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

[Belfi, Karen]

So should we go by what Bob said in the presentation, or what Qnet says below?
They directly contradict each other. Bob said not to abstract septic shock if 
lactate is >4 without crystalloids, but below says the opposite.
Thanks,

Karen Belfi, RN, MSN
Quality Outcomes Coordinator
Lankenau Medical Center
484-476-8092
Pager: 5240
[cid:image001.png@01D126C3.A84271A0]

From: Izard, Kimberly [mailto:kimberly_iz...@ssmhc.com]
Sent: Tuesday, November 24, 2015 1:42 PM
To: Belfi, Karen; 'sepsisgroups@lists.sepsisgroups.org'
Subject: RE: Septic Shock Present [Incident: 151007-000178]

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 

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

[Belfi, Karen]

There is a bullet point in the specification manual that states: If crystalloid 
fluids were not administered after the presentation date and time of severe 
sepsis, choose value "2", which is No.
This was confirmed by Bob Dickerson in his presentation on October 26.
He stated:

"Now please note, in the septic shock present data element, there is a bullet 
point in the note for abstraction indicating that if crystalloid fluids were 
not administered after severe sepsis presentation date and time, that you would 
select allowable value 2 for septic shock present, which is equivalent to No. 
For purposes of SEP-1 measure, at this point in time, regardless of how septic 
shock is identified, if no crystalloid fluids were given after severe sepsis 
presentation, you will select allowable value 2, which is No, for septic shock 
present".

This is found on page 27. Below is a direct link to the transcript.

http://www.qualityreportingcenter.com/wp-content/uploads/2015/11/IQR_10-26_WebinarPresentationTranscript_v2_FINAL_508.pdf


Karen Belfi, RN, MSN
Quality Outcomes Coordinator
Lankenau Medical Center
484-476-8092
Pager: 5240
[cid:image001.png@01D126B1.0D88EFC0]

From: Mary Draper [mailto:mary.dra...@johnmuirhealth.com]
Sent: Tuesday, November 24, 2015 12:02 PM
To: Belfi, Karen; 'sepsisgroups@lists.sepsisgroups.org'
Subject: RE: Septic Shock Present [Incident: 151007-000178]

Karen, I don't see that crystalloids need to be given if the lactate if > 4.
There is an "or" between the fluids and the lactate > 4.

Mary Draper RN BSN
Coordinator Quality Improvement
Peer Review Support CV/CT
Quality Management
Office (925) 674-2045
Cell (925) 451-8792
Fax (925) 674-2373
mary.dra...@johnmuirhealth.com

"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 Belfi, Karen
Sent: Tuesday, November 24, 2015 4:22 AM
To: 'sepsisgroups@lists.sepsisgroups.org'
Subject: Re: [Sepsis Groups] Septic Shock Present [Incident: 151007-000178]

This answer doesn't address crystalloid fluids, however.
In the CMS power point, Bob stated that the patient needed to receive 
crystalloid fluids in order to select septic shock if only criteria is lactate.

Karen Belfi, RN, MSN
Quality Outcomes Coordinator
Lankenau Medical Center
484-476-8092
Pager: 5240
[cid:image001.png@01D126B1.0D88EFC0]

From: Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On 
Behalf Of Tribuiani, Barbara
Sent: Friday, November 20, 2015 10:54 AM
To: 'sepsisgroups@lists.sepsisgroups.org'
Subject: [Sepsis Groups] FW: Septic Shock Present [Incident: 151007-000178]

Hello All-

Please see below response form Qnet re: septic shock present. I found this to 
be very helpful.

Barb

From: IQR Q System [mailto:cms...@mailps.custhelp.com]
Sent: Friday, November 20, 2015 10:11 AM
To: Tribuiani, Barbara
Subject: Septic Shock Present [Incident: 151007-000178]



Recently you requested personal assistance from our on-line support center. 
Below is a summary of your request and our response.

If this issue is not resolved to your satisfaction, you may reopen it within 
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 Subject

Septic Shock Present



 Discussion Thread

 Response Via Email (Deb Lindner)

11/20/2015 10:10 AM

Barbara,

An addendum to the Specifications Manual for the National Hospital Inpatient 
Quality Reporting (IQR) Program (5.0b) has been posted to QualityNet at 
www.qualitynet.org/dcs/ContentServer?c=Page=QnetPublic%2FPage%2FQnetTier2=1141662756099.

There are 3 ways Septic Shock can be present:

1. Documentation of severe sepsis present and persistent hypotension in the 
hour after the conclusion of the 30 mL/kg Crystalloid Fluid Administration

2. Documentation of severe sepsis present and an initial lactate level is >= 4 
mmol/L

3. Physician/APN/PA documentation of Septic Shock

If you have documentation of severe sepsis being present and an initial lactate 
>= 4 mmol/L then you can answer "Yes" to Septic Shock Present.

 Response Via Email (Martha Boese)

10/08/2015 09:19 AM

Due to the volume of inquires related to the SEP-1 measure we are experiencing 
a response lag time. Responses to SEP-1 questions are being answered daily. 
Please be reminded that Q are available in the QualityNet knowledge base 
tool and a SEP-1 fact sheet 

Re: [Sepsis Groups] Persistent Hypotension

[Andre Vovan]

A more common issue is that the pt develops hypotension >1 hour after the
initial 30ml/Kg, we usually give more fluid first and then start pressors
if needed. The goal is still to get mean BP >65 but because the hypotension
occurs greater than 60 min after the initial 30kml/kg bolus, then the
reporting for 6th hour does not apply. That is my understanding. Regardless
we will still be treating for the patient which is more important than CMS
requirement in my mind.

Andre Vovan, MD MBA
Chief of Service, Critical Care
Hoag Memorial Hospital Prebyterian

Andre Vovan, MD, MBA
President/CEO
Newport Critical Care, Inc

On Thu, Nov 19, 2015 at 11:27 AM, Karin Molander 
wrote:

> I would vote for 3 UTD, as there was only one blood pressure taken.
>
> Karin H. Molander MD FACEP
> Mills-Peninsula Hospital
> Sutter Peninsula Coastal
>
> On Wed, Nov 18, 2015 at 3:10 PM, Myran, Robin 
> wrote:
>
>> From the Notes for Abstraction for Persistent Hypotension:
>>
>>
>>
>> The criteria for determining that persistent hypotension was present are
>> as follows:
>>
>> In the one hour following conclusion of administration of crystalloid
>> fluids, two or more consecutive blood pressure readings of either SBP < 90
>> or MAP < 65 or a decrease in SBP by > 40.
>>
>>
>>
>> My question:
>>
>>
>>
>> What if only one blood pressure was taken and the MAP was less than 65?
>> Do I answer the question “2 (No) – persistent hypotension was not present”
>> because there wasn’t two or more consecutive low blood pressures? Or do I
>> answer the question “3 (No) or UTD – the patient was not assessed for
>> persistent hypotension” since there was only one blood pressure taken?
>>
>>
>>
>>
>>
>> Thanks in advance for your thoughts.
>>
>>
>>
>> *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.org 
>>
>>
>>
>> Please note that the information contained in this message and any files
>> transmitted with it are privileged and confidential and are protected from
>> disclosure under the law, including the Health Insurance Portability and
>> Accountability Act (HIPAA). If the reader of this message is not the
>> intended recipient, or an employee or agent responsible for delivering this
>> message to the intended recipient, you are hereby notified that any
>> dissemination, distribution or copying of this communication is strictly
>> prohibited and may subject you to criminal or civil penalties. If you have
>> received this communication in error, please notify the sender by replying
>> to the message and delete the material from any computer. Thank you, Hoag
>> Memorial Hospital Presbyterian and its Affiliates
>>
>> ___
>> Sepsisgroups mailing list
>> Sepsisgroups@lists.sepsisgroups.org
>> http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org
>>
>>
>
>
> --
> Karin H. Molander
>
> Please note that the information contained in this message and any files
> transmitted with it are privileged and confidential and are protected from
> disclosure under the law, including the Health Insurance Portability and
> Accountability Act (HIPAA). If the reader of this message is not the
> intended recipient, or an employee or agent responsible for delivering this
> message to the intended recipient, you are hereby notified that any
> dissemination, distribution or copying of this communication is strictly
> prohibited and may subject you to criminal or civil penalties. If you have
> received this communication in error, please notify the sender by replying
> to the message and delete the material from any computer. Thank you, Hoag
> Memorial Hospital Presbyterian and its Affiliates
>
> ___
> Sepsisgroups mailing list
> Sepsisgroups@lists.sepsisgroups.org
> http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org
>
>
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Re: [Sepsis Groups] Septic Shock Present [Incident: 151007-000178]

[Mary Draper]

Karen, I don't see that crystalloids need to be given if the lactate if > 4.
There is an "or" between the fluids and the lactate > 4.

Mary Draper RN BSN
Coordinator Quality Improvement
Peer Review Support CV/CT
Quality Management
Office (925) 674-2045
Cell (925) 451-8792
Fax (925) 674-2373
mary.dra...@johnmuirhealth.com

"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 Belfi, Karen
Sent: Tuesday, November 24, 2015 4:22 AM
To: 'sepsisgroups@lists.sepsisgroups.org'
Subject: Re: [Sepsis Groups] Septic Shock Present [Incident: 151007-000178]

This answer doesn't address crystalloid fluids, however.
In the CMS power point, Bob stated that the patient needed to receive 
crystalloid fluids in order to select septic shock if only criteria is lactate.

Karen Belfi, RN, MSN
Quality Outcomes Coordinator
Lankenau Medical Center
484-476-8092
Pager: 5240
[cid:image001.png@01D12696.B82D4720]

From: Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On 
Behalf Of Tribuiani, Barbara
Sent: Friday, November 20, 2015 10:54 AM
To: 'sepsisgroups@lists.sepsisgroups.org'
Subject: [Sepsis Groups] FW: Septic Shock Present [Incident: 151007-000178]

Hello All-

Please see below response form Qnet re: septic shock present. I found this to 
be very helpful.

Barb

From: IQR Q System [mailto:cms...@mailps.custhelp.com]
Sent: Friday, November 20, 2015 10:11 AM
To: Tribuiani, Barbara
Subject: Septic Shock Present [Incident: 151007-000178]



Recently you requested personal assistance from our on-line support center. 
Below is a summary of your request and our response.

If this issue is not resolved to your satisfaction, you may reopen it within 
the next 2 days.

Thank you for allowing us to be of service to you.

To access your question from our support site, click 
here.

 Subject

Septic Shock Present



 Discussion Thread

 Response Via Email (Deb Lindner)

11/20/2015 10:10 AM

Barbara,

An addendum to the Specifications Manual for the National Hospital Inpatient 
Quality Reporting (IQR) Program (5.0b) has been posted to QualityNet at 
www.qualitynet.org/dcs/ContentServer?c=Page=QnetPublic%2FPage%2FQnetTier2=1141662756099.

There are 3 ways Septic Shock can be present:

1. Documentation of severe sepsis present and persistent hypotension in the 
hour after the conclusion of the 30 mL/kg Crystalloid Fluid Administration

2. Documentation of severe sepsis present and an initial lactate level is >= 4 
mmol/L

3. Physician/APN/PA documentation of Septic Shock

If you have documentation of severe sepsis being present and an initial lactate 
>= 4 mmol/L then you can answer "Yes" to Septic Shock Present.

 Response Via Email (Martha Boese)

10/08/2015 09:19 AM

Due to the volume of inquires related to the SEP-1 measure we are experiencing 
a response lag time. Responses to SEP-1 questions are being answered daily. 
Please be reminded that Q are available in the QualityNet knowledge base 
tool and a SEP-1 fact sheet 

  is posted on QualityNet. A 
recording,
 
slides
 , and 
Q
 from the August 24th National Provider call are available for review. The 
recording and 
slides
 for September 21st are available for review.

The following link will give you more information on the upcoming October 26th 
National Provider call and the opportunity to register for the event: 
http://www.qualityreportingcenter.com/wp-content/uploads/2015/08/IQR_Sepis_series-Flyer-vFINAL-1508.pdf.

Please close your question if it is answered by these resources. We will 
continue working diligently to reduce response lag time in replying to 
questions.

 Customer By Web Form (barbara tribuiani)

10/07/2015 05:56 PM

Hello,
For this data element is lactate >4 (initial or repeat) enough to say "yes"? I 
know the other criteria is "peristent hypotension after 30ml/kg" but 

[Sepsis Groups] VBG for screening

[Rutherford, Richard]

Hello all,


My hospital is considering expanding our sepsis screening so that a VBG+Lactate 
is checked for every patient with a positive sepsis screen (instead of lactate 
alone).  Have any other hospitals done this?  Does anyone have a second set of 
criteria for sicker patients for whom VBG is ordered?


Thanks,


Richard Rutherford, M.D.
Quality Medical Director, Ventura County Medical Center
3291 Loma Vista Road, Ventura, CA 93003
(805) 665-8234 (cell)
(805) 652-6096 (office)
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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

[MSC:SYS:SYS_15_8403_2015_SSMHealth_StyleGuide:images:SSMHealth_Standard_EmailSignature2.jpg]


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 

Re: [Sepsis Groups] Administrative contraindications to care

[Mary Draper]

Thanks for your input.

Mary Draper RN BSN
Coordinator Quality Improvement
Peer Review Support CV/CT
Quality Management
Office (925) 674-2045
Cell (925) 451-8792
Fax (925) 674-2373
mary.dra...@johnmuirhealth.com

“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: Andre Vovan [mailto:avo...@npccp.com]
Sent: Tuesday, November 24, 2015 9:38 AM
To: Mary Draper
Cc: Kelli Barrieau; sepsisgroups@lists.sepsisgroups.org
Subject: Re: [Sepsis Groups] Administrative contraindications to care

It only makes sense that this counts as an exclusion.

Andre Vovan MD MBA
Chief of Critical Care
Hoag Memorial Hospital Prebyterian


Andre Vovan, MD, MBA
President/CEO
Newport Critical Care, Inc

On Thu, Nov 19, 2015 at 11:29 AM, Mary Draper 
> wrote:
Great question. I have had this same scenario and haven’t been clear on how to 
address it.

Mary Draper RN BSN CCRN
Coordinator Quality Improvement
Peer Review Support CV/CT
Quality Management
Office (925) 674-2045
Cell (925) 451-8792
Fax (925) 674-2373
mary.dra...@johnmuirhealth.com
[cid:image001.png@01D126A9.66468080]
“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 Kelli Barrieau
Sent: Wednesday, November 18, 2015 12:55 PM
To: 
sepsisgroups@lists.sepsisgroups.org
Subject: [Sepsis Groups] Administrative contraindications to care

We had a patient in septic shock who refused to have a central line placed. 
Without the central line, we were not able to give them vasopressors. The 
provider documented the conversation with the patient and family about refusing 
the central line and what it would mean but none of those are exclusions as an 
administrative contraindication to care. Does anyone if refusing any of the 
care would be a contraindication or is it just IV, antibiotics or blood draws?

Thank you,

Kelli A Barrieau RN BSN
Unit Based Quality Nurse
Cooley Dickinson Hospital
PO Box 5001, 30 Locust Street
Northampton, MA 01060-5001
413-582-2859

kelli_barri...@cooley-dickinson.org
Cooley-dickinson.org


Please note that the information contained in this message and any files 
transmitted with it are privileged and confidential and are protected from 
disclosure under the law, including the Health Insurance Portability and 
Accountability Act (HIPAA). If the reader of this message is not the intended 
recipient, or an employee or agent responsible for delivering this message to 
the intended recipient, you are hereby notified that any dissemination, 
distribution or copying of this communication is strictly prohibited and may 
subject you to criminal or civil penalties. If you have received this 
communication in error, please notify the sender by replying to the message and 
delete the material from any computer. Thank you, Hoag Memorial Hospital 
Presbyterian and its Affiliates

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