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<mailto: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

WARNING: This email originated outside of the El Camino Hospital email system!
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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<https://urldefense.com/v3/__https:/nam03.safelinks.protection.outlook.com/?url=https*3A*2F*2Furldefense.proofpoint.com*2Fv2*2Furl*3Fu*3Dhttps-3A__nam02.safelinks.protection.outlook.com_-3Furl-3Dhttp-253A-252F-252Fwww.covenanthealth.org-252F-26data-3D02-257C01-257CJoAnn.Long-2540LCU.EDU-257Cce910366f32840fc35e908d73d0fec92-257Cac351d2dd6fe47c8a15c3c4900d9da18-257C0-257C0-257C637045011227045827-26sdata-3D5zjfS8-252FEVUuhOhFVOm2-252BBClDRJEassSzhdsHyuyxPn8-253D-26reserved-3D0*26d*3DDwMFAg*26c*3DKoC5GYBOIefzxGAm2j6cjFf-Gz7ANghQIP9aFG9DuBs*26r*3DioyVXu84Fgh_cDFmAFc7ayo1-asuRRLLvGo0Fvxncu0*26m*3DhtkFFPsTgs4sGyNR35TyV004FARHmP_o5n3BmkVpbpg*26s*3DPeFB1vLqSAu7_726-NHoqF-pNxiwF4WqChZ_w-QGsSA*26e*3D=02*7C01*7CAMDeffenbaugh*40mercy.com*7C9c6af019275c49251c1408d80e1c3104*7Cbb84ecdc9a5141eb880c178c5153d561*7C0*7C0*7C637274861680911636=P2pT*2BM2TxkCb*2FyUVcVd0rkYLImGeOlsLE9pX5s7YhHA*3D=0__;JSUlJSUlJSUlJSUlJSUlJSUlJSUlJSUlJSUlJSUl!!Ljw3zIE-Fw5odGwP!ZxUnCcjWWvoU_F5Y1H4of_a5obQwM_DXF12D_AZjulLqRKSo0Y9m2oeudPSHnmg94my1zqI$>
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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<mailto: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<https://nam01.safelinks.protection.outlook.com/?url=https%3A%2F%2Furldefense.proofpoint.com%2Fv2%2Furl%3Fu%3Dhttps-3A__nam02.safelinks.protection.outlook.com_-3Furl-3Dhttp-253A-252F-252Fwww.covenanthealth.org-252F-26data-3D02-257C01-257CJoAnn.Long-2540LCU.EDU-257Cce910366f32840fc35e908d73d0fec92-257Cac351d2dd6fe47c8a15c3c4900d9da18-257C0-257C0-257C637045011227045827-26sdata-3D5zjfS8-252FEVUuhOhFVOm2-252BBClDRJEassSzhdsHyuyxPn8-253D-26reserved-3D0%26d%3DDwMFAg%26c%3DKoC5GYBOIefzxGAm2j6cjFf-Gz7ANghQIP9aFG9DuBs%26r%3DioyVXu84Fgh_cDFmAFc7ayo1-asuRRLLvGo0Fvxncu0%26m%3DhtkFFPsTgs4sGyNR35TyV004FARHmP_o5n3BmkVpbpg%26s%3DPeFB1vLqSAu7_726-NHoqF-pNxiwF4WqChZ_w-QGsSA%26e%3D=01%7C01%7Celizabeth.knight%40franciscanalliance.org%7C4b4971112f41453946a108d81216f8fa%7C4b843c54adae4ff29f04d9248f52101e%7C0=j5zDgudXZqqeQMNWsg09Uis851TakQUPS31g9ggL26g%3D=0>
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Re: [Sepsis Groups] [EXTERNAL] Re: Sepsis & COVID

[Deffenbaugh, Amy M]

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
..
[cid:image003.png@01D63FEC.410F93E0][socialicons.jpg]
  [socialicons.jpg] 

  [socialicons.jpg] 

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

[Roney, Jamie K]

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
..
[cid:image007.png@01D63FDB.21698700][socialicons.jpg]
  [socialicons.jpg] 

  [socialicons.jpg] 


[cid:image006.png@01D63FDB.216408C0]



From: Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On 
Behalf Of Deffenbaugh, Amy M
Sent: Tuesday, June 9, 2020 5:07 AM
To: Merwin, Courtney C. ; 
'sepsisgroups@lists.sepsisgroups.org' 
Subject: [EXTERNAL] Re: [Sepsis Groups] Sepsis & COVID

In my opinion, even if there is septic shock, if your source is viral, you 
still do not have to abstract. If there is a “possible superimposed bacterial 
infection” being treated with antibiotics,  you would have to abstract. And 
check your documentation within 6 hours to rule out infection and 24 hours for 
rule out of SIRS and organ dysfunction

Amy M Deffenbaugh RN, BSN
Quality Improvement Coordinator
St Rita’s Medical Center
730 W Market St
Lima, OH 45801
Phone (419) 996-5513
Fax ( 419) 226-9180
amdeffenba...@mercy.com



From: Sepsisgroups 
mailto:sepsisgroups-boun...@lists.sepsisgroups.org>>
 On Behalf Of Merwin, Courtney C.
Sent: Thursday, May 14, 2020 11:49 AM
To: 'sepsisgroups@lists.sepsisgroups.org' 
mailto:sepsisgroups@lists.sepsisgroups.org>>
Subject: [Sepsis Groups] Sepsis & COVID

How are you handling abstractions for Sepsis with COVID?  Clearly infection is 
suspected to be viral including documentation of such.  But when a physician 
documents septic shock, does that have to be abstracted as Severe sepsis 
presentation? What about when there is documentation of antibiotics ordered for 
“possible superimposed bacterial infection”?

Courtney Merwin BS, RRT, CPHQ
Clinical Quality Analyst
East Jefferson General Hospital
4200 Houma Blvd.
Metairie, LA   70006
504-503-5968