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

[Barnes-Daly, Mary Ann, MS, RN, CCRN, DC]

Sutter Health System:


  1.  Are you screening every patient? YES
  2.  Are they screened in Triage or not until they are in a room? Triage
  3.  If not screening every patient, what are the triggers for screening?
  4.  Is the screen on paper or electronic? EHR



Thanks,

MARY ANN BARNES-DALY MS RN CCRN-K DC  | Clinical Performance Improvement 
Consultant
Quality & Clinical Effectiveness Team | Office of Patient Experience
Sutter Health -2200 River Plaza Drive, Sacramento, CA 95833
Mobile 916.200.5604| barne...@sutterhealth.org
Pronouns: They/Them/Theirs






From: Sepsisgroups  On Behalf Of 
Orth, Claudia
Sent: Monday, January 14, 2019 1:05 PM
To: sepsisgroups@lists.sepsisgroups.org
Subject: [**External**] [Sepsis Groups] Sepsis Screening


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.



I'm hoping to get an idea of what other facilities are doing about ED Sepsis 
Screening:


  1.  Are you screening every patient?
  2.  Are they screened in Triage or not until they are in a room?
  3.  If not screening every patient, what are the triggers for screening?
  4.  Is the screen on paper or electronic?

Thank you in advance for being willing to share your expertise and experiences!

Best,
Claudia

Claudia Orth, BSN, RN, CCRN-K
Sepsis Coordinator
Clinical Quality
1105 Sixth St.
Traverse City, MI 49684
(231) 935-5692 voice
(231) 935-6629 fax
(231) 318-0394 pager
cor...@mhc.net

[MMC_Blue-SigSize96dpi]

Website
 I Find a 
Physician
 I 
Maps

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Re: [Sepsis Groups] [**External**] "Sepsis" Mortality vs. "Severe Sepsis" & Septic Shock Mortality

[Barnes-Daly, Mary Ann, MS, RN, CCRN, DC]

Hi Claudia;
At Sutter Health we report severe sepsis and septic shock combined and 
separately.
We show data as an aggregate for our combined 24 acute care facilities and for 
each discreet entity.
We do NOT include "simple" sepsis patients and we do not use the new sepsis 
definitions.



Thanks,

MARY ANN BARNES-DALY MS RN CCRN DC  | Clinical Performance Improvement 
Consultant
Quality & Clinical Effectiveness Team | Office of Patient Experience
Sutter Health -2200 River Plaza Drive, Sacramento, CA 95833
Mobile 916.200.5604| barne...@sutterhealth.org

All changes, even the most longed for, have their melancholy; for what we leave 
behind us is a part of ourselves.

Anatole France

[https://newsplus.sutterhealth.org/peninsula-coastal/files/2017/04/SH_Pride_Plus400-002-177x177.gif]

From: Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On 
Behalf Of Orth, Claudia
Sent: Friday, March 16, 2018 1:35 PM
To: sepsisgroups@lists.sepsisgroups.org
Subject: [**External**] [Sepsis Groups] "Sepsis" Mortality vs. "Severe Sepsis" 
& Septic Shock Mortality


WARNING: This email originated outside of the Sutter Health email system!
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Password.



Good Afternoon,

I am hoping to gain insight into how most other facilities are reporting their 
mortality to senior leadership, the board, etc. Depending on where we get our 
data from the mortality obviously varies greatly and it is not always clear 
what definitions or specifications are actually being used to garner the data!

I would be incredibly grateful to anyone willing to answer the following 
questions so I can make recommendations moving forward for our facility on how 
to best standardize and develop a "source of truth":


*Are you using "Overall Sepsis mortality" that includes all of the 
ICD-10 CM codes identified to fit per the CMS SEP-1 measure 
file:///C:/Users/corth1/Downloads/Appendix_A.1_v5_3a%20(1).pdf
 ?

*Or are you only reporting on "Severe Sepsis and Septic Shock" 
mortality which would be R6520 & R6521 similar to the grid below?

Measure Name:

Severe Sepsis/Septic Shock Mortality Rate

Numerator:

Patients with discharge status of expired

Denominator:

Patients with principle or secondary diagnosis of severe sepsis or septic shock

Harm Prevented:

Sepsis Death

Multiplier:

100

Y-axis title:

Sepsis mortality/100 sepsis diagnoses


*Or are you using something entirely different? :)

*Are you reporting a rate, a percentage, total number of deaths, ???

*Also is the mortality risk adjusted or not?

Thank you in advance for your time and consideration to share!

Sincerely,
Claudia Orth, BSN, RN, CCRN-K
Sepsis Coordinator
Clinical Quality

1105 Sixth St.
Traverse City, MI 49684
(231) 935-5692 voice
(231) 935-6629 fax
(231) 318-0394 pager
cor...@mhc.net

[MMC_Blue-SigSize96dpi]

Website
 I Find a 
Physician
 I 
Maps

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Re: [Sepsis Groups] [**External**] Sepsis Listserve question

[Barnes-Daly, Mary Ann, MS, RN, CCRN, DC]

I would suggest that the any hypotension in the face of sepsis can be 
considered organ failure - so 1 BP to define severe sepsis
2 BPs are needed to define septic shock

Thanks,

MARY ANN BARNES-DALY MS RN CCRN DC  | Clinical Performance Improvement 
Consultant
Quality & Clinical Effectiveness Team | Office of Patient Experience
Sutter Health -2200 River Plaza Drive, Sacramento, CA 95833
Mobile 916.200.5604| barne...@sutterhealth.org

All changes, even the most longed for, have their melancholy; for what we leave 
behind us is a part of ourselves.

Anatole France

[https://newsplus.sutterhealth.org/peninsula-coastal/files/2017/04/SH_Pride_Plus400-002-177x177.gif]

From: Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On 
Behalf Of Duane, Molly
Sent: Thursday, March 01, 2018 8:30 AM
To: 'sepsisgroups@lists.sepsisgroups.org' 
Subject: [**External**] [Sepsis Groups] Sepsis Listserve question


WARNING: This email originated outside of the Sutter Health email system!
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Password.



Good Morning,
I was wondering if anyone could explain the difference between 'Initial 
Hypotension' (that requires documentation of two BP's) and 'Hypotension as 
evidence of organ dysfunction' that only requires one BP reading. If the 
hypotension is used as organ dysfunction criteria for Severe Sepsis and it is 
the initial hypotension, why aren't two BP's required? I listened to the 
webinar yesterday on v5.3a updates for 2018 and still don't understand. (They 
are on slides 30 and 34 from the presentation).

Thanks,
Molly



Molly Duane RN, BSN, CCRN
Sepsis Program Coordinator
Detroit Receiving Hospital
Harper-Hutzel Hospital
Mobile: 248-709-6218
DRH: 313-966-8087
HUH: 313-745-4340
Email: mdu...@dmc.org


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Re: [Sepsis Groups] [**External**] Re: Sepsis Best Practice Alerts

[Barnes-Daly, Mary Ann, MS, RN, CCRN, DC]

At Sutter Health we have several:
First is “possible sepsis” for Infection (active culture, problem list) plus 
available SIRS
Second is “possible severe sepsis” – same as above plus available organ 
dysfunction (excludes BUN/Cr for example for ESRD)
Third is “possible septic shock”  - above with Lactate > 4

1 and 2 fire only for RNs 3 fires for RN, and providers

We are moving toward predictive analytics(PA) – and may or may not continue 
with BPAs – or just go to PA alerts where the recipient doesn’t need to be in 
the chart to be notified, as with a BPA

Thanks,

MARY ANN BARNES-DALY MS RN CCRN DC  | Clinical Performance Improvement 
Consultant
Quality & Clinical Effectiveness Team | Office of Patient Experience
Sutter Health -2200 River Plaza Drive, Sacramento, CA 95833
Mobile 916.200.5604| barne...@sutterhealth.org

“Do the best you can until you know better. Then when you know better, do 
better” Maya Angelou
[https://newsplus.sutterhealth.org/peninsula-coastal/files/2017/04/SH_Pride_Plus400-002-177x177.gif]

From: Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On 
Behalf Of Orth, Claudia
Sent: Wednesday, November 15, 2017 12:50 PM
To: jenny clarke ; Tara Miller 
Cc: sepsisgroups@lists.sepsisgroups.org
Subject: [**External**] Re: [Sepsis Groups] Sepsis Best Practice Alerts


WARNING: This email originated outside of the Sutter Health email system!
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Would you be able to share what criteria is used to fire the Best Practice 
Alert (BPA). We currently have 2 alerts that fire: 1 for SIRS and 1 for SIRS 
PLUS organ dysfunction. We are thinking of blending the 2 together to perhaps 
give them a bit more sensitivity and specificity thereby decreasing some of the 
confusion and  “alert fatigue” we are experiencing.

I am desperately seeking input and feedback on how other institutions have 
addressed this…i.e. what criteria triggers and alert, what is the response, is 
the alert sent out as a page or an open chart alert, etc. There is still 
reluctance to have “alerts” go to providers so nursing currently carries the 
full burden of these.

Our thought is to have an alert fire to nursing that would require a call to 
the provider if the following is present. Please feel free to critique and 
advise:

3/6 of the below criteria is present = EARLY WARNING ALERT FIRES

1.  HR > 90

2.  RR>20

3.  Temp >38.5 or <36.0

4.  WBC >12,000 or <4,000 or Bands >10%

5.  Altered Level of Consciousness

6.  SBP <90
→Nurses order STAT Lactate level  & the notify the Provider who needs to assess 
the patient and document why sepsis is being r/o or begin sepsis orders – 3 
hour bundle. This will also offload the current burden of nursing needing to 
decipher whether or not infection is present or should be suspected.

*? Blends Sepsis 2 and Sepsis 3 definitions and streamlines/simplifies expected 
standard of care/roles & responsibilities. Similar to a Modified Early Warning 
Score?

Thank you in advance for your much valued time, expertise, and anything you may 
be willing and able to share!

Sincerely,
Claudia
Claudia Orth BSN, RN , CCRN-K
Regional Sepsis Coordinator
Clinical Quality
Munson Medical Center
Traverse City, Michigan
231-935-5692
cor...@mhc.net




From: Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On 
Behalf Of jenny clarke
Sent: Monday, November 06, 2017 3:25 PM
To: Tara Miller 
>
Cc: 
sepsisgroups@lists.sepsisgroups.org
Subject: Re: [Sepsis Groups] Sepsis Best Practice Alerts

We set it up to not fire again once cleared by the nurse. But it will still 
fire for Dr and residents. Then ever 8 hours it reset. But I will say I am not 
sure it is helping.  We did add GCS score to take into account neuro status. 
But it is still very hard to get nurses on floor to enter that with all vital 
signs.  Still a struggle!!
Sent from my iPhone

On Nov 6, 2017, at 1:42 PM, Tara Miller 
> wrote:
We use EPIC as our EMR. We currently are using best practice alerts to fire off 
to the nursing staff when a patient meets SIRS criteria and then we have the 
nurse assess the patient and review the record for possible source of infection 
prior to initiating the sepsis code/ alert.

Does anyone else use best practice alerts and use something other than SIRS 
criteria? We would like to make the alert more specific and cut down on all the 
firings throughout the day.

Thanks.

Tara R Miller, RN
Team Leader, Quality Management
Mobile Infirmary Medical Center
Office: 435-5109
Cell: 605-8270



Confidentiality Notice:  This electronic message, including any attachments, is 
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Re: [Sepsis Groups] [**External**] MAP flagging/alerts in Epic

[Barnes-Daly, Mary Ann, MS, RN, CCRN, DC]

We are working on that currently. Email me directly and we can compare notes

Sent from my Android phone using TouchDown (www.symantec.com)

-Original Message-
From: McKnight, Elise [elise.mckni...@uchealth.org]
Received: Saturday, 19 Aug 2017, 5:10AM
To: 'sepsisgroups@lists.sepsisgroups.org' [sepsisgroups@lists.sepsisgroups.org]
Subject: [**External**] [Sepsis Groups] MAP flagging/alerts in Epic


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Hello,

We use Epic at our system and currently the vital signs turn red/flag in Epic 
if they are higher or lower than normal parameters.  This is true for all vital 
signs except for MAP.  We are trying to have MAP also turn red/flag when it is 
less than 65.  We want to help nurses better notice low MAPs even when the SBP 
is within parameter.  For some reason getting Epic to make the MAPs flag when 
outside of parameter is complicated.  Has anyone out there been able to have 
their Epic system flag for low MAPs?

Thank you,

Elise McKnight
Sepsis Coordinator
Medical Center of the Rockies
Poudre Valley Hospital
2500 Rocky Mountain Ave
Loveland, CO 80538
O



970.624.2153

C



970.290.9436

F



970.624.2192

elise.mckni...@uchealth.org
uchealth.org


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Re: [Sepsis Groups] [**External**] Re: FLUID REQUIREMENTS

[Barnes-Daly, Mary Ann, MS, RN, CCRN, DC]

Interesting Angela
– this has been an argument since the beginning of the SSC guidelines – whether 
to use actual or IBW.  The argument that I have heard is that adipose tissue is 
poorly perfused and doesn’t require the same amount of fluid for resuscitation 
as lean mass.

If we know the BMI – great.  If we estimate it………like we do weight, we will 
likely be wrong – but the EMR will get us close if we enter the height and 
weight – unless the weight is estimated.  Compounded errors

BUT – even if we get all the math correct, this “rule” may have some 
interesting unintended consequences.
A person with a BMI of 29 or 30 will get a significantly larger amount of fluid 
than a person with a BMI of 31 – for whom the IBW is used.




Thanks,

MARY ANN BARNES-DALY MS RN CCRN DC  | Clinical Performance Improvement 
Consultant
Quality & Clinical Effectiveness Team | Office of Patient Experience
Sutter Health -2200 River Plaza Drive, Sacramento, CA 95833
Mobile 916.200.5604| barne...@sutterhealth.org

“Do the best you can until you know better. Then when you know better, do 
better” Maya Angelou
[https://newsplus.sutterhealth.org/peninsula-coastal/files/2017/04/SH_Pride_Plus400-002-177x177.gif]

From: Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On 
Behalf Of Angela Craig
Sent: Tuesday, August 01, 2017 3:34 PM
To: 'Izard, Kimberly' ; Belfi, Karen 
; Nicole Dyess ; 
sepsisgroups@lists.sepsisgroups.org
Subject: [**External**] Re: [Sepsis Groups] FLUID REQUIREMENTS


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Password.




I guess I am one who doesn’t just like to go with a “rule” but ask the question 
what is best for our patients.  If you live in a place like I do many patients 
are larger and may not get the fluids they may need if they go with this new 
decision.  I know we CAN but should we?? I would love to hear the evidence 
toward this decision.

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 Izard, Kimberly
Sent: Monday, July 31, 2017 1:09 PM
To: Belfi, Karen; Nicole Dyess; 
sepsisgroups@lists.sepsisgroups.org
Subject: Re: [Sepsis Groups] FLUID REQUIREMENTS


Data Element Name: Crystalloid Fluid Administration

If there is physician/APN/PA documentation identifying the patient has obesity 
(defined as a Body Mass Index >30), the clinician may choose to use Ideal Body 
Weight (IBW) to determine the target ordered crystalloid fluid volume. If the 
clinician prefers to use IBW, it must be documented clearly and the clinician 
must indicate that IBW will be the weight used to determine the target ordered 
volume.

This is from the new updates starting with 2018 discharges.


Thank you, Kim

Kim Izard  | Team Leader­ – Clinical Outcomes
SSMHealth - St. Louis/Mid-MO/Southern Illinois Regions
1015 Corporate Square Drive Suite 240
Creve Coeur, MO 63132
Office – 314-989-2137
Cell – 618-670-3616
kimberly.iz...@ssmhealth.com

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strictly prohibited. If you received this message in error, or are not the 
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From: Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On 
Behalf Of Belfi, Karen
Sent: Monday, July 31, 2017 1:01 PM
To: Nicole Dyess >; 
sepsisgroups@lists.sepsisgroups.org
Subject: Re: [Sepsis Groups] FLUID REQUIREMENTS

CAUTION: This email originated from outside of the SSMHealth organization. Do 
not click links or open attachments unless you recognize the sender and know 
the content is safe. Questions? Contact the TSC at 314-644-7345 or your local 
Help Desk.

The guidelines state not to use ideal body weight.



Use the patient’s actual weight. Use estimated weight only if 
actual weight is not available to determine the volume of crystalloid fluids 
the patient should receive. Do not use ideal weight.


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

From: Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On 
Behalf Of Nicole Dyess
Sent: 

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

[Barnes-Daly, Mary Ann, MS, RN, CCRN, DC]

SEP-1 abstraction is done by specific core measure abstractors - as with other 
core measures at all of Sutter Health

Thanks,

MARY ANN BARNES-DALY MS RN CCRN DC  | Clinical Performance Improvement 
Consultant
Quality & Clinical Effectiveness Team | Office of Patient Experience
Sutter Health -2200 River Plaza Drive, Sacramento, CA 95833
Mobile 916.200.5604| barne...@sutterhealth.org

"Do the best you can until you know better. Then when you know better, do 
better" Maya Angelou
[https://newsplus.sutterhealth.org/peninsula-coastal/files/2017/04/SH_Pride_Plus400-002-177x177.gif]

From: Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On 
Behalf Of maggie.mac...@hcahealthcare.com
Sent: Tuesday, June 13, 2017 8:08 AM
To: sepsisgroups@lists.sepsisgroups.org
Subject: [**External**] [Sepsis Groups] Sepsis question


WARNING: This email originated outside of the Sutter Health email system!
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Password.



Hi all,
I was wondering if you are your facility's sepsis coordinator, do you also do 
the Core Measure abstraction? Or is this something that is handled by an 
outside agency or other analysists in your facility?

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


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

[Barnes-Daly, Mary Ann, MS, RN, CCRN, DC]

Great points Ron; I agree with your conclusion

Thanks,

MARY ANN BARNES-DALY MS RN CCRN DC  | Clinical Performance Improvement 
Consultant
Quality & Clinical Effectiveness Team | Office of Patient Experience
Sutter Health -2200 River Plaza Drive, Sacramento, CA 95833
Mobile 916.200.5604| barne...@sutterhealth.org

“Do the best you can until you know better. Then when you know better, do 
better” Maya Angelou


From: Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On 
Behalf Of Ron Elkin
Sent: Friday, May 19, 2017 9:32 AM
To: Townsend, Sean, M.D. 
Cc: sepsisgroups@lists.sepsisgroups.org
Subject: Re: [Sepsis Groups] [**External**] Sepsis Alert

The study showed worse physiologic derangements and ED survival in arrest 
patients that were bacteremic, but survivals were not different at 28 days or 
beyond. I don't see a comparison of outcomes for bacteremic patients who 
received antibiotics in ED versus those that did not.

The criteria for a diagnosis of severe sepsis or septic shock have included 
suspicion of infection (susceptible to the biases of the observer), SIRS (not 
sensitive or specific but quite likely in arrest both with or without sepsis), 
and evidence of acute organ dysfunction related to infection (but common in 
arrest with or without sepsis).

For the individual patient, a significant challenge would be to distinguish 
between arrest only, arrest with severe sepsis/septic shock, and arrest with 
coincidental bacteremia insufficient to cause severe sepsis/septic shock. Organ 
failure, lactate, and procalcitonin, the latter two sometimes elevated in 
severe physiologic stress of any kind, will not provide this distinction for 
the individual patient.

Therefore,one can make a good case for excluding these patients from analysis 
in the larger group of patients with severe sepsis/septic shock without arrest, 
or at least restricting the analysis to arrest patients.

Thanks for the discussion.

Ron Elkin
San Francisco

On Fri, May 19, 2017 at 7:19 AM, Townsend, Sean, M.D. 
> wrote:
The interesting thing is that the original proposal was to delete these 
patients from your data, but based on Ron’s sleuthing, they may actually be a 
real part of the data.  As a practical matter, it’s one of the last things docs 
will be thinking of in this situation.

Arguing for antibiotics in these cases at a minimum is not a bad idea.

Sounds like all providers will be affected equally with this problem, so I’m 
not worried from a data perspective, but interesting effort to provide 
education around antibiotics in post-arrest situations.

From: Cynthia Wells 
[mailto:cynthia.we...@steward.org]
Sent: Friday, May 19, 2017 7:04 AM
To: Ron Elkin >; Townsend, 
Sean, M.D. >
Cc: 
sepsisgroups@lists.sepsisgroups.org
Subject: RE: [Sepsis Groups] [**External**] Sepsis Alert

Hello,
I definitely agree.. In order to meet the sepsis bundle we would still need the 
other two criteria- suspicion of infection/SIRS, hence we should start abx 
earlier to if nothing else prevent progression if arrest not related to 
bacteremia.  I am concerned about the fluids because most of these lactates are 
sky high they are automatically pulled into shock elements.

Cindy

Cynthia Wells
Steward Health Care
Director of Clinical Performance Analytics
(508) 404-8647

From: Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On 
Behalf Of Ron Elkin
Sent: Thursday, May 18, 2017 10:43 PM
To: Townsend, Sean, M.D. 
>
Cc: 
sepsisgroups@lists.sepsisgroups.org
Subject: Re: [Sepsis Groups] [**External**] Sepsis Alert

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:

Re: [Sepsis Groups] [**External**] lactic acid

[Barnes-Daly, Mary Ann, MS, RN, CCRN, DC]

Ms. Gibbs;

First I would emphasize that metformin does not exactly falsely elevate lactate 
levels; it has been shown to actually elevate levels as part of gluconeogenesis 
from several sources. What is more likely is a coincidental lactate elevation 
in the face of infection.

I would caution however based on reason and experience; in the face of 
infection with lactate elevation, think horses not zebras.
A mortality review of a 39 yo female with DM showed that a lactate elevation 
was ignored because "oh, the patient is on metformin".
The next day the patient was dead from intractable septic shock .

When dealing with infection and possible sepsis, "when in doubt, rule it out". 
Never dismiss an elevated lactate until you can PROVE that it is not cause by 
hypoperfusion from a serious illness, most often but not always, sepsis.

There are several publications that address the metformin/lactate issue - a 
simple lit search will provide many. As you may have discovered many are not 
definitive.
See below - this also has several cross-referenced papers:
[cid:image002.png@01D2C8AA.6B69B150]

Thanks,

MARY ANN BARNES-DALY MS RN CCRN DC  | Clinical Performance Improvement 
Consultant
Quality & Clinical Effectiveness Team | Office of Patient Experience
Sutter Health -2200 River Plaza Drive, Sacramento, CA 95833
Mobile 916.200.5604| barne...@sutterhealth.org

"You never change things by fighting the existing reality. To change something, 
build a new model that makes the existing model obsolete."   ~R. Buckminster 
Fuller

From: Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On 
Behalf Of Gibbs, Katie
Sent: Thursday, March 09, 2017 10:08 AM
To: sepsisgroups@lists.sepsisgroups.org
Subject: [**External**] [Sepsis Groups] lactic acid


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Has anyone found any good evidence based practice related to Metformin falsely 
elevating Lactic Acid Levels ?
Thank you,

Katie Gibbs, RN, BSN
Quality Improvement Specialist
Witham Health Services
PH 765-485-8459
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From: Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On 
Behalf Of Buss, Gerri
Sent: Wednesday, March 08, 2017 10:43 AM
To: 
sepsisgroups@lists.sepsisgroups.org
Subject: [Sepsis Groups] Sepsis screening and treatment in Nursing Homes

I am wondering  if anyone has developed a sepsis screening and treatment 
process/algorithm for their nursing home population?
If so would you be willing to share what you have done?

Gerri Buss MS, RN

Performance Excellence Consultant
Blessing Hospital
Quincy,Il. 62305
217-223-8400 Ext 6894
gerri.b...@blessinghealthsystem.org


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Re: [Sepsis Groups] [**External**] One low MAP can trigger Severe Sepsis presentation

[Barnes-Daly, Mary Ann, MS, RN, CCRN, DC]

Fantastic news, thank you

Thanks,

MARY ANN BARNES-DALY MS RN CCRN DC  | Clinical Performance Improvement 
Consultant
Quality & Clinical Effectiveness Team | Office of Patient Experience
Sutter Health -2200 River Plaza Drive, Sacramento, CA 95833
Mobile 916.200.5604| barne...@sutterhealth.org

“You never change things by fighting the existing reality. To change something, 
build a new model that makes the existing model obsolete.”   ~R. Buckminster 
Fuller

From: Townsend, Sean, M.D.
Sent: Monday, April 17, 2017 10:27 AM
To: Barnes-Daly, Mary Ann, MS, RN, CCRN, DC <barne...@sutterhealth.org>
Cc: Nelson, Kathy <kathy.nel...@advocatehealth.com>; 
sepsisgroups@lists.sepsisgroups.org
Subject: Re: [Sepsis Groups] [**External**] One low MAP can trigger Severe 
Sepsis presentation

This has been built into new specs effective Jan 2018.  Can't do it faster.

In these instances, in the meantime, if the doc states the value was erroneous 
it can be ignored.  This documentation can happen at the time the value was 
obtained, or via query with your clinical documentation integrity team.

On Apr 17, 2017, at 6:38 AM, Barnes-Daly, Mary Ann, MS, RN, CCRN, DC 
<barne...@sutterhealth.org<mailto:barne...@sutterhealth.org>> wrote:

This sender failed our fraud detection checks and may not be who they appear to 
be. Learn about spoofing<http://aka.ms/LearnAboutSpoofing>

Feedback<http://aka.ms/SafetyTipsFeedback>

Yes, I have feedback that occurs and it is problematic.

We need to bring this to CMS.
I would suggest that in the same way 2 consecutive BPs are required to identify 
SEPTIC SHOCK after fluids, the same should be true to signify the onset of 
hypotension.

Thanks,

MARY ANN BARNES-DALY MS RN CCRN DC  | Clinical Performance Improvement 
Consultant
Quality & Clinical Effectiveness Team | Office of Patient Experience
Sutter Health -2200 River Plaza Drive, Sacramento, CA 95833
Mobile 916.200.5604| barne...@sutterhealth.org<mailto:barne...@sutterhealth.org>

“You never change things by fighting the existing reality. To change something, 
build a new model that makes the existing model obsolete.”   ~R. Buckminster 
Fuller

From: Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On 
Behalf Of Nelson, Kathy
Sent: Friday, April 07, 2017 12:43 PM
To: 
sepsisgroups@lists.sepsisgroups.org<mailto:sepsisgroups@lists.sepsisgroups.org>
Subject: [**External**] [Sepsis Groups] One low MAP can trigger Severe Sepsis 
presentation


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.



Question posed by our physician leadership:

Is anyone else having a problem with their CMS bundles when it comes to a low 
MAP.  Our EMR captures every vital sign and if the auto-calculated MAP falls 
only momentarily to 64, it will trigger our data abstractors to establish a 
diagnosis of hypotension and put the patient into the severe sepsis category 
without necessarily having any of the other organ dysfunction criteria for the 
diagnosis.  This results in a fall out on the bundle and makes us non-compliant 
from CMS data collection purposes.  Has anyone else had a similar EMR issue and 
if so, how did you deal with it?

Thanks!

Kathy Nelson, MBA, CPHQ, RHIA
Public Data Manager
Advocate Health Care
Center for Health Information Services (CHIS)

3075 Highland Parkway, Suite 600
Downers Grove, IL 60515
P: 630- 929-6782 (Internal: 55-6782)
kathy.nel...@advocatehealth.com<mailto:kathy.nel...@advocatehealth.com>

This e-mail, and any attachments thereto, is intended only for use by the 
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Re: [Sepsis Groups] [**External**] Re: One low MAP can trigger Severe Sepsis presentation

[Barnes-Daly, Mary Ann, MS, RN, CCRN, DC]

Emily;

We discovered the discrepancy as well.
The short story is that the mathematical algorithm in the monitor that is used 
to calculate the MAP is far more sophisticated (and therefore more accurate) 
than the simple formula that we had been using - sys + 2dys/3.  Therefore we 
always accept the MAP from the monitor as the most accurate.

You can have this verified by your vendor.  I am not permitted to disclose the 
vendor that we used on this listserve

Thanks,

MARY ANN BARNES-DALY MS RN CCRN DC  | Clinical Performance Improvement 
Consultant
Quality & Clinical Effectiveness Team | Office of Patient Experience
Sutter Health -2200 River Plaza Drive, Sacramento, CA 95833
Mobile 916.200.5604| barne...@sutterhealth.org

"You never change things by fighting the existing reality. To change something, 
build a new model that makes the existing model obsolete."   ~R. Buckminster 
Fuller

From: Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On 
Behalf Of Emily C. McKinney
Sent: Monday, April 17, 2017 5:56 AM
To: Nelson, Kathy ; 
sepsisgroups@lists.sepsisgroups.org
Subject: [**External**] Re: [Sepsis Groups] One low MAP can trigger Severe 
Sepsis presentation


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.



We have been having the same problem. However, the issue we have found are some 
inconsistencies in proper MAP calculations. The auto-calculated MAPS are lower 
than when calculating them manually.  We are looking into this but in the 
meantime we are having patients "fall into the fluid bucket" who normally 
should not. And this is also causing us to be non-compliant.


Sincerely,



Emily C. McKinney (Swiss), BSN, RN
Sepsis Coordinator
Quality Excellence
Reicert Health Building
Suite 6003
St. Joseph Mercy Health System
tel: 734-712-2319 | cell:734-395-2859
email: emily.sw...@stjoeshealth.org
www.stjoeshealth.org

Facebook
 | 
Twitter

[cid:image002.png@01D2B761.93FE6840]





From: Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On 
Behalf Of Nelson, Kathy
Sent: Friday, April 07, 2017 3:43 PM
To: 
sepsisgroups@lists.sepsisgroups.org
Subject: [External] [Sepsis Groups] One low MAP can trigger Severe Sepsis 
presentation

Question posed by our physician leadership:

Is anyone else having a problem with their CMS bundles when it comes to a low 
MAP.  Our EMR captures every vital sign and if the auto-calculated MAP falls 
only momentarily to 64, it will trigger our data abstractors to establish a 
diagnosis of hypotension and put the patient into the severe sepsis category 
without necessarily having any of the other organ dysfunction criteria for the 
diagnosis.  This results in a fall out on the bundle and makes us non-compliant 
from CMS data collection purposes.  Has anyone else had a similar EMR issue and 
if so, how did you deal with it?

Thanks!

Kathy Nelson, MBA, CPHQ, RHIA
Public Data Manager
Advocate Health Care
Center for Health Information Services (CHIS)

3075 Highland Parkway, Suite 600
Downers Grove, IL 60515
P: 630- 929-6782 (Internal: 55-6782)
kathy.nel...@advocatehealth.com

This e-mail, and any attachments thereto, is intended only for use by the 
addressee(s) named herein and may contain legally privileged and/or 
confidential information. If you are not the intended recipient of this e-mail 
(or the person responsible for delivering this document to the intended 
recipient), you are hereby notified that any dissemination, distribution, 
printing or copying of this e-mail, and any attachments thereto, is strictly 
prohibited. If you have received this e-mail in error, please respond to the 
individual sending the message and permanently delete the original and any copy 
of any e-mail and any printout thereof.

Confidentiality Notice:
This e-mail, including any attachments is the property of Trinity Health and is 
intended for the sole use of the intended 

Re: [Sepsis Groups] [**External**] One low MAP can trigger Severe Sepsis presentation

[Barnes-Daly, Mary Ann, MS, RN, CCRN, DC]

Yes, I have feedback that occurs and it is problematic.

We need to bring this to CMS.
I would suggest that in the same way 2 consecutive BPs are required to identify 
SEPTIC SHOCK after fluids, the same should be true to signify the onset of 
hypotension.

Thanks,

MARY ANN BARNES-DALY MS RN CCRN DC  | Clinical Performance Improvement 
Consultant
Quality & Clinical Effectiveness Team | Office of Patient Experience
Sutter Health -2200 River Plaza Drive, Sacramento, CA 95833
Mobile 916.200.5604| barne...@sutterhealth.org

"You never change things by fighting the existing reality. To change something, 
build a new model that makes the existing model obsolete."   ~R. Buckminster 
Fuller

From: Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On 
Behalf Of Nelson, Kathy
Sent: Friday, April 07, 2017 12:43 PM
To: sepsisgroups@lists.sepsisgroups.org
Subject: [**External**] [Sepsis Groups] One low MAP can trigger Severe Sepsis 
presentation


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.



Question posed by our physician leadership:

Is anyone else having a problem with their CMS bundles when it comes to a low 
MAP.  Our EMR captures every vital sign and if the auto-calculated MAP falls 
only momentarily to 64, it will trigger our data abstractors to establish a 
diagnosis of hypotension and put the patient into the severe sepsis category 
without necessarily having any of the other organ dysfunction criteria for the 
diagnosis.  This results in a fall out on the bundle and makes us non-compliant 
from CMS data collection purposes.  Has anyone else had a similar EMR issue and 
if so, how did you deal with it?

Thanks!

Kathy Nelson, MBA, CPHQ, RHIA
Public Data Manager
Advocate Health Care
Center for Health Information Services (CHIS)

3075 Highland Parkway, Suite 600
Downers Grove, IL 60515
P: 630- 929-6782 (Internal: 55-6782)
kathy.nel...@advocatehealth.com

This e-mail, and any attachments thereto, is intended only for use by the 
addressee(s) named herein and may contain legally privileged and/or 
confidential information. If you are not the intended recipient of this e-mail 
(or the person responsible for delivering this document to the intended 
recipient), you are hereby notified that any dissemination, distribution, 
printing or copying of this e-mail, and any attachments thereto, is strictly 
prohibited. If you have received this e-mail in error, please respond to the 
individual sending the message and permanently delete the original and any copy 
of any e-mail and any printout thereof.
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