in our COVID19 
PUIs.

But to Dr. Roney’s point, in practice we should not exclude suspicion of viral 
illness from appropriate sepsis care.  SEP-1 abstraction requirements do not 
always align with delivery of care.

The SEP-1 measure does not guide treatment, it guides abstraction methods.


Jessica Harkey, MSN, RN, ACCNS-AG
Manager, Sepsis Quality
Quality, Safety and Risk
2500 Grant Road, Mountain View, CA 94040
650-988-7968 Office
661-330-2396 Cell
jessica_har...@elcaminohealth.org
elcaminohealth.org
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From: Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On 
Behalf Of Deffenbaugh, Amy M
Sent: Thursday, June 11, 2020 9:41 AM
To: Roney, Jamie K; Merwin, Courtney C.; 'sepsisgroups@lists.sepsisgroups.org'
Subject: Re: [Sepsis Groups] [EXTERNAL] Re: Sepsis & COVID

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The CMS specs manual specifically says “Documentation that is not acceptable 
for infection: Viral infections”
Also, it says,  “If physician/APN/PA documentation within 6 hours following the 
initial documentation of an infection indicates that the infection is due to a 
viral, fungal or parasitic source disregard the documentation of the initial 
infection”
From: Roney, Jamie K 
Sent: Thursday, June 11, 2020 11:29 AM
To: Deffenbaugh, Amy M ; Merwin, Courtney C. 
; 'sepsisgroups@lists.sepsisgroups.org' 

Subject: RE: [EXTERNAL] Re: [Sepsis Groups] Sepsis & COVID

Good morning,

Any organism, whether viral, fungal, parasitic, bacterial, etc., has always had 
the possibility of triggering the systemic sepsis response and has never 
changed the treatment recommendations of EGDT by experts. Viral infection is 
not an exclusionary criteria for abstraction and both co-owners of the CMS 
Sepsis Core Measure are a part of this forum (one being Dr. Rivers who 
introduced us to EGDT), thus I should not speak for them. Known bacterial 
infection or not does not impact our treatment or abstraction of these patients.

Respectfully,

Dr. Roney


Jamie Roney, DNP, RN, BSHCM, NPD-BC, CCRN-K
Regional sepsis coordinator/Nursing Professional Development Specialist IV
"Be a yardstick of quality. Some people aren't used to an environment where 
excellence is expected." ~Steve Jobs

3615 19th Street, Lubbock, TX 79410
T: (806) 725-4689C: (806) 773-1914
www.covenanthealth.org
..

Re: [Sepsis Groups] [EXTERNAL] Re: Sepsis & COVID

[Knight Elizabeth]

Here is the question that we submitted and the response that we received from 
CMS:


If Covid-19 or Covid-19 suspect are in the final discharge diagnosis, do 
patients excluded from the Sep-1 bundle (since it is a viral infection)?

Thank you for your question.
You would disregard documentation of a viral infection and continue abstraction 
per the guidance in manual v5.7.
Cases would only be excluded from the measure if they didn't meet the severe 
sepsis present data element or if severe sepsis was documented as due to a 
viral infection within 6 hours after the severe sepsis presentation time.
We are not expecting any additional guidance to be added to manual v5.7 related 
to COVID-19 cases since CMS is no longer requiring submission of 1st or 2nd 
quarter cases.
Manual v5.8 was recently updated with the below guidance, which will be used in 
abstraction of July 1 – December 31, 2020 discharges.
Severe Sepsis Present – Manual v5.8  - Select Value "2" if there is 
physician/APN/PA documentation that coronavirus or COVID-19 is suspected or 
present.

Beth
Beth Knight, BSN, RN, OCN
Clinical Quality Specialist II
Healthcare Quality
Franciscan Health
Indianapolis, Carmel, Mooresville
Sierra Building
1040 Sierra Drive
Suite 1900
Greenwood, IN 46143
Work Phone: 317-528-1470
Cell Phone: 317-965-0430
elizabeth.kni...@franciscanalliance.org


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From: Sepsisgroups  On Behalf Of 
Roney, Jamie K
Sent: Thursday, June 11, 2020 11:29 AM
To: Deffenbaugh, Amy M ; Merwin, Courtney C. 
; 'sepsisgroups@lists.sepsisgroups.org' 

Subject: Re: [Sepsis Groups] [EXTERNAL] Re: Sepsis & COVID


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Good morning,

Any organism, whether viral, fungal, parasitic, bacterial, etc., has always had 
the possibility of triggering the systemic sepsis response and has never 
changed the treatment recommendations of EGDT by experts. Viral infection is 
not an exclusionary criteria for abstraction and both co-owners of the CMS 
Sepsis Core Measure are a part of this forum (one being Dr. Rivers who 
introduced us to EGDT), thus I should not speak for them. Known bacterial 
infection or not does not impact our treatment or abstraction of these patients.

Respectfully,

Dr. Roney


Jamie Roney, DNP, RN, BSHCM, NPD-BC, CCRN-K
Regional sepsis coordinator/Nursing Professional Development Specialist IV
"Be a yardstick of quality. Some people aren't used to an environment where 
excellence is expected." ~Steve Jobs

3615 19th Street, Lubbock, TX 79410
T: (806) 725-4689C: (806) 773-1914
www.covenanthealth.org
..