Re: [Sepsis Groups] Fluid resuscitation prior to time zero

[Boyer, Suzette K.]

Good evening,
We have had several misses for the same thing.  No we don't give the whole 
fluid bolus for all hypotension.
Suzette

Suzette Boyer RN, BSN
Sepsis Coordinator
Office:  719-595-8475
suzette_bo...@parkviewmc.com



From: Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On 
Behalf Of Duane, Molly
Sent: Wednesday, May 29, 2019 5:26 PM
To: 'sepsisgroups@lists.sepsisgroups.org'
Subject: [Sepsis Groups] Fluid resuscitation prior to time zero

Good Evening,
Can someone please explain why we are held accountable to give 30 ml/kg for 
hypotension prior to time zero?

Time zero: 0954 (0420: RR 22, 0435 Temp 35.0; 0420 SBP 87; 0954 H&P: possible 
sepsis).
The patient received 500 ml boluses X4: at 0430, 0929, 1154 & 1210. Pt weighed 
53 kg/required 1530 ml.

The miss is: we did not give 30 ml/kg within 3 hours of initial hypotension 
(0420). Do you all give 30 ml/kg for all hypotension, even if the provider does 
not think sepsis is the cause for the hypotension? In this case we gave more 
than enough fluid within 3 hours of time zero, but obviously still missed.

Any thoughts?
Thanks,
Molly



Molly Duane RN, BSN, CCRN-K
Sepsis Program Coordinator
Detroit Receiving Hospital
Harper-Hutzel Hospital
Office: 313-745-4340
Cell: 248-709-6218

Email: mdu...@dmc.org


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Re: [Sepsis Groups] Early identification in the ED

[Boyer, Suzette K]

Question:  Where did you see that nurse assessment of suspected infection can't 
be used?
This is in the specifications manual for 7/1/18 - 12/31/18
[cid:image003.jpg@01D44508.BDB15F40]



Suzette Boyer RN, BSN
Clinical Effectiveness Specialist
St. Mary-Corwin Medical Center
719-557-5337
1008 Minnequa Ave.
Pueblo, CO  81004
suzettebo...@centura.org
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From: Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On 
Behalf Of Jeanie Bollinger
Sent: Wednesday, September 05, 2018 8:48 AM
To: sepsisgroups@lists.sepsisgroups.org
Subject: [Sepsis Groups] Early identification in the ED

Now that the measure does not use a nurse assessment of "suspect infection" as 
a component in establishing time zero, we are missing this measure as time zero 
is identified by CMS criteria later than our ED nurse triage process with 
automated labs.  ED providers document later which is resulting in us missing 
the measure.  Sepsis is being identified earlier and all appropriate bundle 
care is completed.  Is anyone else recognizing this as an issue?


Jeanie Bollinger MSN,RN, ACCNS-AG, CCRN-K
Clinical Nurse Specialist
Acute Medicine
Mission Health
509 Biltmore Avenue
Asheville, NC 28801

Office: 828-213-7171
Cell: 828-400-1194


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Re: [Sepsis Groups] Focused exam

[Boyer, Suzette K]

It is my understanding that the focused exam will all be rolled into one 
question, not that is not necessary.  
Suzette

-Original Message-
From: Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On 
Behalf Of Conaway, Pamela
Sent: Wednesday, April 18, 2018 5:32 AM
To: Fiona Winterbottom ; 
sepsisgroups@lists.sepsisgroups.org
Subject: Re: [Sepsis Groups] Focused exam

The focused exam will not be necessary beginning with July 2018 discharges.  
This information can be found on Quality Net in the July 2018 inpatient quality 
reporting specifications.

-Original Message-
From: Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On 
Behalf Of Fiona Winterbottom
Sent: Thursday, April 12, 2018 2:12 PM
To: sepsisgroups@lists.sepsisgroups.org
Subject: [Sepsis Groups] Focused exam

Good Afternoon, I was recently at a large conference where the audience was 
told that the focused exam was no longer necessary.
Could someone clarify this with supporting data of where this can be found?
Thanks
Fiona

-Original Message-
From: Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On 
Behalf Of sepsisgroups-requ...@lists.sepsisgroups.org
Sent: Monday, April 09, 2018 9:22 AM
To: sepsisgroups@lists.sepsisgroups.org
Subject: Sepsisgroups Digest, Vol 285, Issue 1

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Today's Topics:

   1. Re: Question re: documentation of attestation that focused
  exam was completed (Pamela Green)
   2. Re: Sepsisgroups Digest, Vol 284, Issue 3 (Pender.Linda)
   3. OB patients (richard.rutherf...@ventura.org)


--

Message: 1
Date: Thu, 5 Apr 2018 18:21:54 +
From: Pamela Green 
To: "Duane, Molly" ,
"Sepsisgroups@lists.sepsisgroups.org"

Cc: Alesha Collins , "Britni N. Fannin"
, Steven May 
Subject: Re: [Sepsis Groups] Question re: documentation of attestation
that focused exam was completed
Message-ID:



Content-Type: text/plain; charset="us-ascii"

Good  afternoon everyone,
We are having a difficult time getting the appropriate documentation to meet 
the bundle compliance even though everything is done correctly! Use of our 
Sepsis  Screening and Evaluation Documentation tool is hit and missed although 
I can see by the labs and treatment protocol that they are doing it.  On the IP 
side it  is the issue with getting them to document to the Sepsis Shift Screen 
and Focus reassessment. With the physicians if they are here when patient is 
admitted to the floor they usually do an admit note that includes a focused 
reassessment so we will catch those.  If it is after hours we are hoping to 
hold the ER physicians accountable to documenting a focused reassessment prior 
to moving patient to PCU or ICU.  I would be open to suggestions for better 
documentation compliance also. Pam Pam

From: Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On 
Behalf Of Duane, Molly
Sent: Thursday, April 05, 2018 11:18 AM
To: Sepsisgroups@lists.sepsisgroups.org
Subject: [Sepsis Groups] Question re: documentation of attestation that focused 
exam was completed

Hello All,
I was wondering if your physicians were using the attestation statement instead 
of documenting the specific focused exam components. If so, how is that going? 
How did you implement this?

We had a miss this month: even though the physician documented in his note the 
specific amount of fluid that was given, followed with "after these 
interventions the patient was reassessed", we missed because the attestation 
did not have a specific time included. The time the note was opened/started was 
used. This was an ED note, started at the beginning of the pt's visit, so that 
wa

Re: [Sepsis Groups] [**External**] CMS Benchmarks for SEP-1 Sepsis Early Management Bundle

[Boyer, Suzette K]

Dr. Townsend,
Where can we find the performance on Q-net?


Suzette Boyer RN, BSN
Quality Operations Analyst
St. Mary-Corwin Medical Center
719-557-5337
1008 Minnequa Ave.
Pueblo, CO  81004
suzettebo...@centura.org
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from your system. Thank you.



From: Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On 
Behalf Of Townsend, Sean, M.D.
Sent: Wednesday, January 31, 2018 10:14 AM
To: Morrell, Vicki ; sepsisgroups@lists.sepsisgroups.org
Subject: Re: [Sepsis Groups] [**External**] CMS Benchmarks for SEP-1 Sepsis 
Early Management Bundle

CMS is not presently releasing benchmark data except to individual hospitals 
via QualityNet.  If you log in there from your institution you can see your 
performance.

To give you a rough sense of the data, the top performing decile of hospitals 
has  approximately 70% compliance.

From: Morrell, Vicki [mailto:morre...@mlhs.org]
Sent: Wednesday, January 31, 2018 7:55 AM
To: 
sepsisgroups@lists.sepsisgroups.org
Cc: Townsend, Sean, M.D. 
mailto:towns...@sutterhealth.org>>
Subject: [**External**] CMS Benchmarks for SEP-1 Sepsis Early Management Bundle


WARNING: This email originated outside of the Sutter Health email system!
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Good Morning! Our organization has recently formed a Performance Excellence 
2020 Sepsis Workgroup to initiate system standardization of processes and best 
practices for our sepsis patients.  My physician leads are querying if there is 
presently a CMS benchmark for this measure.
Dr. Townsend,
I know from our webinars that presently there is not, however, would you know 
at this time how hospitals are performing nationally with an estimated 
compliance rate, i.e.
30%-50% or higher. Any input would be appreciated. Thank you.


Vicki Morrell
System Manager, Quality Outcomes MLHS
Phone:  (484)337-3382
Pager:   3382
E-mail:  morre...@mlhs.org

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Re: [Sepsis Groups] [External] Sepsis Validation

[Boyer, Suzette K]

We have been in validation and CMS is validating the sepsis cases.  They are 
part of the compliance score.
They do the branch logic.  If the patient doesn't meet the measure early in the 
algorithm -the validators continue the abstraction per branch logic.  We have 
sent several cases back for education review and they have agreed with our 
assessment on several of them, although it does not change your score.

From: Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On 
Behalf Of Mary Draper
Sent: Wednesday, December 20, 2017 2:16 PM
To: DHILLON, ROOPINDER ; 
sepsisgroups@lists.sepsisgroups.org
Subject: Re: [Sepsis Groups] [External] Sepsis Validation

No one to date that I know of has been validated by CMS. I don't think it 
matters if you use branch logic or not. Once a metric isn't met the abstraction 
stops there.

Mary Draper RN BSN
Coordinator Quality Improvement
Peer Review Support CV/CT
JMH Quality Management
Office (925) 674-2045
Cell (925) 451-8792
Fax (925) 674-2373
mary.dra...@johnmuirhealth.com
[cid:image004.png@01D37EEA.5761A360][cid:image006.png@01D37EEA.5761A360]
"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

From: Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On 
Behalf Of DHILLON, ROOPINDER
Sent: Friday, December 15, 2017 7:34 AM
To: 
sepsisgroups@lists.sepsisgroups.org
Subject: [External] [Sepsis Groups] Sepsis Validation


Caution: This email originated outside JMH. Do not open attachments or click on 
links if you do not recognize the sender.

Hi,
I wanted to know if any hospital has been validated by CMS for Core Measure 
SEP-1. My question is, are we supposed to use branching logic for abstraction? 
For example, if we answer 'Yes' to Severe sepsis, but we don't have an Initial 
Lactate collected and we say 'No' to Initial Lactate question; do we stop at 
that point or do we have to still go ahead and answer the rest of the questions?

If anyone has been validated, what did you do? If you used branching logic (did 
not answer rest of the questions) was it taken against the hospital and 
considered as 'wrong' abstraction?


Thank you,
Roopa Dhillon MBBS, MBA
Clinical Quality Analyst I
Quality Improvement/Clinical Outcomes
University Hospitals Elyria Medical Centre
630 East River
Elyria, Ohio  44035
T 440-329-4959 F 440-329-5971
Roopinder.Dhillon@UHhospitals .org
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[Sepsis Groups] CMS guidelines

[Boyer, Suzette K]

Do you interpret the manual that if a patient develops severe sepsis and has a 
lactate over 4 - as Septic shock?  With or without hypotension?

What about the timeframe that the fluids must be infused by?  So if it is 
charted that the total volume of fluids wasn't infused for 8 hours- then within 
an hour after that there is an episode of hypotension- does that start the 
clock for the persistent hypotension and for the re-evaluation?

Just wondering your ideas?


Suzette Boyer RN
Quality Operations Analyst
St. Mary-Corwin Medical Center
719-557-5337
1008 Minnequa Ave
Pueblo, CO  81004
suzettebo...@centura.org
[cid:image001.png@01D09EBA.095ADDC0]



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