Re: [Sepsis Groups] 30ml/kg bolus exemption

[Izard, Kimberly]

CMS does not currently allow for any "opt" out for not providing the correct 
amount of fluids. It doesn't matter how well the reason is documented by the 
physician. We have multiple IQR responses regarding this same issue. CMS does 
not accept any reason. The criteria is 30ml/kg regardless of other co-morbid 
conditions.  If they die from sepsis due to under resuscitation with fluids, 
then we will not need to worry about their CHF or renal status. Dr. Townsend 
said it much better than myself in prior email responses.



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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-Original Message-
From: Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On 
Behalf Of Carlson, Brenda L
Sent: Thursday, September 13, 2018 9:39 AM
To: 'sepsisgroups@lists.sepsisgroups.org' 
Subject: Re: [Sepsis Groups] Sepsisgroups Digest, Vol 304, Issue 2

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Perhaps CMS would have accepted this as an appropriate exclusion if the 
provider had included wording such as "CHF with pulmonary edema and concerns 
for fluid overload" or "ESRD on HD with anasarca and concerns for fluid 
overload". The provider didn't clearly state why there was a concern for fluid 
overload.

Brenda L. Carlson MS, BSN, RN
Assistant Quality Officer
Office of Clinical Practice Evaluation
University of Rochester Medical Center
265 Crittenden Blvd., Saunders Research Building, 3.205
585-273-4721
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Sent: Wednesday, September 12, 2018 4:06 PM
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Subject: Sepsisgroups Digest, Vol 304, Issue 2

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Today's Topics:

   1. 30mL/Kg Bolus Exemptions (Culver, Danette)
   2. Re: Blood cultures false positive (Vickie Robertson)


--

Message: 1
Date: Wed, 12 Sep 2018 13:35:59 -0400
From: "Culver, Danette" 
To: "Sepsisgroups@lists.sepsisgroups.org"

Subject: [Sepsis Groups] 30mL/Kg Bolus Exemptions
Message-ID:
<6fe413f8a5447e4498be19afc648a354015120393...@nhc0902.nhc.network.local>

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

All,

We recently queried CMS for accepting the following documentation as refusal to 
30ml/kg bolus and they stated it did not meet the criteria. Can anyone provide 
a rationale as to why this documentation doesn't suffice? My providers prefer 
taking a more positive approach that is more inclusive of the patient, not the 

Re: [Sepsis Groups] FLUID REQUIREMENTS

[Izard, Kimberly]

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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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

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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: Saturday, July 29, 2017 12:02 PM
To: 
sepsisgroups@lists.sepsisgroups.org
Subject: [EXTERNAL] [Sepsis Groups] FLUID REQUIREMENTS


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For the 30ml/kg fluid requirement, is anyone using IBW for your obese patients? 
I have found conflicting statements on if this will satisfy the requirement. If 
you do use IBW, can you send me your reference that supports using it.


Thanks!
Nicole Dyess, PharmD
Antimicrobial Stewardship Team Leader
Conway Regional Health System
2302 College Ave, Conway, AR 72034
(501) 513-5152
(501) 450-2368 Fax

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Re: [Sepsis Groups] Septic Shock Present [Incident: 151007-000178]

[Izard, Kimberly]

This is the latest response we have received. Hope it helps!






 Subject

Septic Shock Present



 Discussion Thread

 Response Via Email (Mary Cox)

11/17/2015 03:44 PM

Please refer to the specifications notes for abstraction.
Based on V5.0b, Septic Shock - We are aware there are some cases were 2 
different notes for abstraction "fit" the case, and one indicates Value "1" 
while the other indicates Value "2". There will be some changes for 7/1/16 
discharges, which CMS is aware of. At this time, we are not able to make them 
effective until that time.

The 2 are:

  *   If crystalloid fluids were not administered after the presentation date 
and time of severe sepsis, choose Value "2."  In this case, there must have 
been NO crystalloid fluids administered. If there are some, but not the 30mL/kg 
requirement, this cannot be used. It could be that the criteria were not met 
and there IS physician/APN/PA documentation of Septic Shock. If NO crystalloid 
fluids were given, select this response.
  *   If criteria for Septic Shock are not met, but there is physician/APN/PA 
documentation of Septic Shock, choose Value "1." --- If ANY crystalloid fluids 
were given, select this response.



 Customer By Web Form

11/13/2015 06:39 AM

Question #3. Does this mean no crystalloids or just not the full amount of 
30ml/kg? Also, the specs manual does say if the criteria are not met but there 
is documentation of septic shock, answer value 1. Your answer seems to 
contradict that dot point but does the dot point "if crystalloid fluids are not 
administered after the presence of severe sepsis choose value 2" come into 
play? Please clarify. Thank you.

 Response Via Email (Mary Cox)

11/12/2015 05:42 PM

1. If the patient does not receive a crystalloid bolus in the full amount of 
30ml/kg after presentation of severe sepsis, I would answer NO to septic shock 
present even if the initial lactate was equal to or greater than 4.0?
No. If Severe Sepsis is present and the Initial Lactate level is >=4, that 
meets the criteria for Septic Shock.

2. If the patient met criteria for severe sepsis but did not receive 
crystalloid bolus in the full amount of 30ml/kg, I would answer NO to Septic 
Shock Present.
Yes. They cannot meet the Hypotention persists in the hour after conclusion of 
the 30mL/kg Crystalloid Fluid administration if the fluid amount is not given. 
Therefore, unless they have the Initial Lactate >=4, they cannot meet the 
criteria for Septic Shock.

3. If the patient has physician documentation of septic shock but did not meet 
criteria and did not receive the 30 ml/kg crystalloid fluids, I would answer NO 
to septic shock? Please give rationale for your responses.
You are correct. This goes to the inability to determine persistent hypotension 
since no fluids were given.


09/23/2015 09:28 AM

.

 Customer By Web Form

09/23/2015 09:02 AM

I have had several responses regarding septic shock present, 150608-83, 
150626-00014 and 150601-32 to mention a few. The responses seem to be 
conflicting. The specs manual states, "If crystalloid fluids were NOT 
administered after the presentation date and time of Severe Sepsis, select 
Allowable Value "2 (No)." and " If criteria for Septic Shock are not met, but 
there is physician/APN/PA documentation of Septic Shock, choose Value "1 (Yes)" 
I have two examples and please tell me if I am correct in my assumptions. 1. If 
the patient does not receive a crystalloid bolus in the full amount of 30ml/kg 
after presentation of severe sepsis, I would answer NO to septic shock present 
even if the initial lactate was equal to or greater than 4.0? 2. If the patient 
met criteria for severe sepsis but did not receive crystalloid bolus in the 
full amount of 30ml/kg, I would answer NO to Septic Shock Present. 3. If the 
patient has physician documentation of septic shock but did not meet criteria 
and did not receive the 30 ml/kg crystalloid fluids, I would answer NO to 
septic shock? Please give rationale for your responses.



 Question Reference #150923-18

Escalation Level:

5 Business Days

Product Level 1:

Hospital Inpatient Quality Reporting

Category Level 1:

Hospital Inpatient - Sepsis

Category Level 2:

Septic Shock Present

Date Created:

09/23/2015 09:02 AM

Last Updated:

11/17/2015 03:44 PM

Status:

Resolved (IP only)

Discharge Period:

N/A

CCN:




Thank you, Kim

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

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Re: [Sepsis Groups] Fluids in non-shock sepsis

[Izard, Kimberly]

The sepsis core measure requires 30ml/kg.

Thank you, Kim

Kim Izard, BS, RN
Supervisor Clinical Outcomes/Core Measures
SSM Health - St. Louis Network
1015 Corporate Square Drive Suite 240
Creve Coeur, MO 63132
Office - 314-989-2137
Cell - 618-670-3616
kimberly_iz...@ssmhc.commailto:kimberly_iz...@ssmhc.com

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Change is a challenge and an opportunity; not a threat
-Prince Phillip of England

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From: Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On 
Behalf Of Myran, Robin
Sent: Friday, June 12, 2015 2:16 PM
To: Stroud, Shalan; sepsisgroups@lists.sepsisgroups.org
Subject: Re: [Sepsis Groups] Fluids in non-shock sepsis

Shalan -

We use the previous guideline of 20 mL/kg for those patients with a lactate 2.0 
- 3.9 who are not hypotensive. If they become hypotensive, we add the 
additional 10 mL/kg.


Robin Myran, MSN, RN, PCCN
Sepsis Coordinator
Hoag Memorial Hospital Presbyterian
One Hoag Drive
Newport Beach, CA 92658
Office: (949) 764-4588
Fax: (949) 764-5387
Cell: (949) 300-9137
robin.my...@hoag.orgmailto:jodi.caggi...@hoag.org



From: Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On 
Behalf Of Stroud, Shalan
Sent: Thursday, June 11, 2015 12:37 PM
To: 
sepsisgroups@lists.sepsisgroups.orgmailto:sepsisgroups@lists.sepsisgroups.org
Subject: [Sepsis Groups] Fluids in non-shock sepsis

The expectation for 30 ml/kg IVF in septic shock is in response to 
hypotension/L.A. 4.0.

What have you all set for initial volume to be infused in patients with a L.A. 
4.0 and not hypotensive (yet) who of course, still need fluid?

We are using the traditional 1 liter and then re-evaluate but making the 
wording and expectation for each population remains pretty unclear for our 
providers.

Any ideas you all have would be great!



Shalan Stroud RN, APRN, ACNS-BC, ACCNS-AG
Critical Care Clinical Nurse Specialist
Nursing Resources | Shawnee Mission Medical Center |9100 W. 74th St., Shawnee 
Mission, KS 66204
P: 913-676-7476
Much more than medicine.
ShawneeMission.org | Facebook.com/ShawneeMission


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Re: [Sepsis Groups] Sepsisgroups Digest, Vol 158, Issue 6

[Izard, Kimberly]

The criteria you list below would not equal time 0 for severe sepsis. The 
manual states septic shock presentation (time 0) is determined by two criteria:
MD documentation of septic shock AND tissue hypoperfusion persisting after 
fluid administration ( they list metrics for identifying hypoperfusion)
Typically we see MD documentation of septic shock and that starts the clock.
As far as I can tell, CMS does not track time from hypotension to fluid bolus. 
It does track time fluids finished; up to one hour after completion. That is 
used to determine persistent hypotension. Which then calls for the rest of the 
bundle.

Thank you, Kim

Kim Izard, BS, RN
Supervisor Clinical Outcomes/Core Measures
SSM Health - St. Louis Network
1015 Corporate Square Drive Suite 240
Creve Coeur, MO 63132
Office - 314-989-2137
Cell - 618-670-3616
kimberly_iz...@ssmhc.com



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-Original Message-
From: Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On 
Behalf Of Gerard, Daniel
Sent: Friday, May 29, 2015 3:29 PM
To: sepsisgroups@lists.sepsisgroups.org
Subject: Re: [Sepsis Groups] Sepsisgroups Digest, Vol 158, Issue 6

We changed triage time to time of onset of hypotension/lactate 4 a while back 
as time zero. It made sense and that is what our state quality improvement 
project had been collecting. I have the same concerns about time 0 in a pt with 
clear septic shock being AFTER fluid administration and BP status is known. 
Time from hypotension to fluid bolus seems like one of the most important parts 
of the bundle. i assume the time after the fluid bolus if lactate  4 would 
also be considered time 0 regardless of blood pressure?


Daniel Gerard RPh
Critical Care Pharmacist
McLaren Northern Michigan
231-487-4770
FAX: 213-487-4817

From: Sepsisgroups sepsisgroups-boun...@lists.sepsisgroups.org on behalf of 
sepsisgroups-requ...@lists.sepsisgroups.org 
sepsisgroups-requ...@lists.sepsisgroups.org
Sent: Friday, May 29, 2015 8:30 AM
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Subject: Sepsisgroups Digest, Vol 158, Issue 6

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Today's Topics:

   1. Joint Commission Performance Measure Time Zero (Angela Craig)
   2. Re: Joint Commission Performance Measure (Angela Craig)
   3. Re: CMS Guidelines (Brandy Cuevas)


--

Message: 1
Date: Thu, 28 May 2015 10:32:10 -0500
From: Angela Craig acr...@crmchealth.org
To: 'megan.bor...@hcahealthcare.com'
megan.bor...@hcahealthcare.com,
Sepsisgroups@lists.sepsisgroups.org
Sepsisgroups@lists.sepsisgroups.org
Subject: [Sepsis Groups] Joint Commission Performance Measure Time
Zero
Message-ID:

343E31412FC9094487B54371286ADDA01F2B14CB48@D109EXCHMB.crmchealth.hospital

Content-Type: text/plain; charset=utf-8

OK so most of us have changed to time of triage for time zero  I would assume.  
I had a meeting with our data abstractor for Sepsis Core Measures yesterday and 
she mentioned time zero would be changing.  She then showed me the manual for 
the data abstractors.

It stated for Septic Shock Present the following:  Criteria

There must be documentation of severe sepsis present AND Tissue hypoperfusion 
persists after crystalloid fluid administration evidenced by either SBP 90, or 
MAP65, or a decrease in SBP by 40points OR Lactate level is 4

S My abstractor was under the impression this would be the new time zero 
based on this.

There was a sheet on Severe Sepsis Present as well.  What concerns me is that 
based on documentation is what will que them for time zero.  I am worried that 
there will be delays in care if that is how it will be determined.  What are 
everyone's thoughts?

Am I missing something?  Will everyone just stay with time zero that we feel is 
clinically 

Re: [Sepsis Groups] Sepsisgroups - Core Measure - ED and IP?

[Izard, Kimberly]

Beth,
You are correct. It applies to ED patients/direct admits. And those that 
develop sepsis during the stay.



Thank you, Kim

Kim Izard, BS, RN
Supervisor Clinical Outcomes/Core Measures
SSM Health - St. Louis Network
1015 Corporate Square Drive Suite 240
Creve Coeur, MO 63132
Office - 314-989-2137
Cell - 618-670-3616
kimberly_iz...@ssmhc.com



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-Original Message-
From: Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On 
Behalf Of Beth Leffard
Sent: Friday, May 29, 2015 9:43 AM
To: sepsisgroups@lists.sepsisgroups.org
Subject: Re: [Sepsis Groups] Sepsisgroups - Core Measure - ED and IP?

For someone further along in Sepsis Core Measure prep than me:
My first impression from reading the CMS guidelines was that this measure would 
only apply to ED patients or direct admits (not transfer from ACF), but upon 
further reading, it appears it will apply to inpatients who develop sepsis 
during the stay. Is that correct?
Does the CMS Sepsis Core Measure apply to both ED pts and IPs with sepsis not 
present on admission?
Thank you.
Beth

Beth Leffard, MSN, RN - Assistant Director of Quality Management University of 
South Alabama Medical Center
2451 Fillingim St. Mobile, AL 36617
Office 251-471-7210 / Fax 251-445-9118
email meleff...@health.southalabama.edu
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Behalf Of sepsisgroups-requ...@lists.sepsisgroups.org
Sent: Friday, May 29, 2015 7:33 AM
To: sepsisgroups@lists.sepsisgroups.org
Subject: Sepsisgroups Digest, Vol 158, Issue 11

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Today's Topics:

   1. Re: CMS Guidelines (peggy.siene...@hcahealthcare.com)


--

Message: 1
Date: Thu, 28 May 2015 16:02:43 +
From: peggy.siene...@hcahealthcare.com
To: deborah.chambl...@hcahealthcare.com,
Sepsisgroups@lists.sepsisgroups.org
Subject: Re: [Sepsis Groups] CMS Guidelines
Message-ID:

1629a24ac5c93b429687ace36144bb2905ffa...@xrdcwpmsghcmd2a.hca.corpad.net

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

Notice that the guidelines state reassessment  by a licensed independent 
practitionerRNs do not qualify for that position because we are not 
independent. Docs, PAs, ARNPs is what I believe they are saying it has to be. I 
truly believe an RN could do those things so I am unclear as to why they chose 
that title to do that reassessment.  Any input on that .or did we interpret 
it incorrectly?

From: Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On 
Behalf Of deborah.chambl...@hcahealthcare.com
Sent: Wednesday, May 27, 2015 3:25 PM
To: Sepsisgroups@lists.sepsisgroups.org
Subject: [EXTERNAL] [Sepsis Groups] CMS Guidelines

So, I've read through the new CMS Guidelines and it states that a repeat 
assessment must be completed within 6 hrs with either a focused exam (including 
VS, cardiopulmonary exam, cap refill, peripheral pulse eval and skin exam) or 
any two of the four: CVP, SV02, bedside cardiovascular ultrasound, passive leg 
raise or fluid challenge.

At our hospital, we have the shift evaluation and shift re-evaluation.  If 
the nurse documents the shift re-evaluation they are basically saying nothing 
has changed since the last evaluation.  I'm wondering if that will suffice, or 
if they actually have to do another complete head-to-toe assessment.  Any 
thoughts??

Thanks,
Debbie

Debbie Chambless, MSN, RN, ARNP-C

Re: [Sepsis Groups] CMS fluid metric

[Izard, Kimberly]

Jeanie,
We have been sending questions through the IQR and receiving responses. I have 
attached a response we received regarding your questions below. According to 
this answer we can take fluids prior, even from EMS. The challenge for us; the 
amount received is not consistently documented by EMS or ED RN. Difficult to 
“count” in for the amount to be given if no amount documented.
Hope this helps.

Thank you, Kim

Kim Izard, BS, RN
Supervisor Clinical Outcomes/Core Measures
SSM Health - St. Louis Network
1015 Corporate Square Drive Suite 240
Creve Coeur, MO 63132
Office – 314-989-2137
Cell – 618-670-3616
kimberly_iz...@ssmhc.commailto:kimberly_iz...@ssmhc.com

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From: Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On 
Behalf Of Jeanie Bollinger
Sent: Tuesday, June 02, 2015 11:22 AM
To: 'sepsisgroups@lists.sepsisgroups.org'
Subject: [Sepsis Groups] CMS fluid metric

Hello all,
I wanted to ask a question pertaining to the fluid metric.  It appears that CMS 
is not giving any “credit” to any fluid given prior to hypotension or lactate 
4.  The issue we are having is that if a patient presents with severe sepsis 
and organ dysfunction, is tachycardiac and is given a fluid bolus proactively 
prior to hypotension or getting the lactate results back, that fluid is not 
counted in the resuscitation bolus compliance metric.  What are everyone 
thoughts on this issue?  Also if patient is hypotensive for EMS and receives 
fluid PTA, these fluids are not counted either.  Thoughts?

Jeanie Bollinger RN,MSN,ACCNS-AG, CCRN
Sepsis Clinical Nurse Specialist
Center For Nursing Excellence
Mission Health
Asheville, NC.

Phone 828-213-7171
Pager 207-2363



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Fluid Administration.docx
Description: Fluid Administration.docx
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Re: [Sepsis Groups] CMS Guidelines

[Izard, Kimberly]

Time zero is not necessarily triage time. It is based on MD/PA/NP documentation 
of severe sepsis or septic shock OR if the patient meets the criteria whichever 
is first.

For the IP case, we need to see the same documentation, either by 
physician/NP/PA or look to see if the patient has the three necessary criteria. 
If we use the criteria, the clock starts with the last criteria met (for 
example, if the lactate result was last, that is when the clock starts.) If the 
criteria is met prior to the MD documentation then again we need to take the 
time of the last criteria. If MD documentation occurs firstthen that is 
when the clock starts.

We are developing a code sepsis process that we hope will help us identify 
time zero in the IP. We are working with the clinical staff on the units in 
order to assist them in early identification of sepsis.

Thank you, Kim

Kim Izard, BS, RN
Supervisor Clinical Outcomes/Core Measures
SSM Health - St. Louis Network
1015 Corporate Square Drive Suite 240
Creve Coeur, MO 63132
Office - 314-989-2137
Cell - 618-670-3616
kimberly_iz...@ssmhc.commailto:kimberly_iz...@ssmhc.com

[cid:image001.png@01D03C74.E7E7DEB0]

Change is a challenge and an opportunity; not a threat
-Prince Phillip of England

This e-mail message is confidential, intended only for the named recipient(s) 
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From: Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On 
Behalf Of Parker, Erin
Sent: Monday, June 01, 2015 2:36 PM
To: Sepsisgroups@lists.sepsisgroups.org
Subject: [Sepsis Groups] CMS Guidelines

I understand that time zero for ED is triage, but confused with SEP-1 when does 
the clock start if a person is in the ICU/Floor?

Erin K. Parker RN, BSN, ACM | Infection Control | Sepsis Coordinator
Genesys Regional Medical Center |  One Genesys Parkway | Grand Blanc, MI 48439
Phone: 810.606.5093| Fax: 810-606-5495 | 
erin.par...@genesys.orgmailto:erin.par...@genesys.org | 
www.genesys.orghttp://www.genesys.org/


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Re: [Sepsis Groups] Fluid resuscitation

[Izard, Kimberly]

The only accepted fluids by CMS for the core measure are 0.9% NS and full 
strength LR. Plasmalyte is not an option according to the specifications manual.

Thank you, Kim

Kim Izard, BS, RN
Supervisor Clinical Outcomes/Core Measures
SSM Health - St. Louis Network
1015 Corporate Square Drive Suite 240
Creve Coeur, MO 63132
Office - 314-989-2137
Cell - 618-670-3616
kimberly_iz...@ssmhc.com



Change is a challenge and an opportunity; not a threat
-Prince Phillip of England

This e-mail message is confidential, intended only for the named recipient(s) 
above and may contain information that is privileged or exempt from disclosure 
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-Original Message-
From: Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On 
Behalf Of Kramer, George C.
Sent: Friday, May 15, 2015 6:12 AM
To: Mascioli, Charles MD
Cc: Savino, Terri; sepsisgroups@lists.sepsisgroups.org
Subject: Re: [Sepsis Groups] Fluid resuscitation

LR is a balanced solution.

Most evidence of the superiority of plasmalyte has been compared to NS.  NS can 
cause renal failure and hypochloremic acidosis and many believe it should be 
avoided in high doses.  Using either PLT or LR as solution should be equivalent.

imho


George Kramer, PhD
Professor
Director Resuscitation Research Lab
Dept. of Anesthesiology
UTMB, Galveston
409-939-3040


 On May 13, 2015, at 8:24 PM, Mascioli, Charles MD cmasc...@covhlth.com 
 wrote:

 Hello, The sepsis consultant stated that we need to use NS or RL..for 
 fluid resuscitation,  that balanced solutions such as plasmalyte wer not 
 approved??? Does anybody know what the actual  CMS  rule is?
 Thanks C Mascioli  MD, MMC ,Oak Ridge Tn
 
 From: Sepsisgroups [sepsisgroups-boun...@lists.sepsisgroups.org] on
 behalf of Savino, Terri [terri.sav...@midhosp.org]
 Sent: Friday, May 08, 2015 8:16 PM
 To: sepsisgroups@lists.sepsisgroups.org
 Subject: [Sepsis Groups] Fluid resuscitation

 I was wondering if anyone could clarify what time CMS is looking for fluid 
 administration?  It looks like to me they want the time it was hung 
 (appropriate order for fluid resuscitation), but isn't it important to know 
 the time the 30ml/kg are infused, not when they are hung?  What time does the 
 surviving sepsis campaign use?

 Thank you in advance for your response.

 Terri

 Terri Savino MSN, RN, CPHQ
 Core Measure Specialist
 Quality Improvement Coordinator
 Trauma Coordinator

 Middlesex Hospital
 28 Crescent St
 Middletown, CT 06457
 office: 860-358-3026
 fax: 860-358-4088
 www.middlesexhospital.orghttp://www.middlesexhospital.org

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Re: [Sepsis Groups] Fluid resuscitation

[Izard, Kimberly]

Yes, it is important to note when the fluids complete in order to answer the 
Hypotension question. This data element looks at 1 hour after the fluid is 
administered.
We have been submitting questions to the IQR and we are receiving responses. I 
have attached one for your reference.

Thank you, Kim

Kim Izard, BS, RN
Supervisor Clinical Outcomes/Core Measures
SSM Health - St. Louis Network
1015 Corporate Square Drive Suite 240
Creve Coeur, MO 63132
Office – 314-989-2137
Cell – 618-670-3616
kimberly_iz...@ssmhc.commailto:kimberly_iz...@ssmhc.com

[cid:image001.png@01D03C74.E7E7DEB0]

“Change is a challenge and an opportunity; not a threat”
-Prince Phillip of England

This e-mail message is confidential, intended only for the named recipient(s) 
above and may contain information that is privileged or exempt from disclosure 
under applicable law. If you are not the intended recipient(s), you are 
notified that the dissemination, distribution or copying of this message is 
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From: Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On 
Behalf Of Savino, Terri
Sent: Friday, May 08, 2015 7:16 PM
To: sepsisgroups@lists.sepsisgroups.org
Subject: [Sepsis Groups] Fluid resuscitation

I was wondering if anyone could clarify what time CMS is looking for fluid 
administration?  It looks like to me they want the time it was hung 
(appropriate order for fluid resuscitation), but isn't it important to know the 
time the 30ml/kg are infused, not when they are hung?  What time does the 
surviving sepsis campaign use?
Thank you in advance for your response.
Terri

Terri Savino MSN, RN, CPHQ
Core Measure Specialist
Quality Improvement Coordinator
Trauma Coordinator

Middlesex Hospital
28 Crescent St
Middletown, CT 06457
office: 860-358-3026
fax: 860-358-4088
www.middlesexhospital.orghttp://www.middlesexhospital.org

[http://middlesexhospital.org/wsimages/logo-header.png]




This e-mail message may be protected by the attorney client privilege and the 
work product doctrines.  This e-mail may also be protected by section 19a-17b 
of the CT General Statutes.

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System by sending a reply email to the sender or calling the Middlesex Hospital 
Privacy Office Hotline at 860-358-4630 and then delete this email and all 
attachments.

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Health System are confidential under federal and state law and are intended 
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recipient, you are hereby notified that any inappropriate use or reproduction 
of the information is strictly prohibited and may subject you to civil or 
criminal penalties.



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Fluid Administration.docx
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