Re: [Sepsis Groups] [External] Sepsis: Automated antibiotics
We have not. Mary Draper RN BSN Coordinator Quality Improvement Peer Review Support Medicine/CV/CT JMH Quality Management Office (925) 674-2045 Cell (925) 451-8792 Fax (925) 674-2373 mary.dra...@johnmuirhealth.com [cid:image002.png@01D5EE3D.4B392670] “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-boun...@lists.sepsisgroups.org [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On Behalf Of McKnight, Elise Sent: Tuesday, February 11, 2020 10:22 AM To: sepsisgroups@lists.sepsisgroups.org Subject: [External] [Sepsis Groups] Sepsis: Automated antibiotics Caution: This email originated outside JMH. Do not open attachments or click on links if you do not recognize the sender. Has any organization implemented automated antibiotics for a Sepsis Alert or with Sepsis Best Practice Alert in their EHR? Thanks! Elise McKnight Sepsis Coordinator Medical Center of the Rockies Poudre Valley Hospital Yampa Valley Medical Center Greeley Hospital 2500 Rocky Mountain Ave Loveland, CO 80538 O 970.624.2153 C 970.290.9436 F 970.624.2192 elise.mckni...@uchealth.org<mailto:elise.mckni...@uchealth.org> uchealth.org [UCHealth]<https://www.uchealth.org/> ___ Sepsisgroups mailing list Sepsisgroups@lists.sepsisgroups.org<mailto:Sepsisgroups@lists.sepsisgroups.org> http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org ___ Sepsisgroups mailing list Sepsisgroups@lists.sepsisgroups.org http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org
Re: [Sepsis Groups] [External] RE: Sepsis Mortality
We exclude hospice patients as well in the first 24 hours. Thanks Mary Draper RN BSN QI Coordinator Quality Management Office (925) 674-2045 Cell (925) 451-8792 Fax (925) 674-2373 mary.dra...@johnmuirhealth.com<mailto:mary.dra...@johnmuirhealth.com> On Nov 12, 2019, at 11:43 AM, DHILLON, ROOPINDER wrote: Caution: This email originated outside JMH. Do not open attachments or click on links if you do not recognize the sender. What about hospice patients? Roopa Dhillon MBBS, MBA-HCA Clinical Quality Specialist 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<mailto:Roopinder.Dhillon@UHhospitals>.org Quality Assurance/Peer Review Privileged Pursuant to Ohio Rev. Code secs. 2305.24, 2305.25, 2305.251, 2305.252 and 2305.253 From: Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On Behalf Of Mary Draper Sent: Thursday, November 07, 2019 2:10 PM To: sepsisgroups@lists.sepsisgroups.org Subject: [Sepsis Groups] Sepsis Mortality Importance: High External E-mail: Careful opening links or attachments. We use all 3 diagnosis codes, sepsis, severe sepsis and septic shock and exclude comfort care in the first 24 hours to determine our rate. We have a dashboard that allows us to filter for this and it includes, POA and NPOA. Do you any of you use this metric? Thanks. Mary Draper RN BSN Coordinator Quality Improvement Peer Review Support Medicine/CV/CT JMH Quality Management Office (925) 674-2045 Cell (925) 451-8792 Fax (925) 674-2373 mary.dra...@johnmuirhealth.com<mailto: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 Visit us at www.UHhospitals.org. The enclosed information is STRICTLY CONFIDENTIAL and is intended for the use of the addressee only. University Hospitals and its affiliates disclaim any responsibility for unauthorized disclosure of this information to anyone other than the addressee. Federal and Ohio law protect patient medical information, including psychiatric_disorders, (H.I.V) test results, A.I.Ds-related conditions, alcohol, and/or drug_dependence or abuse disclosed in this email. Federal regulation (42 CFR Part 2) and Ohio Revised Code section 5122.31 and 3701.243 prohibit disclosure of this information without the specific written consent of the person to whom it pertains, or as otherwise permitted by law. ___ Sepsisgroups mailing list Sepsisgroups@lists.sepsisgroups.org http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org
[Sepsis Groups] Sepsis Mortality
We use all 3 diagnosis codes, sepsis, severe sepsis and septic shock and exclude comfort care in the first 24 hours to determine our rate. We have a dashboard that allows us to filter for this and it includes, POA and NPOA. Do you any of you use this metric? Thanks. Mary Draper RN BSN Coordinator Quality Improvement Peer Review Support Medicine/CV/CT JMH Quality Management Office (925) 674-2045 Cell (925) 451-8792 Fax (925) 674-2373 mary.dra...@johnmuirhealth.com [cid:image001.png@01D5955B.E68E36A0] "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 ___ Sepsisgroups mailing list Sepsisgroups@lists.sepsisgroups.org http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org
Re: [Sepsis Groups] [External] Procalcitonin in Sepsis Order Set?
We don’t at this point. We are a 2 hospital system combined we have about 550 beds. Thanks 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:image002.png@01D58363.D0EFE000] “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-boun...@lists.sepsisgroups.org [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On Behalf Of Rosemary Grant Sent: Thursday, October 10, 2019 11:28 AM To: sepsisgroups@lists.sepsisgroups.org Subject: [External] [Sepsis Groups] Procalcitonin in Sepsis Order Set? Caution: This email originated outside JMH. Do not open attachments or click on links if you do not recognize the sender. Hello! I’m curious how many hospitals include procalcitonin in their sepsis order set (both for ED and inpatient if you have different order sets?) How many beds does your hospital have and do you include procalcitonin in sepsis order sets? Thank you! Rosemary Rosemary Mitchell Grant, BSN, RN, CPHQ Director, Safety and Quality- Sepsis and Readmissions Washington State Hospital Association 999 Third Avenue, Suite 1400 Seattle, WA 98104 Phone: 206-216-2516 Email: rosema...@wsha.org<mailto:rosema...@wsha.org> [WSHA_logo_blue_SignatureFriendlySize--2_PhotoGalleryReSize] - CONFIDENTIALITY NOTICE: This e-mail message, including any attachments, is for the sole use of the intended recipient(s) and may contain confidential and privileged information protected by federal and state law. Any unauthorized review, use, disclosure or distribution is prohibited. If you are not the intended recipient, please contact the sender by reply e-mail and destroy all copies of the original message. - CONFIDENTIALITY NOTICE: This e-mail message, including any attachments, is for the sole use of the intended recipient(s) and may contain confidential and privileged information protected by federal and state law. Any unauthorized review, use, disclosure or distribution is prohibited. If you are not the intended recipient, please contact the sender by reply e-mail and destroy all copies of the original message. ___ Sepsisgroups mailing list Sepsisgroups@lists.sepsisgroups.org<mailto:Sepsisgroups@lists.sepsisgroups.org> http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org ___ Sepsisgroups mailing list Sepsisgroups@lists.sepsisgroups.org http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org
[Sepsis Groups] POC Lactate
Are any of your facilities using a "code sepsis" blast page for your inpatient population? If so, do you use POC (iSTAT) testing for the lactate? Thanks for your feedback. 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:image003.png@01D52811.FC4F2CE0] "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: Lorena Tilton Sent: Friday, June 21, 2019 8:34 AM To: Baraka Peterman ; Mary Draper Subject: POC Lactate Good Morning, Do either of you have any information on how the lactates are run for facilities that have code sepsis. I know Sutter uses iSTAT but I need more information. I having trouble making this a smooth transition. Thank you, Lorena Tilton, RN, MSN, CCRN Professional Development Specialist John Muir Health 925-674-2060 Ext. 22060 lorena.til...@johnmuirhealth.com<mailto:lorena.til...@johnmuirhealth.com> [cid:image001.jpg@01D30F82.A4ACF5C0][Magnet Recognition Logo CMYK [jpg]] ___ Sepsisgroups mailing list Sepsisgroups@lists.sepsisgroups.org http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org
Re: [Sepsis Groups] [External] lactic acid reflex time
We use 4 hours. Our intensivists think that any time earlier (i.e. 3 hours) isn't enough time to see clinical significance. 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:image003.png@01D521CB.B16DF9F0] "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 Laura Soares Sent: Thursday, June 06, 2019 1:50 PM To: 'sepsisgroups@lists.sepsisgroups.org' Subject: [External] [Sepsis Groups] lactic acid reflex time Caution: This email originated outside JMH. Do not open attachments or click on links if you do not recognize the sender. Good afternoon, Currently we reflex any lactic acid that is > 2 to be re-drawn in 2 hrs. I'm wondering what others' practices are when reflexing the lactic acid - do you use a 2 hr timeframe, or 3 hr, or? Thanks so much! Laura Soares MSN RN SCRN Sepsis & Stroke Program Coordinator 559.788.6067 Office 559.280.2036 Cell "Teamwork is the ability to work together toward a common vision--the ability to direct individual accomplishments toward organizational objectives. It is the fuel that allows common people to attain uncommon results"- Andrew Carnegie [SVMC Logo] 465 W. Putnam Ave Porterville, CA 93257 DISCLAIMER: The information contained in this email transmission is confidential and intended for the addressee only. If the reader of this message is not the addressee or addressee's agent, you are hereby advised that any dissemination, distribution or copying of the information is strictly prohibited. The information contained in this email transmission may be protected under the Attorney/Client Privilege and protected from disclosure under California Evidence Code section 1157. If protected by the attorney/client privilege or by California Evidence Code Section 1157, the information contained in this email transmission shall continue to be protected and will not be negated by virtue of sending the information via this email. If you receive this email in error, please call the Information Technology Security Coordinator at (559) 788-6090 (collect if necessary) immediately upon receipt. Thank you for your cooperation. DISCLAIMER: The information contained in this email transmission is confidential and intended for the addressee only. If the reader of this message is not the addressee or addressee's agent, you are hereby advised that any dissemination, distribution or copying of the information is strictly prohibited. The information contained in this email transmission may be protected under the Attorney/Client Privilege and protected from disclosure under California Evidence Code section 1157. If protected by the attorney/client privilege or by California Evidence Code Section 1157, the information contained in this email transmission shall continue to be protected and will not be negated by virtue of sending the information via this email. If you receive this email in error, please call the Information Technology Security Coordinator at (559) 788-6090 (collect if necessary) immediately upon receipt. Thank you for your cooperation. ___ Sepsisgroups mailing list Sepsisgroups@lists.sepsisgroups.org http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org
Re: [Sepsis Groups] [External] Question for sepsis groups
Thanks for the information! From: Belfi, Karen [mailto:bel...@mlhs.org] Sent: Wednesday, August 08, 2018 11:46 AM To: Mary Draper ; Duane, Molly ; Sepsisgroups@lists.sepsisgroups.org Subject: RE: [Sepsis Groups] [External] Question for sepsis groups Caution: This email originated outside JMH. Do not open attachments or click on links if you do not recognize the sender. They are. But according to the spec manual oral or rectal vanco is appropriate for c diff: If the patient has C. difficile, and IV antibiotic(s) from Table 5.0 or an appropriate combination of IV antibiotics from Table 5.1 are not started within the 3 hours following presentation of severe sepsis, and the following conditions are met, choose value "1." o There is physician/APN/PA documentation within 24 hours prior to the antibiotic start time identifying the presence of C. difficile. o Any one of the treatments below is initiated within 3 hours following severe sepsis presentation: Oral vancomycin with or without oral or IV metronidazole (Flagyl) Rectal vancomycin with or without IV metronidazole (Flagyl) IV metronidazole (Flagyl) monotherapy Karen Belfi, RN, MSN Quality Outcomes Coordinator Lankenau Medical Center (484)476-8092 From: Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On Behalf Of Mary Draper Sent: Friday, August 03, 2018 1:28 PM To: Duane, Molly; Sepsisgroups@lists.sepsisgroups.org<mailto:Sepsisgroups@lists.sepsisgroups.org> Subject: Re: [Sepsis Groups] [External] Question for sepsis groups This message originated from outside MLHS systems. Any attachments or links should be carefully considered before proceeding. Please contact the Help Desk at 484-596-4357 with any questions or forward a questionable email to helpd...@mlhs.org<mailto:helpd...@mlhs.org> That's a great question. I think though the definition is looking for IV antibiotics. 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<mailto:mary.dra...@johnmuirhealth.com> [cid:image001.png@01D42F10.0476E530] "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 Duane, Molly Sent: Thursday, August 02, 2018 12:23 PM To: Sepsisgroups@lists.sepsisgroups.org<mailto:Sepsisgroups@lists.sepsisgroups.org> Subject: [External] [Sepsis Groups] Question for sepsis groups Caution: This email originated outside JMH. Do not open attachments or click on links if you do not recognize the sender. Good Afternoon, Re: antibiotic choice, if there is a positive C Diff culture, with oral vanco and IV flagyl ordered, do we also have to give broad spectrum IV antibiotics? My understanding was that we could be more specific with the antibiotic if we had a culture result directing the choice. Thank you, Molly Molly Duane RN, BSN, CCRN Sepsis Program Coordinator Detroit Receiving Hospital Harper-Hutzel Hospital Office: 313-745-4340 Cell: 248-709-6218 Email: mdu...@dmc.org<mailto:mdu...@dmc.org> This message (including any attachments) is confidential and intended solely for the use of the individual or entity to whom it is addressed, and is protected by law. If you are not the intended recipient, please delete the message (including any attachments) and notify the originator that you received the message in error. Any disclosure, copying, or distribution of this message, or the taking of any action based on it, is strictly prohibited. Any views expressed in this message are those of the individual sender, except where the sender specifies and with authority, states them to be the views of Tenet Healthcare Corporation. ___ Sepsisgroups mailing list Sepsisgroups@lists.sepsisgroups.org http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org
Re: [Sepsis Groups] [External] Antibiotics Admin/ Dialysis
I have not run across this issue. Tough scenario. It was probably best for the patient to receive the dialysis first and then be given the antibiotic. From: Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On Behalf Of Tara Miller Sent: Tuesday, August 07, 2018 10:52 AM To: 'sepsisgroups@lists.sepsisgroups.org' Subject: [External] [Sepsis Groups] Antibiotics Admin/ Dialysis Caution: This email originated outside JMH. Do not open attachments or click on links if you do not recognize the sender. Good afternoon. We had a scenario of a patient who was in "septic shock" along with severe hyperkalemia with EKG changes. The patient had to go on emergent hemodialysis in the emergency room. The physician, pharmacist, and nursing staff did not want to give the antibiotics due to having it pulled right back out with dialysis. Once the patient was removed from dialysis machine, the antibiotics was given which was on hour 4. Has anyone else had this same situation? What are you doing about it? Are you just taking the fallout for sepsis or are you administering the antibiotic regardless? Thanks. Tara R Miller, RN, BSN Team Leader, Quality Management Mobile Infirmary Medical Center Office: 435-5109 Cell: 605-8270 [IH_Logo_20170609] Confidentiality Notice: This electronic message, including any attachments, is for the sole use of the intended recipient(s) and may contain confidential and privileged information. Any unauthorized review, use, disclosure or distribution is prohibited. If you are not the intended recipient, you are hereby notified that any disclosure, copying, distribution, or action taken in reliance on the contents of this electronic message and/or any attachments is strictly prohibited. This quality assurance document is for the use of Infirmary Health and is prepared and maintained pursuant to Section 22-21-8 of the 1975 Code of Alabama. Prepared in an anticipation of litigation. ___ Sepsisgroups mailing list Sepsisgroups@lists.sepsisgroups.org http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org
Re: [Sepsis Groups] [External] Question for sepsis groups
That's a great question. I think though the definition is looking for IV antibiotics. 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<mailto:mary.dra...@johnmuirhealth.com> [cid:image003.png@01D42B14.949E2740] "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 Duane, Molly Sent: Thursday, August 02, 2018 12:23 PM To: Sepsisgroups@lists.sepsisgroups.org Subject: [External] [Sepsis Groups] Question for sepsis groups Caution: This email originated outside JMH. Do not open attachments or click on links if you do not recognize the sender. Good Afternoon, Re: antibiotic choice, if there is a positive C Diff culture, with oral vanco and IV flagyl ordered, do we also have to give broad spectrum IV antibiotics? My understanding was that we could be more specific with the antibiotic if we had a culture result directing the choice. Thank you, Molly Molly Duane RN, BSN, CCRN Sepsis Program Coordinator Detroit Receiving Hospital Harper-Hutzel Hospital Office: 313-745-4340 Cell: 248-709-6218 Email: mdu...@dmc.org<mailto:mdu...@dmc.org> This message (including any attachments) is confidential and intended solely for the use of the individual or entity to whom it is addressed, and is protected by law. If you are not the intended recipient, please delete the message (including any attachments) and notify the originator that you received the message in error. Any disclosure, copying, or distribution of this message, or the taking of any action based on it, is strictly prohibited. Any views expressed in this message are those of the individual sender, except where the sender specifies and with authority, states them to be the views of Tenet Healthcare Corporation. ___ Sepsisgroups mailing list Sepsisgroups@lists.sepsisgroups.org http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org
Re: [Sepsis Groups] [External] Question about focused exam
I don't think so. There isn't anything specific about perfusion. 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<mailto:mary.dra...@johnmuirhealth.com> [cid:image001.png@01D41F67.78019850] "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: Wednesday, July 18, 2018 10:45 AM To: sepsisgroups@lists.sepsisgroups.org Subject: [External] [Sepsis Groups] Question about focused exam Caution: This email originated outside JMH. Do not open attachments or click on links if you do not recognize the sender. This is for a Jan-June 2018 DC. Could I use either of these for the focused exam question? I know that we can't use it if it's in a header, but would these be considered headers? [cid:image001.png@01D41DA5.0EFB0C10] Or: [cid:image006.png@01D41DA5.C2971E80] For both, there's a heading that says Review of Systems and Physical Examination. Would you consider the documentation below to also be a header? Thanks. Karen Belfi, RN, MSN Quality Outcomes Coordinator Lankenau Medical Center (484)476-8092 ___ Sepsisgroups mailing list Sepsisgroups@lists.sepsisgroups.org http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org
Re: [Sepsis Groups] [External] noninvasive BP monitoring
That is a great observation. I have always been cautious about non-invasive readings automatically calculating MAP. 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<mailto:mary.dra...@johnmuirhealth.com> [cid:image003.png@01D4095B.302F30E0] "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 Tish Poserina Sent: Thursday, June 21, 2018 4:06 AM To: sepsisgroups@lists.sepsisgroups.org Subject: [External] [Sepsis Groups] noninvasive BP monitoring Caution: This email originated outside JMH. Do not open attachments or click on links if you do not recognize the sender. As I review sepsis cases in patients with non-invasive pressure monitoring; I am finding that quite often the MAP does not correlate with the standard formula (S=2D/3); and I understand that non-invasive monitoring relies on pulse amplitude to calculate mean. Should we really be utilizing MAP with non-invasive pressure devices? To say we should re-check it manually can hardly be practical when many areas of the hospital use non-invasive devices for BP monitoring. Tish Poserina, RN,MSN, CCRN, CNRN Sepsis Coordinator St Mary Medical Center pposer...@stmaryhealthcare.org<mailto:pposer...@stmaryhealthcare.org> W 215.710.4347 C 215.710.7644 1201 Langhorne-Newtown Road Langhorne, Pa 19047 stmaryhealthcare.org| Facebook| Twitter|LinkedIn Confidentiality Notice: This e-mail, including any attachments is the property of Trinity Health and is intended for the sole use of the intended recipient(s). It may contain information that is privileged and confidential. Any unauthorized review, use, disclosure, or distribution is prohibited. If you are not the intended recipient, please delete this message, and reply to the sender regarding the error in a separate email. ___ Sepsisgroups mailing list Sepsisgroups@lists.sepsisgroups.org http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org
Re: [Sepsis Groups] [External] Fw: Sepsis definitions
I think the frustration and confusion still is in what the coding can be. They can still just code "sepsis" or "severe sepsis without septic shock" and severe sepsis with septic shock. I find many are coded "sepsis" and "acidosis" which I review for the sepsis core measure focus study b/c the lactate can be > 2 which pushed the patient into the severe sepsis category. Does that make any sense? 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<mailto:mary.dra...@johnmuirhealth.com> [cid:image001.png@01D407D7.6DDF49A0] "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 SCOTT GALLAGHER Sent: Saturday, June 16, 2018 10:07 AM To: sepsisgroups@lists.sepsisgroups.org Subject: [External] [Sepsis Groups] Fw: Sepsis definitions Caution: This email originated outside JMH. Do not open attachments or click on links if you do not recognize the sender. Dear Sepsis Groups, Would someone kindly clarify whether the current SSC guidelines (2016, 2018 update) have adopted the Sepsis-3 definitions of sepsis (along with qSOFA) and septic shock or whether the current SSC guidelines utilized the established definitions of sepsis (along with SIRS), severe sepsis and septic shock put forth in Sepsis-1 and Sepsis-2? An article was published March 4, 2017 in ACEP Now (https://www.acepnow.com/article/acep-endorses-latest-surviving-sepsis-campaign-recommendations/) that stated the SSC Guidelines (2016) did not adopt the Sepsis-3 definitions, yet abandoned the term severe sepsis, and defined sepsis as the established definition (Sepsis-1 and -2) of severe sepsis, and maintained the established definition for septic shock. Thank you for any clarification you can provide me and my colleagues. Very sincerely, Scott Gallagher, MD Emergency Department Aspen Valley Hospital ___ Sepsisgroups mailing list Sepsisgroups@lists.sepsisgroups.org http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org
Re: [Sepsis Groups] [External] Sepsis Checklist for Early Recognition at SNFs
I don't have one but would be interested in seeing if others do. Thanks. 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<mailto:mary.dra...@johnmuirhealth.com> [cid:image001.png@01D3ECFC.F5917260] "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 Mary ann David Sent: Monday, May 14, 2018 8:46 AM To: sepsisgroups@lists.sepsisgroups.org Subject: [External] [Sepsis Groups] Sepsis Checklist for Early Recognition at SNFs Caution: This email originated outside JMH. Do not open attachments or click on links if you do not recognize the sender. Hi all, I was wondering if anyone has access and is willing to share a sepsis checklist designed for early recognition in SNFs? Thanks, Mary Ann David, MSN, RN, CNS, ACNS-BC Clinical Nurse Specialist, MICU/SICU/RRT Sharp Chula Vista Medical Center Tel. No. 619-502-3165 Hospital Cell No. 619-502-5578 Pager No. 619-688-7124 Fax. No. 619-502-4076 Email. maryann.da...@sharp.com<mailto:maryann.da...@sharp.com> ___ Sepsisgroups mailing list Sepsisgroups@lists.sepsisgroups.org http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org
Re: [Sepsis Groups] [External] IV intake for Sepsis
I think you can take credit for 1 liter as it was started and the administration time of over 1 hour was documented. 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<mailto:mary.dra...@johnmuirhealth.com> [cid:image001.png@01D3ED02.2759F240] “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 Davis, Diana Sent: Wednesday, May 09, 2018 12:56 PM To: sepsisgroups@lists.sepsisgroups.org Subject: [External] [Sepsis Groups] IV intake for Sepsis Caution: This email originated outside JMH. Do not open attachments or click on links if you do not recognize the sender. Good afternoon to all- The pt. for this scenario met Sepsis at 1600. I have an order for IV fluids that reads: at 1630- 0.9%NS 1000/ml IV ; Rate 999ml/hr- The nurse has documented at 1630- NS 1000 0.9% bolus infusing over 1 hr in Rt. Subclavian. The next documentation is at 1739: follow-up: Infusion continued upon admission. There is no I documented how much the pt. received of that IV. I have read and re-read the guidelines for IV fluids and still not 100% clear if I can count this IV fluid. Do I need only the MD order for fluids or do I have to actually see the amount of fluids that was infused ? Can anyone give me some guidance? Thank you, Diana Davis, Quality Outcomes Coordinator CMH Regional Health System Disclaimer The information transmitted via this e-mail is intended only for the person or entity to which it is addressed and may contain confidential and/or proprietary information. Any use, review, retransmission, dissemination or other use of, or pursuing of any action in reliance upon this information by persons or entities other than the intended recipient is strictly prohibited. If you are the recipient of this e-mail transmission in error, please reply to the sender and delete the material from any computer. Thank you. ___ Sepsisgroups mailing list Sepsisgroups@lists.sepsisgroups.org http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org
Re: [Sepsis Groups] [External] sepsis mortality benchmark
We have set internal goals over the years based on the previous year's rate. We try to reduce the rate by 5-10% each year. 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<mailto:mary.dra...@johnmuirhealth.com> [cid:image001.png@01D3D894.ABE223C0] "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 Maupin, Christina Sent: Thursday, April 19, 2018 3:54 PM To: sepsisgroups@lists.sepsisgroups.org Cc: Littrell, Judy <judy.littr...@bakersfieldhearthospital.com> Subject: [External] [Sepsis Groups] sepsis mortality benchmark Caution: This email originated outside JMH. Do not open attachments or click on links if you do not recognize the sender. Hello Sepsis Experts, Is there a risk adjusted sepsis mortality model / prediction model you are using for standardized mortality comparison and benchmarks for severe sepsis w/wo shock? Is CMS developing a RSMR model for sepsis based on the data collected from SEP-1? I am wondering how your facilities are benchmarking and setting goals for mortality reduction. Thanks! Chris Christina Maupin MN, RN, CNS Clinical Outcomes Specialist Bakersfield Heart Hospital 3001 Sillect Ave. Bakersfield, CA 93308 661-316-6016 [BHH_Logo_vector_4c] Confidentiality Notice: This e-mail message, including any attachments, is for the sole use of the intended recipient (s) and may contain confidential and privileged information. Any unauthorized review, use, disclosure or distribution is prohibited. If you are not the intended recipient, please contact the sender by reply e-mail and destroy all copies of the original message. ___ Sepsisgroups mailing list Sepsisgroups@lists.sepsisgroups.org http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org
[Sepsis Groups] FW: [External] Surviving Sepsis Campaign Adult Guideline Translations Now Available
Forwarding my question that I sent to Lori. See below. Thanks. From: Lori Harmon [mailto:lhar...@sccm.org] Sent: Wednesday, January 03, 2018 10:32 AM To: Mary Draper <mary.dra...@johnmuirhealth.com> Subject: RE: [External] [Sepsis Groups] Surviving Sepsis Campaign Adult Guideline Translations Now Available Caution: This email originated outside JMH. Do not open attachments or click on links if you do not recognize the sender. I haven't seen anything new Mary. Good question for the list serv!!! From: Mary Draper [mailto:mary.dra...@johnmuirhealth.com] Sent: Wednesday, January 3, 2018 12:28 PM To: Lori Harmon <lhar...@sccm.org<mailto:lhar...@sccm.org>> Subject: RE: [External] [Sepsis Groups] Surviving Sepsis Campaign Adult Guideline Translations Now Available Hi Lori, has there been any discussion about time zero? Currently, we use "triage complete time" but run into problems with compliance when SIRS criteria isn't met at this time. We have a BPA that fires in our ED documentation when 2 of the SIRS criteria is met and this gives the nurse an option to document "suspect infection". For the CM SEP-1 this needs to be met so that I can rule in the patient for "sepsis". Thanks for your feedback. 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<mailto:mary.dra...@johnmuirhealth.com> [cid:image001.png@01D38486.A2C80D20] "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 Lori Harmon Sent: Wednesday, January 03, 2018 9:15 AM To: sepsisgroups@lists.sepsisgroups.org<mailto:sepsisgroups@lists.sepsisgroups.org> Subject: [External] [Sepsis Groups] Surviving Sepsis Campaign Adult Guideline Translations Now Available Caution: This email originated outside JMH. Do not open attachments or click on links if you do not recognize the sender. Colleagues, Happy new year from the Surviving Sepsis Campaign! The International Guidelines for the Management of Severe Sepsis and Septic Shock: 2016 are now available in the following languages on the Campaign website<http://www.survivingsepsis.org/Guidelines/Pages/default.aspx>: Arabic, Chinese, French, Japanese, Portuguese, Spanish and English. Scroll down to the guidelines tab to view, download and print copies. With best regards, Lori Lori A. Harmon, RRT, MBA | Director of Quality | Society of Critical Care Medicine 500 Midway Drive, Mount Prospect, IL 60056-5811 USA t: +1 847.493.6403 | m: +1 847.693.0359 | www.survivingsepsis.org<http://www.survivingsepsis.org/> ___ Sepsisgroups mailing list Sepsisgroups@lists.sepsisgroups.org http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org
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<mailto:mary.dra...@johnmuirhealth.com> [cid:image001.png@01D37994.A64189B0][cid:image002.png@01D37994.A64189B0] "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<mailto:Roopinder.Dhillon@UHhospitals> .org Quality Assurance/Peer Review Privileged Pursuant to Ohio Rev. Code secs. 2305.24, 2305.25, 2305.251, 2305.252 and 2305.253 [UH-Master-RGB-v1] Visit us at www.UHhospitals.org<http://www.UHhospitals.org>. The enclosed information is STRICTLY CONFIDENTIAL and is intended for the use of the addressee only. University Hospitals and its affiliates disclaim any responsibility for unauthorized disclosure of this information to anyone other than the addressee. Federal and Ohio law protect patient medical information, including psychiatric_disorders, (H.I.V) test results, A.I.Ds-related conditions, alcohol, and/or drug_dependence or abuse disclosed in this email. Federal regulation (42 CFR Part 2) and Ohio Revised Code section 5122.31 and 3701.243 prohibit disclosure of this information without the specific written consent of the person to whom it pertains, or as otherwise permitted by law. ___ Sepsisgroups mailing list Sepsisgroups@lists.sepsisgroups.org http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org
[Sepsis Groups] Time zero
For our internal compliance with the Severe Sepsis guidelines we are using triage complete. I am finding patients that don't even meet SIRS criteria or have a documented infection at that time. Has anyone else run into this issue and if so how are you handling it? This is outside of the SEP 1 definitions where I have more options to rule the patient in for severe sepsis. Thanks. 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<mailto:mary.dra...@johnmuirhealth.com> [cid:image001.png@01D37350.6AC37A50][cid:image002.png@01D37350.6AC37A50] "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 ___ Sepsisgroups mailing list Sepsisgroups@lists.sepsisgroups.org http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org
Re: [Sepsis Groups] [External] Serious Safety Event Classification of Sepsis cases
We do have septic shock cases that go into our Serious Safety Event Classification. They are identified through the core measure sepsis reviews. We look for compliance with the bundles. Thanks. 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<mailto:mary.dra...@johnmuirhealth.com> [cid:image002.png@01D36D09.3A78E0D0] "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 Orth, Claudia Sent: Monday, December 04, 2017 8:11 AM To: sepsisgroups@lists.sepsisgroups.org Subject: [External] [Sepsis Groups] Serious Safety Event Classification of Sepsis cases Caution: This email originated outside JMH. Do not open attachments or click on links if you do not recognize the sender. I am interested in learning if anyone in the sepsis community is currently working with their Quality and Safety leaders to classify sepsis cases as 'Serious Safety Events' and if so what criteria/algorithm is being used to do so? We are struggling to figure out how to do this as we feel there are 2 categories perhaps? And depending on what criteria or definition is used, there could be a very large number of these 1. Early recognition 2. Timely response and treatment Thank you as always and in advance for your time, expertise, and consideration to help us. Sincerely, Claudia Orth, BSN, RN, CCRN-K Sepsis Coordinator Clinical Quality 1105 Sixth St. Traverse City, MI 49684 (231) 935-56992 voice (231) 935-6629 fax (231) 318-0394 pager cor...@mhc.net<mailto:cor...@mhc.net> [MMC_Blue-SigSize96dpi] Website<http://www.munsonhealthcare.org/mmc> I Find a Physician<http://www.munsonhealthcare.org/physician> I Maps<http://www.munsonhealthcare.org/maps> ___ Sepsisgroups mailing list Sepsisgroups@lists.sepsisgroups.org http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org
Re: [Sepsis Groups] [External] finacial impact of sepsis measures
CMS has not announced this. They normally do validation requests before the measure is made public and becomes part of the reimbursement. 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<mailto:mary.dra...@johnmuirhealth.com> [cid:image002.png@01D35237.64B663F0] "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 Bly, Lori Sent: Monday, October 30, 2017 11:57 AM To: sepsisgroups@lists.sepsisgroups.org Subject: [External] [Sepsis Groups] finacial impact of sepsis measures Caution: This email originated outside JMH. Do not open attachments or click on links if you do not recognize the sender. What is the performance period being collected for the Sepsis/Severe Sepsis measures that will impact hospital reimbursement? Are what we currently abstracting being included in any reimbursement? Thank you. Lori Bly, RN Quality Management Department ACMH Hospital One Nolte Drive Kittanning, PA 16201 Extension: 8459 email: b...@acmh.org<mailto:b...@acmh.org> Confidentiality Notice: This e-mail message, including any attachments, is for the sole use of the intended recipient(s) and may contain confidential and privileged information. Any unauthorized review, use, disclosure or distribution is prohibited. If you are not the intended recipient, please contact the sender by reply e-mail and destroy all copies of the original message. [cid:image003.jpg@01D35237.64B663F0] <https://s-media-cache-ak0.pinimg.com/736x/c7/e3/1b/c7e31bdd1d0c4a3a34f47861e586c1f5.jpg> ___ Sepsisgroups mailing list Sepsisgroups@lists.sepsisgroups.org http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org
Re: [Sepsis Groups] EMS fluids: How to capture
My understanding is that if the fluids administered by EMS are captured in your ED documentation then it can be used. There is also a 10% leeway for the volume administered. 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<mailto:mary.dra...@johnmuirhealth.com> [cid:image001.png@01D3383C.AF3B5210] "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 Jeanie Bollinger Sent: Monday, September 25, 2017 6:26 AM To: sepsisgroups@lists.sepsisgroups.org Subject: [Sepsis Groups] EMS fluids: How to capture Group, We are continuing to not meet the CMS bundle for fluids due to fluids being given prior to admission. Our EMS services work off of state protocols and do not document discrete time fields of start, finish, type of fluid, and rate. We do have a place on our triage form that requires an entry of EMS volume of fluid: zero or amount. If the ED admit MD order states 30ml/kg to include EMA fluids, will this count as passing the measure? Would like to know what other solutions are to meet this piece of the measure. We are doing the right thing in our ED but keep missing the measure. 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 This message and its attachments may contain confidential and/or legally-sensitive information that is intended for the sole use of the addressee(s). Any unauthorized review, use, disclosure, or distribution of the information contained in this message and its attachments is prohibited. If you have received this message or any of its attachments in error, please destroy all originals and copies of the same and notify the sender immediately. ___ Sepsisgroups mailing list Sepsisgroups@lists.sepsisgroups.org http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org
Re: [Sepsis Groups] Provider orders or protocols for IVF administered by EMS
We are going to work with our ED staff to document in the intake the amount given by EMS so that it can be pulled electronically. We have the EMS record scanned into Epic to verify but it is just a paper report so no discrete fields. 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<mailto:mary.dra...@johnmuirhealth.com> [cid:image001.png@01D312B7.85002250] "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 Carlson, Brenda L Sent: Thursday, August 10, 2017 9:16 AM To: 'sepsisgroups@lists.sepsisgroups.org' <sepsisgroups@lists.sepsisgroups.org> Subject: [Sepsis Groups] Provider orders or protocols for IVF administered by EMS Has anyone figured out a way to include IVF given by EMS? We are struggling with this since provider orders or protocols must be found in the hospital record and none of the local EMS companies provide this type of information. The NYSDOH approved protocols used by all EMS agencies in upstate NY are available here: https://www.mlrems.org/GetFile.aspx?fileID=10896 There are no patient specific orders, these are standing order for all patients with suspected septic shock. Has anyone found a way to comply with provider orders in the hospital record for IVF given by EMS? Thank you for your help. 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 This message may contain information which is confidential and privileged. Unless you are the addressee (or authorized to receive for the addressee), you may not use, copy or disclose to anyone the message or any information contained in the message (including attachments). If you have received the message in error, please advise sender by reply email, and delete the message. Thank you! ___ Sepsisgroups mailing list Sepsisgroups@lists.sepsisgroups.org http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org
Re: [Sepsis Groups] Core Measures for Sepsis
I don't know of any source for reimbursement based on the sepsis core measures compliance. It isn't tied to value based purchasing yet. Mary Draper RN BSN Coordinator Quality Improvement Peer Review Support CV/CT Quality Management JMH Office (925) 674-2045 Cell (925) 451-8792 Fax (925) 674-2373 mary.dra...@johnmuirhealth.com<mailto:mary.dra...@johnmuirhealth.com> [cid:image002.png@01D31122.FF32B5B0] "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 Tracie Hopkins Sent: Tuesday, August 08, 2017 10:00 AM To: sepsisgroups@lists.sepsisgroups.org Subject: [Sepsis Groups] Core Measures for Sepsis Hello, Does anyone know where I can find the details for Core Measure for Sepsis? Not what they are-but the threshold for payment? Is it just SEP-1 or is each element measured for compliance & payment? What percentage is required? I thought it might be in the 5.3 version-but cannot find the specifics for reimbursement. Any information you can share would be appreciated. Our compliance rate is just over 50% & am planning on next steps to improve our numbers. Knowing the financial impact will help gain support. Thank you- Tracie L Hopkins RN, BSN, CCRN Sepsis Program Administrator Covenant Healthcare Saginaw, MI 48602 989-583-6604 Office 989-258-8587 Pager [cid:image001.png@01D1B1D2.839602F0] This email may contain legally privileged and/or confidential information. If you are not the intended recipient, or the employee or agent responsible for delivery of this message to the intended recipient, you are hereby notified that any dissemination, distribution or copying of this email is strictly prohibited. If you have received this message in error, please immediately notify the sender and delete this email from your computer. Your cooperation is appreciated. ___ Sepsisgroups mailing list Sepsisgroups@lists.sepsisgroups.org http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org
Re: [Sepsis Groups] Sepsis Transfers
It depends on where they are transferred to. If they arrive in our ED, the labs may be repeated but not always if they go to critical care. Since they are excluded from the focus study I don't follow up on them unless there are other issues that need to be addressed. Mary Draper RN BSN Coordinator Quality Improvement Peer Review Support CV/CT Quality Management JMH Office (925) 674-2045 Cell (925) 451-8792 Fax (925) 674-2373 mary.dra...@johnmuirhealth.com<mailto:mary.dra...@johnmuirhealth.com> [cid:image001.png@01D2E420.B6DF7570] "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 Carol Groen Sent: Tuesday, June 13, 2017 3:33 AM To: sepsisgroups@lists.sepsisgroups.org Subject: [Sepsis Groups] Sepsis Transfers This question is for those facilities that receive transfers. When getting a severe sepsis or septic shock patient from an outside facility . . . do you repeat the labs included in the sepsis bundle? Carol Groen, MSN, RN, CEN, NE-BC| Manager Clinical Certifications & Special Projects HaysMed, part of The University of Kansas Health System 785-623-6569 (Fax: 785-623-6559)|carol.gr...@haysmed.com<mailto:carol.gr...@haysmed.com> | PO BOX 8100, Hays, Kansas 67601 Core Purpose: To help people be healthy Core Values: respect, compassion, spirituality, trustworthiness, excellence, professionalism Core Vision: To be the best tertiary care center in rural America Important: This e-mail and any attachments may contain confidential information subject to protection under the Federal Standards for Privacy of Individually Identifiable Health Information (45 C.F.R. Parts 160 and 164). If you or your organization is a "Covered Entity" under the above mentioned regulations, you are obligated to treat such information in a manner consistent with the regulations. If it appears that this email was sent to you in error, (1) you are prohibited from utilizing or disseminating this email or any attachments; (2) please immediately delete it from your computer and any servers or other locations where it might be stored and email (christy.st...@haysmed.com<mailto:christy.st...@haysmed.com>) or call Christy Stahl at 785-623-2188 advising that you have done so. We appreciate your cooperation. ___ Sepsisgroups mailing list Sepsisgroups@lists.sepsisgroups.org http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org
Re: [Sepsis Groups] [**External**] Sepsis Alert
Thanks Ron good analysis. Mary Draper RN BSN QI Coordinator Quality Management Office (925) 674-2045<tel:(925)%20674-2045> Cell (925) 451-8792<tel:(925)%20451-8792> Fax (925) 674-2373<tel:(925)%20674-2373> mary.dra...@johnmuirhealth.com<mailto:mary.dra...@johnmuirhealth.com> On May 18, 2017, at 7:42 PM, Ron Elkin <elkin@gmail.com<mailto:elkin@gmail.com>> wrote: 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. <towns...@sutterhealth.org<mailto:towns...@sutterhealth.org><mailto:towns...@sutterhealth.org>> 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 <mary.dra...@johnmuirhealth.com<mailto:mary.dra...@johnmuirhealth.com><mailto:mary.dra...@johnmuirhealth.com>> wrote: Hi Dr. Townsend, I have been looking through the Severe Sepsis guidelines with regards to patient who present in cardiac arrest to the ED. I have not found any information specific to this issue. Most of them have an elevated lactate. It is difficult to determine what was the cause of the arrest. We are proposing to our Sepsis committee that we delete these patients from the focus study. What are your thoughts on this subject? Thanks Mary Draper RN BSN Coordinator Quality Improvement Peer Review Support CV/CT Quality Management JMH Office (925) 674-2045<tel:%28925%29%20674-2045> Cell (925) 451-8792<tel:%28925%29%20451-8792> Fax (925) 674-2373<tel:%28925%29%20674-2373> mary.dra...@johnmuirhealth.com<mailto:mary.dra...@johnmuirhealth.com><mailto: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 -Original Message- From: Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org<mailto:sepsisgroups-boun...@lists.sepsisgroups.org>] On Behalf Of Gwen S. Schneider Sent: Saturday, May 13, 2017 10:20 AM To: Townsend, Sean, M.D. <towns...@sutterhealth.org<mailto:towns...@sutterhealth.org><mailto:towns...@sutterhealth.org>>; Parker, Erin <erin.par...@ascension.org<mailto:erin.par...@ascension.org><mailto:erin.par...@ascension.org>> Cc: sepsisgroups@lists.sepsisgroups.org<mailto:sepsisgroups@lists.sepsisgroups.org><mailto:sepsisgroups@lists.sepsisgroups.org> Subject: Re: [Sepsis Groups] [**External**] Sepsis Alert Hello, I am interested in the responses you might receive from your question. We use EPIC, and we have for LA a value of >2.0 a call from lab as a critical. I am wondering if other hospitals are doing the same. And what does MS have to say about it? Sierra Schneider Salem Oregon From: Sepsisgroups [sepsisgroups-boun...@lists.sepsisgroups.org<mailto:sepsisgroups-boun...@lists.sepsisgroups.org><mailto:sepsisgroups-boun...@lists.sepsisgroups.org>] On Behalf Of Townsend, Sean, M.D. [towns...@sutterhealth.org<mailto:towns...@sutterhealth.org><mailto:towns...@sutterhealth.org>] Sent: Thursday, May 11, 2017 9:36 PM To: Parker, Erin Cc: sepsisgroups@lists.sepsisgroups.org<mailto:sepsisgroups@lists.sepsisgroups.org><mailto:sepsisgroups@lists.sepsisgroups.org> Subject: Re: [Sepsis Groups] [**External**] Sepsis Alert Erin, I'm sorry you received an inflammatory and obtuse response to your question. Such posts have earned the name "troll" or having been "trolled" for for a reason. Maybe to get a real answer to your question, you could share with us which EHR you use? Sean On May 5, 2017, at 7:05 AM, Parker, Erin <erin.par...@ascension.org<mailto:erin.par...@ascension.org><mailto:erin.par...@ascension.org><mailto:erin.par...@ascension.org<mailto:erin.par...@ascension.org>>> wrote: 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. Would any one like to share EHR sepsis alert criteria, a
Re: [Sepsis Groups] [**External**] Sepsis Alert
Hi Dr. Townsend, I have been looking through the Severe Sepsis guidelines with regards to patient who present in cardiac arrest to the ED. I have not found any information specific to this issue. Most of them have an elevated lactate. It is difficult to determine what was the cause of the arrest. We are proposing to our Sepsis committee that we delete these patients from the focus study. What are your thoughts on this subject? Thanks Mary Draper RN BSN Coordinator Quality Improvement Peer Review Support CV/CT Quality Management JMH 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 -Original Message- From: Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On Behalf Of Gwen S. Schneider Sent: Saturday, May 13, 2017 10:20 AM To: Townsend, Sean, M.D. <towns...@sutterhealth.org>; Parker, Erin <erin.par...@ascension.org> Cc: sepsisgroups@lists.sepsisgroups.org Subject: Re: [Sepsis Groups] [**External**] Sepsis Alert Hello, I am interested in the responses you might receive from your question. We use EPIC, and we have for LA a value of >2.0 a call from lab as a critical. I am wondering if other hospitals are doing the same. And what does MS have to say about it? Sierra Schneider Salem Oregon From: Sepsisgroups [sepsisgroups-boun...@lists.sepsisgroups.org] On Behalf Of Townsend, Sean, M.D. [towns...@sutterhealth.org] Sent: Thursday, May 11, 2017 9:36 PM To: Parker, Erin Cc: sepsisgroups@lists.sepsisgroups.org Subject: Re: [Sepsis Groups] [**External**] Sepsis Alert Erin, I'm sorry you received an inflammatory and obtuse response to your question. Such posts have earned the name "troll" or having been "trolled" for for a reason. Maybe to get a real answer to your question, you could share with us which EHR you use? Sean On May 5, 2017, at 7:05 AM, Parker, Erin <erin.par...@ascension.org<mailto:erin.par...@ascension.org>> wrote: 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. Would any one like to share EHR sepsis alert criteria, and also be willing to share how it is working? Thanks, Erin Erin Parker RN, BSN, ACM Infection Preventionist, Epidemiology Ascension | Genesys One Genesys Parkway Grand Blanc, MI 48439 Ascension.org/Michigan<http://Ascension.org/Michigan> T: 810.606.5093 F: 810-606-5495 M: erin.par...@ascension.org<mailto:erin.par...@ascension.org> CONFIDENTIALITY NOTICE: This email message and any accompanying data or files is confidential and may contain privileged information intended only for the named recipient(s). If you are not the intended recipient(s), you are hereby notified that the dissemination, distribution, and or copying of this message is strictly prohibited. If you receive this message in error, or are not the named recipient(s), please notify the sender at the email address above, delete this email from your computer, and destroy any copies in any form immediately. Receipt by anyone other than the named recipient(s) is not a waiver of any attorney-client, work product, or other applicable privilege. ___ Sepsisgroups mailing list Sepsisgroups@lists.sepsisgroups.org<mailto:Sepsisgroups@lists.sepsisgroups.org> https://na01.safelinks.protection.outlook.com/?url=http%3A%2F%2Flists.sepsisgroups.org%2Flistinfo.cgi%2Fsepsisgroups-sepsisgroups.org=02%7C01%7Ctownsesr%40sutterhealth.org%7Caf1d447036e7484cca1a08d493bfbfda%7Caef453eadaa243e0be62818066e9ff63%7C0%7C0%7C636295899144836742=5nENeH7ocjTBGbv4xeAlTFMYikFwvRBZ039myyFKLg0%3D=0 ** Confidentiality Notice: The information contained in this email and any attachments may be legally privileged and confidential. If you are not an intended recipient, you are hereby notified that any dissemination, distribution, or copying of this email is strictly prohibited. If you have received this email in error, please notify the sender and permanently delete the email and any attachments immediately. You should not retain, copy, or use this email or any attachment for any purpose; nor disclose all or any part of the contents to any other person. ___ Sepsisgroups mailing list Sepsisgroups@lists.sepsisgroups.org http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org ___ Sepsisgroups mailing list Sepsisgroups@lists.sepsisgroups.org http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org
Re: [Sepsis Groups] EMS pre-hospital treatment for sepsis
This practice has not been implemented in California that I am aware of. Mary Draper RN BSN Coordinator Quality Improvement Peer Review Support CV/CT Quality Management JMH Office (925) 674-2045 Cell (925) 451-8792 Fax (925) 674-2373 mary.dra...@johnmuirhealth.com<mailto:mary.dra...@johnmuirhealth.com> [cid:image002.png@01D2ADF0.4A4A5F30] "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 Helsley, Anne Sent: Monday, April 03, 2017 12:29 PM To: sepsisgroups@lists.sepsisgroups.org Subject: [Sepsis Groups] EMS pre-hospital treatment for sepsis A local EMS is planning a protocol to screen for Severe Sepsis in the field pre-hospital. Based upon the screening results (which do not include a lactate), they will be administering crystalloid fluids, drawing blood cultures and giving a broad spectrum antibiotic. While I can find literature to support the fluid administration, I have been unable to find any support for the antibiotic administration. Are you familiar with this practice, is it happening in your area, or are you familiar with any literature to support/not-support. Thank you in advance. Anne Helsley MS, RN, CPHQ Health Informatics Specialist | Quality Management St. Mary's Health 3700 Washington Avenue Evansville, IN 47750 812.485.7925 TEL | 812.485.7862 FAX amhels...@stmarys.org <mailto:amhels...@stmarys.org%20> | www.stmarys.org<http://www.stmarys.org> [cid:image003.png@01D2ADF0.4A4A5F30] The Magnet Recognition Program(r), ANCC Magnet Recognition(r) , Magnet(r) names and logos are registered trademarks of the American Nurses Credentialing Center. All rights reserved CONFIDENTIALITY NOTICE: This email message and any accompanying data or files is confidential and may contain privileged information intended only for the named recipient(s). If you are not the intended recipient(s), you are hereby notified that the dissemination, distribution, and or copying of this message is strictly prohibited. If you receive this message in error, or are not the named recipient(s), please notify the sender at the email address above, delete this email from your computer, and destroy any copies in any form immediately. Receipt by anyone other than the named recipient(s) is not a waiver of any attorney-client, work product, or other applicable privilege. ___ Sepsisgroups mailing list Sepsisgroups@lists.sepsisgroups.org http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org
Re: [Sepsis Groups] severe sepsis documentation
The first documentation is the one that counts. Per the guidelines we only enter one episode per admission. "Sepsis" alone unless clinical criteria is met doesn't rule the patient in for the focus study. Mary Draper RN BSN Coordinator Quality Improvement Peer Review Support CV/CT Quality Management JMH Office (925) 674-2045 Cell (925) 451-8792 Fax (925) 674-2373 mary.dra...@johnmuirhealth.com<mailto:mary.dra...@johnmuirhealth.com> [cid:image001.png@01D2883F.CC3099A0] "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 Schrecengost, Lisa M. Sent: Tuesday, February 14, 2017 5:18 AM To: sepsisgroups@lists.sepsisgroups.org Cc: Pavlekovsky, Kim <pavlekovs...@acmh.org>; Hoss, Ashley K. <ho...@acmh.org> Subject: [Sepsis Groups] severe sepsis documentation If a physician documents severe sepsis one day and the next day he documents sepsis, is this considered severe sepsis or sepsis? Thanks, Lisa Lisa Schrecengost RN BSN Clinical Resource Management ACMH Hospital One Nolte Drive Kittanning, PA 16201 Phone: 724-543-8871 email: schrecengo...@acmh.org<mailto:schrecengo...@acmh.org> Confidentiality Notice: This e-mail message, including any attachments, is for the sole use of the intended recipient(s) and may contain confidential and privileged information. Any unauthorized review, use, disclosure or distribution is prohibited. If you are not the intended recipient, please contact the sender by reply e-mail and destroy all copies of the original message. ___ Sepsisgroups mailing list Sepsisgroups@lists.sepsisgroups.org http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org
[Sepsis Groups] Using SpO2 for peripheral perfusion-cap refill
Has anyone queried CMS about this? When I googled the definition for peripheral perfusion, SpO2 monitoring came up first. What are your thoughts? Thanks. Mary Draper RN BSN Coordinator Quality Improvement Peer Review Support CV/CT Quality Management JMH Office (925) 674-2045 Cell (925) 451-8792 Fax (925) 674-2373 mary.dra...@johnmuirhealth.com<mailto:mary.dra...@johnmuirhealth.com> [cid:image001.png@01D22AE3.270E3130] "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 ___ Sepsisgroups mailing list Sepsisgroups@lists.sepsisgroups.org http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org
Re: [Sepsis Groups] initial hypotension
Thanks for sending the additional notes, David! Mary Draper RN BSN Coordinator Quality Improvement Peer Review Support CV/CT Quality Management JMH Office (925) 674-2045 Cell (925) 451-8792 Fax (925) 674-2373 mary.dra...@johnmuirhealth.com<mailto:mary.dra...@johnmuirhealth.com> [cid:image003.png@01D217D1.9EC9BA70] "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: Rivera, David [mailto:david.riv...@ahss.org] Sent: Monday, September 26, 2016 4:51 AM To: Mary Draper <mary.dra...@johnmuirhealth.com>; 'Brown, Linda' <linda.br...@nmhs.org>; sepsisgroups@lists.sepsisgroups.org Subject: RE: initial hypotension The Addl note for V5.1 expand on this initial hypotension question. See attached :) Regards David Rivera Quality Coordinator Quality Management Department | Adventist Health System | Email: david.riv...@ahss.org<mailto:david.riv...@ahss.org> [cid:image004.jpg@01D217D1.9EC9BA70] CONFIDENTIALITY NOTICE: This communication, including any attachments, may contain confidential information and is intended only for the individual or entity to which it is addressed. Any review, dissemination, or copying of this communication by anyone other than the intended recipient is strictly prohibited. If you are not the intended recipient, please contact the sender by reply email and delete and destroy all copies of the original message. From: Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On Behalf Of Mary Draper Sent: Monday, September 19, 2016 12:26 PM To: 'Brown, Linda' <linda.br...@nmhs.org<mailto:linda.br...@nmhs.org>>; sepsisgroups@lists.sepsisgroups.org<mailto:sepsisgroups@lists.sepsisgroups.org> Subject: Re: [Sepsis Groups] initial hypotension For the patient to have septic shock, if the lactate isn't ≥ 4 or the MD doesn't document septic shock, the patient requires consecutive BPs < 90 (at least 2) after fluid resuscitation of 30ml/kg. Mary Draper RN BSN Coordinator Quality Improvement Peer Review Support CV/CT Quality Management JMH Office (925) 674-2045 Cell (925) 451-8792 Fax (925) 674-2373 mary.dra...@johnmuirhealth.com<mailto:mary.dra...@johnmuirhealth.com> [cid:image005.png@01D217D1.9EC9BA70] "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 Brown, Linda Sent: Thursday, September 15, 2016 12:25 PM To: sepsisgroups@lists.sepsisgroups.org<mailto:sepsisgroups@lists.sepsisgroups.org> Subject: [Sepsis Groups] initial hypotension If the patient only has one BP <90 or MAP <65 and meets the rest of the severe sepsis criteria, does this meet the criteria for septic shock or does the patient need to have consecutive BP's <90 or MAP <65. Thank you Linda Brown BSN RN Performance Improvement Nebraska Methodist Hospital Omaha, Ne 402-354-4006 This message and any included attachments are from Nebraska Methodist Health System and its affiliates and are intended only for the addressee. The message may contain privileged, confidential and/or proprietary information intended only for the person(s) named. Unauthorized forwarding, printing, copying, distribution, or use of such information is strictly prohibited and may be unlawful. If you are not the addressee, please promptly delete this message and notify the sender of the delivery error by e-mail or you may call Nebraska Methodist Health System and its affiliates in Omaha, Nebraska, U.S.A at (402)354-2280. ___ Sepsisgroups mailing list Sepsisgroups@lists.sepsisgroups.org http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org
Re: [Sepsis Groups] initial hypotension
For the patient to have septic shock, if the lactate isn't ≥ 4 or the MD doesn't document septic shock, the patient requires consecutive BPs < 90 (at least 2) after fluid resuscitation of 30ml/kg. Mary Draper RN BSN Coordinator Quality Improvement Peer Review Support CV/CT Quality Management JMH Office (925) 674-2045 Cell (925) 451-8792 Fax (925) 674-2373 mary.dra...@johnmuirhealth.com<mailto:mary.dra...@johnmuirhealth.com> [cid:image001.png@01D21257.DE543140] "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 Brown, Linda Sent: Thursday, September 15, 2016 12:25 PM To: sepsisgroups@lists.sepsisgroups.org Subject: [Sepsis Groups] initial hypotension If the patient only has one BP <90 or MAP <65 and meets the rest of the severe sepsis criteria, does this meet the criteria for septic shock or does the patient need to have consecutive BP's <90 or MAP <65. Thank you Linda Brown BSN RN Performance Improvement Nebraska Methodist Hospital Omaha, Ne 402-354-4006 This message and any included attachments are from Nebraska Methodist Health System and its affiliates and are intended only for the addressee. The message may contain privileged, confidential and/or proprietary information intended only for the person(s) named. Unauthorized forwarding, printing, copying, distribution, or use of such information is strictly prohibited and may be unlawful. If you are not the addressee, please promptly delete this message and notify the sender of the delivery error by e-mail or you may call Nebraska Methodist Health System and its affiliates in Omaha, Nebraska, U.S.A at (402)354-2280. ___ Sepsisgroups mailing list Sepsisgroups@lists.sepsisgroups.org http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org
Re: [Sepsis Groups] Lactate levels and POCT
We use POC istat lactate and a whole lactate in the ED. The whole blood lactate is run off of the ABG machine and may either a venous or arterial sample. The turnaround time for POC istat lactate is about 5 mins and the whole blood sample is about 20 mins. Mary Draper RN BSN Coordinator Quality Improvement Peer Review Support CV/CT Quality Management JMH Office (925) 674-2045 Cell (925) 451-8792 Fax (925) 674-2373 mary.dra...@johnmuirhealth.com<mailto:mary.dra...@johnmuirhealth.com> [cid:image001.png@01D21258.26A75C10] "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 Carlson, Brenda L Sent: Thursday, September 15, 2016 12:31 PM To: 'sepsisgroups@lists.sepsisgroups.org' <sepsisgroups@lists.sepsisgroups.org> Subject: [Sepsis Groups] Lactate levels and POCT What is the turnaround time for lactate levels at your hospital, from ordering to resulted time? Nearly all of our initial lactates are drawn by bedside nurses (approx. 70% in ED setting) and sent to the main lab for processing. We seem to be averaging about 1.5 hours from order to result and are looking for ways to improve. Is anyone using POCT to obtain lactate levels, especially in the Emergency Department? Thank you for your help. 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 This message may contain information which is confidential and privileged. Unless you are the addressee (or authorized to receive for the addressee), you may not use, copy or disclose to anyone the message or any information contained in the message (including attachments). If you have received the message in error, please advise sender by reply email, and delete the message. Thank you! ___ Sepsisgroups mailing list Sepsisgroups@lists.sepsisgroups.org http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org
Re: [Sepsis Groups] EGDT
In some instances yes though not as much as they used to. I think it would be very beneficial in the renal failure and HF patients since they tend to under resuscitate these patients. Mary Draper RN BSN Coordinator Quality Improvement Peer Review Support CV/CT Quality Management JMH Office (925) 674-2045 Cell (925) 451-8792 Fax (925) 674-2373 mary.dra...@johnmuirhealth.com<mailto:mary.dra...@johnmuirhealth.com> [cid:image002.png@01D1EE2C.3659C6C0] "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 Pender.Linda Sent: Tuesday, August 02, 2016 10:54 AM To: 'sepsisgroups@lists.sepsisgroups.org' <sepsisgroups@lists.sepsisgroups.org> Subject: [Sepsis Groups] EGDT Is anyone still using EGDT with placing CVP lines and arterial line to monitor fluid status? If so, do you feel this is beneficial? Linda G. Pender RRT-NPS Sepsis Coordinator Patient Care Services Administration phone: 478-633-6806 pager: KNOW Sepsis: Inside & Out [cid:image003.png@01D1EE2C.3659C6C0]<http://www.navicenthealth.org/> Email: pender.li...@navicenthealth.org<mailto:pender.li...@navicenthealth.org> CONFIDENTIALITY NOTICE: The information transmitted in this e-mail message, including any attachments, is for the sole use of the intended recipient(s) or entity to which it is addressed and may contain confidential, privileged, and/or proprietary information. Any unauthorized review, retransmission, use, disclosure, dissemination, or other use of, or taking any action in reliance upon this information by persons or entities other than the intended recipient is prohibited. If you are not the intended recipient, you are hereby notified that any reading, dissemination, distribution, copying, or other use of this message or its attachments is strictly prohibited. If you have received this message in error, please notify the sender immediately by reply e-mail, or by calling (478) 633-7272, and destroy the original message, attachments, and all copies thereof on all computers and in any other form. Thank you. Navicent Health. http://www.navicenthealth.org/ ___ Sepsisgroups mailing list Sepsisgroups@lists.sepsisgroups.org http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org
Re: [Sepsis Groups] ED provider notes
Thanks Sam, unfortunately he didn’t do that. I may pursue this with medical records and or ED billing to see how they handled it. Appreciate the feedback. Mary Draper RN BSN Coordinator Quality Improvement Peer Review Support CV/CT Quality Management JMH Office (925) 674-2045 Cell (925) 451-8792 Fax (925) 674-2373 mary.dra...@johnmuirhealth.com<mailto:mary.dra...@johnmuirhealth.com> [cid:image002.png@01D1BCDC.04CBFF00] “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: Sam Farrell [mailto:pm.sjintensiv...@gmail.com] Sent: Thursday, June 02, 2016 2:34 PM To: Mary Draper <mary.dra...@johnmuirhealth.com> Cc: sepsisgroups@lists.sepsisgroups.org Subject: Re: [Sepsis Groups] ED provider notes What did he indicate as his date and time of service? Those should be evident in his note - especially since an accurate DOS will be necessary for billing. If he has indicated that he saw the patient on 2/12 and notes the time within the requisite window, the 2/14 note should be fine IMHO Hope that helps! Sam -- Sam Farrell, RN CCRN Intensivist Program Manager West Coast Critical Care Specialists office: 805.988.7004 fax: 805.988.7101 cell: 805.444.3730 wccriticalcare.com<http://wccriticalcare.com> CONFIDENTIALITY NOTICE : This message and any included attachments are intended only for the addressee and may contain confidential information belonging to the sender that is legally protected. Unauthorized forwarding, printing, copying, distribution, or use of such information is strictly prohibited and may be unlawful. If you are not the addressee, please promptly delete this message and notify the sender of the delivery error by e-mail. Thank you. On Thu, Jun 2, 2016 at 12:14 PM, Mary Draper <mary.dra...@johnmuirhealth.com<mailto:mary.dra...@johnmuirhealth.com>> wrote: I have an interesting situation where the ED provider of record on the day of arrival to the ED (2/12) didn’t dictate his note until (2/14 or date/time the service as on 2/12). With this discrepancy in dates yet it is clear from the orders, etc that he cared for this patient on 2/12 what do you all think about using his PE to meet the 6 hr bundle compliance? Appreciate any feedback, thanks. Mary Draper RN BSN Coordinator Quality Improvement Peer Review Support CV/CT Quality Management JMH Office (925) 674-2045<tel:%28925%29%20674-2045> Cell (925) 451-8792<tel:%28925%29%20451-8792> Fax (925) 674-2373<tel:%28925%29%20674-2373> mary.dra...@johnmuirhealth.com<mailto:mary.dra...@johnmuirhealth.com> [cid:image003.png@01D1BCDC.04CBFF00] “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 ___ Sepsisgroups mailing list Sepsisgroups@lists.sepsisgroups.org<mailto:Sepsisgroups@lists.sepsisgroups.org> http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org ___ Sepsisgroups mailing list Sepsisgroups@lists.sepsisgroups.org http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org
[Sepsis Groups] ED provider notes
I have an interesting situation where the ED provider of record on the day of arrival to the ED (2/12) didn't dictate his note until (2/14 or date/time the service as on 2/12). With this discrepancy in dates yet it is clear from the orders, etc that he cared for this patient on 2/12 what do you all think about using his PE to meet the 6 hr bundle compliance? Appreciate any feedback, thanks. Mary Draper RN BSN Coordinator Quality Improvement Peer Review Support CV/CT Quality Management JMH Office (925) 674-2045 Cell (925) 451-8792 Fax (925) 674-2373 mary.dra...@johnmuirhealth.com<mailto:mary.dra...@johnmuirhealth.com> [cid:image001.png@01D1BCC8.45364280] "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 ___ Sepsisgroups mailing list Sepsisgroups@lists.sepsisgroups.org http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org
Re: [Sepsis Groups] [External] Nursing Lactate Protocol Information
Good to know we are all on the same page!! Mary Draper RN BSN QI Coordinator Quality Management Office (925) 674-2045<tel:(925)%20674-2045> Cell (925) 451-8792<tel:(925)%20451-8792> Fax (925) 674-2373<tel:(925)%20674-2373> mary.dra...@johnmuirhealth.com<mailto:mary.dra...@johnmuirhealth.com> On May 27, 2016, at 2:07 PM, Barnes-Daly, Mary Ann <barne...@sutterhealth.org<mailto:barne...@sutterhealth.org>> wrote: MARY! Hello Friend; All Sutter Health hospitals have the opportunity to use a nursing SP for initiation of the severe sepsis bundle (1L bolus if hypotension present) Slightly different for ED and inpatient (RRT uses) Not all affiliates use either or both , but most do. And as of July 12, we have automated repeat lactates for any value >1.9. 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| Office 916.286.6717 | 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 Sullivan, Mary Cook Sent: Wednesday, May 25, 2016 11:32 AM To: sepsisgroups@lists.sepsisgroups.org<mailto:sepsisgroups@lists.sepsisgroups.org> Subject: [External] [Sepsis Groups] Nursing Lactate Protocol Information Good Morning, For facilities that use a Nursing procedure to collect lactate specimens, how does your institution verify or co-sign the order of the lactate? Is anyone using a completely independent nursing standard procedure or protocol that providers do not verify or authenticate? Thank you in advance! Mary Cook Sullivan RN, MS, CNS Sepsis Project Manager Quality Improvement Department Division of Patient Safety and Quality Services UCSF Medical Center 350 Parnassus, Suite 706, San Francisco, CA 94117 marycook.sulli...@ucsfmedctr.org<mailto:marycook.sulli...@ucsfmedctr.org> Office: 415 353 3978 Pager: 415 443 3930 ___ Sepsisgroups mailing list Sepsisgroups@lists.sepsisgroups.org<mailto:Sepsisgroups@lists.sepsisgroups.org> http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org ___ Sepsisgroups mailing list Sepsisgroups@lists.sepsisgroups.org http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org
[Sepsis Groups] 30ml/kg
Does anyone know if there is any leeway with the calculated volume? For example pt weighs 107 kg which requires 3210ml. Pt only receives 3000. Does this become an opportunity for improvement? Clinically I doubt an extra 210 ml would have made an impact on the patients hemodynamics. Thanks for your feedback. Mary Draper RN BSN Coordinator Quality Improvement Peer Review Support CV/CT Quality Management JMH Office (925) 674-2045 Cell (925) 451-8792 Fax (925) 674-2373 mary.dra...@johnmuirhealth.com<mailto:mary.dra...@johnmuirhealth.com> [cid:image003.png@01D19FBA.C0793F40] "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 ___ Sepsisgroups mailing list Sepsisgroups@lists.sepsisgroups.org http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org
Re: [Sepsis Groups] Sepsis 3
Thanks for the feedback. Mary Draper RN BSN Coordinator Quality Improvement Peer Review Support CV/CT Quality Management JMH Office (925) 674-2045 Cell (925) 451-8792 Fax (925) 674-2373 mary.dra...@johnmuirhealth.com<mailto:mary.dra...@johnmuirhealth.com> [cid:image001.png@01D194B2.D0943B40] "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: Seckel, Maureen M [mailto:msec...@christianacare.org] Sent: Tuesday, April 12, 2016 11:57 AM To: Mary Draper <mary.dra...@johnmuirhealth.com>; 'beh...@aol.com' <beh...@aol.com>; sepsisgroups@lists.sepsisgroups.org Cc: garry.h...@enjoincdi.com Subject: RE: [Sepsis Groups] Sepsis 3 Hi, Sepsis 3 replaces the 2001 (Sepsis 2)sepsis task force definitions. The original definitions were made at the 1991 consensus conference (Sepsis 1). The 2012 SSC guidelines provided the recommendations for care based on the current definitions at that time. The revision to the 2012 guidelines are currently a work in progress. Maureen A. Seckel, APRN, ACNS-BC, CCNS, CCRN, FCCM Lead CNS Medical Pulmonary Critical Care Sepsis Coordinator Christiana Care Health System 4755 Ogletown-Stanton Road 3E29 Newark, DE 19718 Office 302 733-6023 msec...@christianacare.org<mailto:msec...@christianacare.org> [cid:image002.jpg@01D194B2.D0943B40] From: Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On Behalf Of Mary Draper Sent: Monday, April 11, 2016 3:34 PM To: 'beh...@aol.com'; sepsisgroups@lists.sepsisgroups.org<mailto:sepsisgroups@lists.sepsisgroups.org> Cc: garry.h...@enjoincdi.com<mailto:garry.h...@enjoincdi.com> Subject: Re: [Sepsis Groups] Sepsis 3 The 2012 definitions updated the 2001 definitions. I don't think the Sepsis 3 released Feb this year, actually has "replaced" the 2012 definitions. Appreciate feedback if there are others who think it does. Thanks. Mary Draper RN BSN Coordinator Quality Improvement Peer Review Support CV/CT Quality Management JMH Office (925) 674-2045 Cell (925) 451-8792 Fax (925) 674-2373 mary.dra...@johnmuirhealth.com<mailto:mary.dra...@johnmuirhealth.com> [cid:image003.png@01D194B2.D0943B40] "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 beh...@aol.com<mailto:beh...@aol.com> Sent: Friday, April 08, 2016 9:23 AM To: sepsisgroups@lists.sepsisgroups.org<mailto:sepsisgroups@lists.sepsisgroups.org> Cc: garry.h...@enjoincdi.com<mailto:garry.h...@enjoincdi.com> Subject: [Sepsis Groups] Sepsis 3 Do you think that Sepsis 3 definition at this time replaces the previous sepsis definitions in 2001 international definition conference or the SSC 2012? William E. Haik, M.D., F.C.C.P., C.D.I.P. AHIMA Approved ICD-10-CM/PCS Trainer Office: (850) 863-2110<tel:(850)%20863-2110> Cell: (850) 803-5854<tel:(850)%20803-5854> Fax: (850) 864-4438<tel:(850)%20864-4438> ___ Sepsisgroups mailing list Sepsisgroups@lists.sepsisgroups.org http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org
Re: [Sepsis Groups] Sepsis 3
The 2012 definitions updated the 2001 definitions. I don't think the Sepsis 3 released Feb this year, actually has "replaced" the 2012 definitions. Appreciate feedback if there are others who think it does. Thanks. Mary Draper RN BSN Coordinator Quality Improvement Peer Review Support CV/CT Quality Management JMH Office (925) 674-2045 Cell (925) 451-8792 Fax (925) 674-2373 mary.dra...@johnmuirhealth.com<mailto:mary.dra...@johnmuirhealth.com> [cid:image001.png@01D193EE.62B36AC0] "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 beh...@aol.com Sent: Friday, April 08, 2016 9:23 AM To: sepsisgroups@lists.sepsisgroups.org Cc: garry.h...@enjoincdi.com Subject: [Sepsis Groups] Sepsis 3 Do you think that Sepsis 3 definition at this time replaces the previous sepsis definitions in 2001 international definition conference or the SSC 2012? William E. Haik, M.D., F.C.C.P., C.D.I.P. AHIMA Approved ICD-10-CM/PCS Trainer Office: (850) 863-2110<tel:(850)%20863-2110> Cell: (850) 803-5854<tel:(850)%20803-5854> Fax: (850) 864-4438<tel:(850)%20864-4438> ___ Sepsisgroups mailing list Sepsisgroups@lists.sepsisgroups.org http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org
[Sepsis Groups] Reflex lactates
We have been piloting a lab generated reflex lactate done four hours after the initial draw time on patients that have a lactate of > 2. The only pushback we have had is related to our trauma patients who routinely have one done on admission. Are any of your facilities trauma centers and are you doing reflex lactates and has there been any pushback? Thanks for your feedback. Mary Draper RN BSN Coordinator Quality Improvement Peer Review Support CV/CT Quality Management JMH Office (925) 674-2045 Cell (925) 451-8792 Fax (925) 674-2373 mary.dra...@johnmuirhealth.com<mailto:mary.dra...@johnmuirhealth.com> [cid:image001.png@01D18F23.D4378250] "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 ___ Sepsisgroups mailing list Sepsisgroups@lists.sepsisgroups.org http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org
Re: [Sepsis Groups] source of infection
That is a good way to look at that. Thanks. Mary Draper RN BSN Coordinator Quality Improvement Peer Review Support CV/CT Quality Management JMH Office (925) 674-2045 Cell (925) 451-8792 Fax (925) 674-2373 mary.dra...@johnmuirhealth.com<mailto: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 Overmyer, Diane Sent: Tuesday, December 29, 2015 11:59 AM To: 'Lanna Dimond'; Merwin, Courtney C. Cc: Sepsisgroups; sepsisgroups@lists.sepsisgroups.org Subject: Re: [Sepsis Groups] source of infection One way I think about it this: Leukocystosis is a "symptom" of an infection, not an "infection". If something is a symptom of an infection, it can't be counted as a source of infection. From: Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On Behalf Of Lanna Dimond Sent: Tuesday, December 29, 2015 11:50 AM To: Merwin, Courtney C. Cc: Sepsisgroups; sepsisgroups@lists.sepsisgroups.org<mailto:sepsisgroups@lists.sepsisgroups.org> Subject: Re: [Sepsis Groups] source of infection The guidelines state that documentation needs to be more specific. For example, suspect catheter-related infection, possible leukocytosis related infection. Inclusion guidelines for abstraction are :Severe Sepsis, R/O Severe Sepsis and can also use a Differential diagnosis of Severe Sepsis. Exclusions Guidelines for abstraction are: Sepsis, Septic, Septicemia, Bacteremia and infection. (retrieved from Specification Manuel) Thank you, Lanna Lanna Dimond RN Jordan Valley Medical Center West Valley Campus Quality / Core Measure Data Analyst Office 801.964.3454 Fax 801.964.3545 ldim...@iasishealthcare.com<mailto:ldim...@iasishealthcare.com> NOTICE: This email may contain PRIVILEGED and CONFIDENTIAL information and is intended only for the use of the specific individual(s) to which it is addressed. It may contain Protected Health Information that is privileged and confidential. Protected Health Information may be used or disclosed in accordance with law and you may be subject to penalties under law for improper use or further disclosure of the Protected Health Information in this email. If you are not an intended recipient of this email, you are hereby notified that any unauthorized use, dissemination or copying of this email or the information contained in it or attached to it is strictly prohibited. If you have received this email in error, please delete it and immediately notify the person named above by reply email. Thank you. From:"Merwin, Courtney C." <ccmer...@ejgh.org<mailto:ccmer...@ejgh.org>> To: "sepsisgroups@lists.sepsisgroups.org<mailto:sepsisgroups@lists.sepsisgroups.org>" <sepsisgroups@lists.sepsisgroups.org<mailto:sepsisgroups@lists.sepsisgroups.org>> Date:12/23/2015 01:16 PM Subject:[Sepsis Groups] source of infection Sent by:"Sepsisgroups" <sepsisgroups-boun...@lists.sepsisgroups.org<mailto:sepsisgroups-boun...@lists.sepsisgroups.org>> Hello all... Would you consider leukocytosis as acceptable documentation of "infection or source of infection"? Thanks! Courtney Merwin Quality Management East Jefferson General Hospital 4200 Houma Blvd. Metairie, LA 70006 504-503-5968 ccmer...@ejgh.org<mailto:ccmer...@ejgh.org> IMPORTANT NOTICE: This message and any included attachments are from East Jefferson General Hospital or its Affiliates, is for the intended addressee(s)only, and may include Protected Health (PHI) or other confidential information. If you are the intended recipient, you are obligated to maintain it in a secure and confidential manner and re-disclosure without additional consent or as permitted by law is prohibited. If you are not the intended recipient, use of this information is strictly prohibited and may be unlawful. Please promptly reply to the sender by email and delete this message from your computer. East Jefferson General Hospital greatly appreciates your cooperation.___ Sepsisgroups mailing list Sepsisgroups@lists.sepsisgroups.org<mailto:Sepsisgroups@lists.sepsisgroups.org> http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org CONFIDENTIALITY NOTICE: This transmission and the documents accompanying this transmission may contain confidential information. The information is intended only for the use of the individual(s) or entity named above. If you are not the intended recipient, you are notified that any disclosure
Re: [Sepsis Groups] capillary refill and skin assessment
The definition about skin exam says to include color, so the physician needs to say "skin normal in color" or "pale", "no cyanosis", etc. Mary Draper RN BSN Coordinator Quality Improvement Peer Review Support CV/CT Quality Management JMH Office (925) 674-2045 Cell (925) 451-8792 Fax (925) 674-2373 mary.dra...@johnmuirhealth.com<mailto: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 Barnes-Daly, Mary Ann Sent: Tuesday, December 29, 2015 1:14 PM To: 'Carlson, Brenda L'; 'sepsisgroups@lists.sepsisgroups.org' Subject: Re: [Sepsis Groups] capillary refill and skin assessment I would say yes, but still need peripheral pulse documentation Thanks, MARY ANN BARNES-DALY RN BSN CCRN DC | Clinical Performance Improvement Consultant Sutter Health - Office of Patient Experience | 2200 River Plaza Drive, Sacramento, CA 95833 Mobile 916.200.5604| Office 916.286.6717 | 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 Carlson, Brenda L Sent: Tuesday, December 29, 2015 6:48 AM To: 'sepsisgroups@lists.sepsisgroups.org' Subject: [Sepsis Groups] capillary refill and skin assessment If a provider documents, "Extremities warm and well perfused" is that sufficient documentation for capillary refill and skin color? 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 This message may contain information which is confidential and privileged. Unless you are the addressee (or authorized to receive for the addressee), you may not use, copy or disclose to anyone the message or any information contained in the message (including attachments). If you have received the message in error, please advise sender by reply email, and delete the message. Thank you! ___ Sepsisgroups mailing list Sepsisgroups@lists.sepsisgroups.org http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org
Re: [Sepsis Groups] Repeat lactate
I have not seen any references to it being the same type of lactate, whole blood, venous or iSTAT. Mary Draper RN BSN Coordinator Quality Improvement Peer Review Support CV/CT Quality Management JMH Office (925) 674-2045 Cell (925) 451-8792 Fax (925) 674-2373 mary.dra...@johnmuirhealth.com<mailto: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 Shelly Guyer Sent: Friday, February 05, 2016 1:16 PM To: 'Sepsisgroups@lists.sepsisgroups.org' Subject: [Sepsis Groups] Repeat lactate Does anyone remember seeing that a repeat lactate must be drawn using the same route as the initial lactate? I know I saw this somewhere, but now I can’t find it. The spec manual does not say it must be the same route. Would appreciate any comments. Thank You Shelly Guyer RN, MSN Performance Improvement 691-5497 Confidentiality Notice: This email message, including any attachments, is for the sole use of the intended recipient(s), and may contain privileged or confidential information. Any unauthorized review, use, disclosure or distribution is prohibited. If you are not the intended recipient, please notify the sender of this email, and destroy all copies of the original message. ___ Sepsisgroups mailing list Sepsisgroups@lists.sepsisgroups.org http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org
Re: [Sepsis Groups] Arterial line versus venous draw
Yes, lactates can be run off of either venous or arterial blood. Mary Draper RN BSN Coordinator Quality Improvement Peer Review Support CV/CT Quality Management JMH Office (925) 674-2045 Cell (925) 451-8792 Fax (925) 674-2373 mary.dra...@johnmuirhealth.com<mailto: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 Gerolamo, Jeannine Sent: Friday, January 08, 2016 10:42 AM To: 'sepsisgroups@lists.sepsisgroups.org' Subject: [Sepsis Groups] Arterial line versus venous draw Are lactic acids drawn from an arterial line acceptable? Jeannine Gerolamo (Fahy), MSN, BS, RN Safety/Quality Specialist The Center for Patient Safety and Healthcare Quality 215-481-4334 (Office) 215-481-3510 (Fax) jgerol...@abingtonhealth.org<mailto:jgerol...@abingtonhealth.org> [cid:image001.png@01D14D2A.10B2BF10]<http://www.abingtonhealth.org/> [cid:image002.png@01D14D2A.10B2BF10] <http://www.facebook.com/AbingtonHealth> [cid:image003.png@01D14D2A.10B2BF10] <http://twitter.com/AbingtonHealth> [cid:image004.png@01D14D2A.10B2BF10] <http://www.youtube.com/AbingtonHealth> [cid:image005.png@01D14D2A.10B2BF10] <http://instagram.com/AbingtonHealth/> ** CONFIDENTIALITY NOTICE ** This e-mail contains LEGALLY PRIVILEGED AND CONFIDENTIAL INFORMATION intended only for the use of the recipient named above. If you are not the intended recipient, you are hereby notified that any dissemination or copying of this e-mail is strictly prohibited. If you have received this e-mail in error, please notify the transmitting hospital by telephone or e-mail and delete the original e-mail received in error. THIS INFORMATION HAS BEEN DISCLOSED TO YOU FROM RECORDS WHOSE CONFIDENTIALITY IS PROTECTED BY STATE AND FEDERAL LAW. ANY FURTHER DISCLOSURE, COPYING, DISTRIBUTION OR ACTION TAKEN IN RELIANCE ON THE CONTENTS OF THESE DOCUMENTS WITHOUT THE PRIOR WRITTEN CONSENT OF THE PERSON TO WHOM IT PERTAINS IS PROHIBITED. YOU ARE REQUIRED TO DESTROY THE INFORMATION AFTER THE STATED NEED HAS BEEN FULFILLED. ___ Sepsisgroups mailing list Sepsisgroups@lists.sepsisgroups.org http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org
Re: [Sepsis Groups] 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<mailto: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.<https://cms-ip.custhelp.com/app/account/questions/detail/i_id/267055> 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<http://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<https://cms-ip.custhelp.com/app/answers/list/c/576> and a SEP-1 fact sheet <https://www.qualitynet.org/dcs/BlobServer?blobkey=id=true=1228890481688=multipart%2Foctet-stream=Content-Disposition=attachment%3Bfilename%3DHos_Sepsis-FactSheet_082015.pdf=urldata=MungoBlobs> is posted on QualityNet. A recording<http://qualityreportingcenter.com/media/eventrecordings/IQR/IQR08242015/index.html>, slides<http://www.qualityreportingcenter.com/wp-content/uploads/2015/08/IQR_Webinar-August_SEP-1-Part-I-20150824-vFINAL-5081.pdf> , and Q<http://www.qualityreportingcenter.com/wp-content/uploads/2015/09/8-24-15-IQR-Q-A-Transcript_Responses.pdf> from the August 24th National Provider call are available for review. The recording<https://cc.readytalk.com/play?id=g35che> and slides<http://www.qualityreportingcenter.com/wp-content/uploads/2015/09/IQR_Webinar-September_SEP-1-PartII_FINAL2015-09-21_508.pdf> 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 (i
Re: [Sepsis Groups] Administrative contraindications to care
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<mailto: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 <mary.dra...@johnmuirhealth.com<mailto:mary.dra...@johnmuirhealth.com>> 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<tel:%28925%29%20674-2045> Cell (925) 451-8792<tel:%28925%29%20451-8792> Fax (925) 674-2373<tel:%28925%29%20674-2373> mary.dra...@johnmuirhealth.com<mailto: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<mailto:sepsisgroups-boun...@lists.sepsisgroups.org>] On Behalf Of Kelli Barrieau Sent: Wednesday, November 18, 2015 12:55 PM To: sepsisgroups@lists.sepsisgroups.org<mailto: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<mailto: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 ___ Sepsisgroups mailing list Sepsisgroups@lists.sepsisgroups.org<mailto:Sepsisgroups@lists.sepsisgroups.org> http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org ___ Sepsisgroups mailing list Sepsisgroups@lists.sepsisgroups.org http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org
Re: [Sepsis Groups] Administrative contraindications to care
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<mailto:mary.dra...@johnmuirhealth.com> [cid:image001.png@01D122BD.9DE79BE0] "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<mailto:kelli_barri...@cooley-dickinson.org> Cooley-dickinson.org ___ Sepsisgroups mailing list Sepsisgroups@lists.sepsisgroups.org http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org
[Sepsis Groups] Onset of severe sepsis
I am doing a review where the SIRS criteria is met and 2 signs of organ dysfunction are present but there isn't any documentation about "infection, r/o infection, etc". However the pulmonologist orders contact isolation without a reason. Can I use the time of that order as "possible infection"? Thanks for your feedback. 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<mailto: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 ___ Sepsisgroups mailing list Sepsisgroups@lists.sepsisgroups.org http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org
[Sepsis Groups] repeat lactate in the first 6 hours
What value are you all using for the repeat lactate? A lactate > 2? Thanks. 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<mailto:mary.dra...@johnmuirhealth.com> [cid:image003.png@01D100E8.741AC860] "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 ___ Sepsisgroups mailing list Sepsisgroups@lists.sepsisgroups.org http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org
Re: [Sepsis Groups] CMS Abstraction for Severe Sepsis/Septic Shock PRESENT...
Dr. Townsend, I greatly appreciate your clear, concise and reasonable responses to all the CMS Severe Sepsis questions and discussions. Thank you. Mary Draper RN BSN CCRN Quality Manager-Best Practice Support Quality Management Supervisor Office (925) 674-2045tel:(925)%20674-2045 Cell (925) 451-8792tel:(925)%20451-8792 Fax (925) 674-2373tel:(925)%20674-2373 mary.dra...@johnmuirhealth.commailto:mary.dra...@johnmuirhealth.com On Apr 10, 2015, at 6:07 AM, Townsend, Sean, M.D. towns...@sutterhealth.orgmailto:towns...@sutterhealth.org wrote: This question will require formal clarification by CMS and the vendors it uses to capture the information. The vendor your hospital system uses to send information to CMS will create a means to capture this information uniformly. Our hospital system for instance uses Midas. This vendor will resolve this question with CMS in a compliant fashion. Typically, if a selected case is indeterminate as to diagnosis by abstraction guidelines at the hospital level, hospitals have freedom to select another chart during the sampling period. This is true for any measure included in the inpatient quality reporting (IQR) data set. Long and short, I wouldn’t worry about this issue with too much of my attention. From: Brown, Sheree [mailto:sheree.br...@allegiancehealth.org] Sent: Thursday, April 09, 2015 8:44 AM To: 'beh...@aol.commailto:beh...@aol.com'; Townsend, Sean, M.D. Cc: sepsisgroups@lists.sepsisgroups.orgmailto:sepsisgroups@lists.sepsisgroups.org; garry.h...@drgreview.commailto:garry.h...@drgreview.com; james@drgreview.commailto:james@drgreview.com; robert.st...@drgreview.commailto:robert.st...@drgreview.com; edgar.bote...@drgreview.commailto:edgar.bote...@drgreview.com; emcc...@eleanormccain.netmailto:emcc...@eleanormccain.net Subject: RE: [Sepsis Groups] CMS Abstraction for Severe Sepsis/Septic Shock PRESENT... Actually, the abstraction guidelines list provider (physician/PA/APNPA) notes as the preferred data source to determine if a patient has severe sepsis. Severe sepsis is considered present if the provider documents any of these specific terms: Inclusion Guidelines for Abstraction: • Severe Sepsis • R/O severe sepsis • Differential diagnosis: severe sepsis • Possible severe sepsis If there is no documentation of any of these terms by the provider, then the record is reviewed to see if patient meets the 3 criteria for severe sepsis (infection + 2 SIRS + 1 organ dysfunction). So as I understand it…if the physician/PA/NP documents ‘severe sepsis’ then the SIRS criteria does not need to be met. Sheree Sheree Brown MSN, RN, CNL Manager, Performance Excellence Phone: 517 788-4800 ext. 4209 Pager: 517 534-0127 Fax: 517 788-4715 sheree.br...@allegiancehealth.orgallegiancehealth.org image001.gif From: beh...@aol.commailto:beh...@aol.com [mailto:beh...@aol.com] Sent: Thursday, April 09, 2015 10:23 AM To: towns...@sutterhealth.orgmailto:towns...@sutterhealth.org; Brown, Sheree; beh...@aol.commailto:beh...@aol.com Cc: sepsisgroups@lists.sepsisgroups.orgmailto:sepsisgroups@lists.sepsisgroups.org; garry.h...@drgreview.commailto:garry.h...@drgreview.com; james@drgreview.commailto:james@drgreview.com; robert.st...@drgreview.commailto:robert.st...@drgreview.com; edgar.bote...@drgreview.commailto:edgar.bote...@drgreview.com; emcc...@eleanormccain.netmailto:emcc...@eleanormccain.net Subject: Re: [Sepsis Groups] CMS Abstraction for Severe Sepsis/Septic Shock PRESENT... I am seeing denials of severe sepsis as a reported diagnosis by third party auditors ( CMS and other auditors) as they feel severe sepsis is not clinically validated as the patient does not have 2 of the sirs criteria, despite having signs of severe sepsis ( organ dysfunction due to infection) This is medically incorrect as one can have severe sepsis without any of the sirs criteria (even though it is uncommon, it does occur based on my experience and as Dr Levy had told me by phone several years ago,) This is also noted in a recent NEJM article ( http://www.nejm.org/doi/full/10.1056/NEJMoa1415236?query=pulmonary ) Therefore, I am concerned that the criteria kindly forwarded by Ms Brown ( see below) would add to the problem if it rules out the diagnosis of severe sepsis based on not having 2 of the 4 sirs criteria. Any thoughts? William E. Haik, M.D., F.C.C.P., C.D.I.P. AHIMA Approved ICD-10-CM/PCS Trainer Office: (850) 863-2110tel:(850)%20863-2110 Cell: (850) 803-5854tel:(850)%20803-5854 Fax: (850) 864-4438 tel:(850)%20864-4438 tel:(850)%20864-4438 In a message dated 4/8/2015 4:21:14 P.M. Central Daylight Time, towns...@sutterhealth.org writes:tel:(850)%20864-4438 Good detective work! Still verifying details as I do not want to distribute misleading information here. Please stay tuned. Sean R. Townsend, MD Vice President of Quality Safety California Pacific Medical Center 2330 Clay Street #301 San Francisco, CA 94115 towns
Re: [Sepsis Groups] time zero
We use triage time. This is based on the 2012 SCCM Surviving Sepsis Guidelines. Mary Draper RN BSN CCRN Quality Manager-Best Practice Support Quality Management Supervisor Office (925) 674-2045 Cell (925) 451-8792 Fax (925) 674-2373 mary.dra...@johnmuirhealth.commailto:mary.dra...@johnmuirhealth.com [cid:image001.png@01D07117.F6776270] From: Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On Behalf Of Gerolamo, Jeannine Sent: Monday, April 06, 2015 8:12 AM To: sepsisgroups@lists.sepsisgroups.org Subject: [Sepsis Groups] time zero I am looking for information on how you identify time zero and where/how in the EMR you are documenting. Thanks. ** CONFIDENTIALITY NOTICE ** This e-mail contains LEGALLY PRIVILEGED AND CONFIDENTIAL INFORMATION intended only for the use of the recipient named above. If you are not the intended recipient, you are hereby notified that any dissemination or copying of this e-mail is strictly prohibited. If you have received this e-mail in error, please notify the transmitting hospital by telephone or e-mail and delete the original e-mail received in error. THIS INFORMATION HAS BEEN DISCLOSED TO YOU FROM RECORDS WHOSE CONFIDENTIALITY IS PROTECTED BY STATE AND FEDERAL LAW. ANY FURTHER DISCLOSURE, COPYING, DISTRIBUTION OR ACTION TAKEN IN RELIANCE ON THE CONTENTS OF THESE DOCUMENTS WITHOUT THE PRIOR WRITTEN CONSENT OF THE PERSON TO WHOM IT PERTAINS IS PROHIBITED. YOU ARE REQUIRED TO DESTROY THE INFORMATION AFTER THE STATED NEED HAS BEEN FULFILLED. ___ Sepsisgroups mailing list Sepsisgroups@lists.sepsisgroups.org http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org
Re: [Sepsis Groups] field resuscitation
We count the field resuscitation fluids in our data. Mary Draper RN BSN CCRN Quality Manager-Best Practice Support Quality Management Supervisor Office (925) 674-2045tel:(925)%20674-2045 Cell (925) 451-8792tel:(925)%20451-8792 Fax (925) 674-2373tel:(925)%20674-2373 mary.dra...@johnmuirhealth.commailto:mary.dra...@johnmuirhealth.com On Apr 9, 2014, at 5:34 AM, Dian Nuxoll ddnux...@evergreenhealthcare.orgmailto:ddnux...@evergreenhealthcare.org wrote: Do you count field fluid resuscitation in your 3 hr bundle? Time zero is when they hit the door, so do you only count fluid starting as they hit the door? Dian Nuxoll, RN, BSN Clinical Quality Analyst – Quality Management 425.899.2359 I EvergreenHealth MS-62, 12040 NE 128th St., Kirkland, WA 98034 Follow EvergreenHealth on Facebookhttp://www.facebook.com/evergreenhospital.org and Twitterhttp://twitter.com/ | www.evergreenhealthcare.orghttp://www.evergreenhealthcare.org/ Picture (Device Independent Bitmap) 1.jpg Please note: My e-mail address has changed to ddnux...@evergreenhealth.commailto:ddnux...@evergreenhealth.com DISCLAIMER: EvergreenHealth Confidentiality Notice: This email message, including any attachments, is for the sole use of the intended recipient(s) and may contain confidential and privileged information. Any unauthorized review, use, disclosure or distribution is prohibited. If you are not the intended recipient, please contact the sender by e-mail and destroy all copies of the original message or you may call EvergreenHealth in Kirkland, WA U.S.A at (425)899-1740. ___ Sepsisgroups mailing list Sepsisgroups@lists.sepsisgroups.orgmailto:Sepsisgroups@lists.sepsisgroups.org http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org ___ Sepsisgroups mailing list Sepsisgroups@lists.sepsisgroups.org http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org
Re: [Sepsis Groups] Hypoglycemia
We do check BG and follow BG values in all our sepsis patients and do not just focus on known diabetic patients. Mary Draper RN BSN CCRN Quality Manager-Best Practice Support Quality Management Supervisor Office (925) 674-2045tel:(925)%20674-2045 Cell (925) 451-8792tel:(925)%20451-8792 Fax (925) 674-2373tel:(925)%20674-2373 mary.dra...@johnmuirhealth.commailto:mary.dra...@johnmuirhealth.com On Mar 21, 2014, at 5:48 AM, Brochis, Dale. dbroc...@rwjuhr.commailto:dbroc...@rwjuhr.com wrote: It would be interesting to look at these hypoglycemic patients for common characteristics, history, sources of sepsis, severity of illness upon presentation, and medication regimen. Dale Brochis Gainsharing Project Coordinator Case Management Department Robert Wood Johnson University Hospital at Rahway 865 Stone Street Rahway, NJ 07065 732-499-6217 Office / 732-428-2108 Cell dbroc...@rwjuhr.commailto:dbroc...@rwjuhr.com From: sepsisgroups-boun...@lists.sepsisgroups.orgmailto:sepsisgroups-boun...@lists.sepsisgroups.org [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On Behalf Of Mary Draper Sent: Thursday, March 20, 2014 5:33 PM To: smckin...@regionalhealth.commailto:smckin...@regionalhealth.com Cc: Sepsisgroups@lists.sepsisgroups.orgmailto:Sepsisgroups@lists.sepsisgroups.org Subject: Re: [Sepsis Groups] Hypoglycemia Interesting, we have not found hypoglycemia in our severe sepsis patient population. Mary Draper RN BSN CCRN Quality Manager-Best Practice Support Quality Management Supervisor Office (925) 674-2045tel:(925)%20674-2045 Cell (925) 451-8792tel:(925)%20451-8792 Fax (925) 674-2373tel:(925)%20674-2373 mary.dra...@johnmuirhealth.commailto:mary.dra...@johnmuirhealth.com On Mar 20, 2014, at 12:10 PM, smckin...@regionalhealth.commailto:smckin...@regionalhealth.com smckin...@regionalhealth.commailto:smckin...@regionalhealth.com wrote: In a recent review of some of our sepsis records, we found a group of patients who had profoundly low blood sugars (11-40). I don’t hear much about hypoglycemia in Sepsis as much as hyperglycemia. We are curious how other hospitals are looking at this and what the plan of care is when this occurs. Is it part of your sepsis bundles to check blood sugars? Only in diabetics? How do you treat and follow up?? Thanks in advance, Susan McKinney, RN Susan McKinney Clinical Quality Coordinator- -Sepsis-VTE Clinical Effectiveness Team smckin...@regionalhealth.commailto:smckin...@regionalhealth.com 605-484-7381 Cell 605-755-4428-please note new number Regional Health's mission is to provide and support health care excellence in partnership with the communities we serve. Note: The information contained in this message, including any attachments, may be privileged, confidential, or protected from disclosure under state or federal laws . 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. If you have received this communication in error, please notify the Sender immediately by a reply to sender only message and destroy all electronic or paper copies of the communication, including any attachments. ___ Sepsisgroups mailing list Sepsisgroups@lists.sepsisgroups.orgmailto:Sepsisgroups@lists.sepsisgroups.org http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org This e-mail and any files transmitted with it are confidential and are intended solely for the use of the individual or entity to whom they are addressed. This communication represents the originator's personal views and opinions, which do not necessarily reflect those of Robert Wood Johnson University Hospital Rahway. If you are not the original recipient or the person responsible for delivering the e-mail to the intended recipient, be advised that you have received this e-mail in error, and that any use, dissemination, forwarding, printing, or copying of this e-mail is strictly prohibited. If you receive this email in error, please immediately notify postmas...@rwjuhr.commailto:postmas...@rwjuhr.com. ___ Sepsisgroups mailing list Sepsisgroups@lists.sepsisgroups.org http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org
Re: [Sepsis Groups] ED to ICU
We have worked hard to get the transfer time to 4 hours. The ED MDs call the intensivists directly to expedite transfer to Critical Care. Mary Draper RN BSN CCRN Quality Manager-Best Practice Support Quality Management Supervisor Office (925) 674-2045tel:(925)%20674-2045 Cell (925) 451-8792tel:(925)%20451-8792 Fax (925) 674-2373tel:(925)%20674-2373 mary.dra...@johnmuirhealth.commailto:mary.dra...@johnmuirhealth.com On Feb 21, 2014, at 2:10 PM, DanaMarie Smith danamariesm...@ariahealth.orgmailto:danamariesm...@ariahealth.org wrote: Hi everyone, I was wondering what your Hospital policy was for sepsis patients from arrival to er to ICU bed time. Our hospital average is 6 hrs and we want to change that and make it much less but don't know what the standard is across other hospitals. I would appreciate some feedback. Thank you. Dana Dana Marie Smith RN Clinical Data Analyst Quality/Performance Improvement Phone # 215- 612-4888 Fax # 215-612-4463 ___ Sepsisgroups mailing list Sepsisgroups@lists.sepsisgroups.orgmailto:Sepsisgroups@lists.sepsisgroups.org http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org ___ Sepsisgroups mailing list Sepsisgroups@lists.sepsisgroups.org http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org
Re: [Sepsis Groups] Sepsisgroups Digest, Vol 82, Issue 2
We don't rely on pumps, the nurse runs the fluids wide open. We have been able to get 2 liters in within 60 mins if we have 2 IV sites. Mary Draper RN BSN CCRN Quality Manager-Best Practice Support Quality Management Supervisor Office (925) 674-2045 Cell (925) 451-8792 Fax (925) 674-2373 mary.dra...@johnmuirhealth.com -Original Message- From: sepsisgroups-boun...@lists.sepsisgroups.org [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On Behalf Of Louis Landman Sent: Monday, November 04, 2013 2:58 PM To: sepsisgroups@lists.sepsisgroups.org Subject: Re: [Sepsis Groups] Sepsisgroups Digest, Vol 82, Issue 2 I'm glad we're not the only ones with woefully slow pumps! We make up for it by using 2 or 3 infusion sites; for instance, 999 m/hr in each arm and through a central line, so about 1L every 20 minutes. Louis Landman, MD -Original Message- From: sepsisgroups-requ...@lists.sepsisgroups.org Sent: Monday, November 04, 2013 5:50 PM To: sepsisgroups@lists.sepsisgroups.org Subject: Sepsisgroups Digest, Vol 82, Issue 2 Send Sepsisgroups mailing list submissions to sepsisgroups@lists.sepsisgroups.org To subscribe or unsubscribe via the World Wide Web, visit http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org or, via email, send a message with subject or body 'help' to sepsisgroups-requ...@lists.sepsisgroups.org You can reach the person managing the list at sepsisgroups-ow...@lists.sepsisgroups.org When replying, please edit your Subject line so it is more specific than Re: Contents of Sepsisgroups digest... Today's Topics: 1. Re: Initial Fluid Bolus (Hawkins, Denis) -- Message: 1 Date: Mon, 4 Nov 2013 22:50:17 + From: Hawkins, Denis denis.hawk...@mountsinai.org To: 'hassaballa.hes...@cogenthmg.com' hassaballa.hes...@cogenthmg.com, 'gkra...@utmb.edu' gkra...@utmb.edu Cc: 'wmile...@utmb.edu' wmile...@utmb.edu, 'mkin...@utmb.edu' mkin...@utmb.edu, 'sepsisgroups@lists.sepsisgroups.org' sepsisgroups@lists.sepsisgroups.org, 'matil...@utmb.edu' matil...@utmb.edu, 'ldpac...@utmb.edu' ldpac...@utmb.edu, 'wwhit...@utmb.edu' wwhit...@utmb.edu Subject: Re: [Sepsis Groups] Initial Fluid Bolus Message-ID: 1d03c7f613bcdd4eac466f6a435ddf2b013dc...@smesexcp014031.msnyuhealth.org Content-Type: text/plain; charset=utf-8 Anyone have a good article to use as evidence for initial fluid bolus? From: Hesham Hassaballa [mailto:hassaballa.hes...@cogenthmg.com] Sent: Sunday, November 03, 2013 03:32 PM To: Kramer, George C. gkra...@utmb.edu Cc: Mileski, William wmile...@utmb.edu; sepsisgroups@lists.sepsisgroups.org sepsisgroups@lists.sepsisgroups.org; Tillman, Melinda A. matil...@utmb.edu; Pacheco, Luis D. ldpac...@utmb.edu; Whitehead, William E. wwhit...@utmb.edu; Kinsky, Michael P. mkin...@utmb.edu Subject: Re: [Sepsis Groups] Initial Fluid Bolus I completely agree with George. 999 mL/hr is WAY too slow. The problem is the pumps can't go any faster, and many times the patients have poor IV lines that can't take pressure bag boluses ( because many times we are putting in the central line) Hesham A. Hassaballa, MD Program Medical Director Critical Care Rush-Copley Medical Center 2000 Ogden Avenue Aurora, IL 60504 Phone: (331) 454-6572 ### CONFIDENTIALITY NOTICE ### This message and any included attachments are from Cogent HMG and are intended only for the addressee. The contents in this message contain confidential information belonging to the sender that is legally protected. Unauthorized forwarding, printing, copying, distribution, or use of such information is strictly prohibited and may be unlawful. If you are not the addressee, please promptly delete this message and notify the sender of the delivery error by e-mail or contact the Cogent HMG Privacy Officer at privacyoffi...@cogenthmg.commailto:privacyoffi...@cogenthmg.com. On Nov 3, 2013, at 8:08 AM, Kramer, George C. gkra...@utmb.edumailto:gkra...@utmb.edu wrote: Phil and Terry, Am I off base here? To me, and the clinicians at our institution, it is often not so much the volume, but the rate of infusion and how promptly to deliver the volume that is the controversy. And there is a very active debate at our institution on this. I suggest that 999 ml/kg is largely an inadequate rate. Our surgical intensivists totally support boluses administered by pressure bag and at a minimum wide open going in fast. However, many of our medical intensivists and nurses seem to believe that 999 ml/hr is acceptable and even ideal. It makes sense to me that sometimes 999 is ok, sometimes, but often it is inadequate and puts the patient at risk for remaining in a state of hypo perfusion. And even if fluid overload is a concern rapid bolus, with assessment after each is in order in septic shock and severe sepsis. g George Kramer, PhD UTMB OvidSP Resultsmessage:%3c201311021035.ra2az0ag004...@txrdc-fe03.tx.ovid.com%3E From
Re: [Sepsis Groups] Sepsisgroups Digest, Vol 77, Issue 1
We had set a goal of 2 hr from triage before the latest guidelines had been released. We have decided to stay with that goal as we have improved our compliance over the last couple of years. Mary Draper RN BSN CCRN Quality Manager-Best Practice Support Quality Management Supervisor Office (925) 674-2045 Cell (925) 451-8792 Fax (925) 674-2373 mary.dra...@johnmuirhealth.com -Original Message- From: sepsisgroups-boun...@lists.sepsisgroups.org [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On Behalf Of Robyn Haddock Crosswhite Sent: Monday, September 30, 2013 11:19 AM To: sepsisgroups@lists.sepsisgroups.org Subject: Re: [Sepsis Groups] Sepsisgroups Digest, Vol 77, Issue 1 Do other hospitals follow the 3 hr sepsis bundle (ie lactate, antibiotics) or do you check lactate levels as well as antibiotics within the first hour of recognition? Thanks Robyn Crosswhite BSN, RN,CCRN Nurse Educator Sepsis Coordinator Medical Center Hospital Odessa TX 79758 Sent from my iPhone On Sep 30, 2013, at 9:59 AM, sepsisgroups-requ...@lists.sepsisgroups.org sepsisgroups-requ...@lists.sepsisgroups.org wrote: Send Sepsisgroups mailing list submissions to sepsisgroups@lists.sepsisgroups.org To subscribe or unsubscribe via the World Wide Web, visit http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.o rg or, via email, send a message with subject or body 'help' to sepsisgroups-requ...@lists.sepsisgroups.org You can reach the person managing the list at sepsisgroups-ow...@lists.sepsisgroups.org When replying, please edit your Subject line so it is more specific than Re: Contents of Sepsisgroups digest... Today's Topics: 1. Re: Sepsisgroups Digest, Vol 76, Issue 3 (Yash Javeri) 2. Pre-hospital Antibiotic Administration (Josie Gray) 3. Re: Where Does Severe Sepsis Belong? (Martha Mattson) 4. IMPRESS Study Update - November 7 right around thecorner (Lori Harmon) -- Message: 1 Date: Sat, 28 Sep 2013 22:25:00 +0530 From: Yash Javeri dryashjav...@yahoo.com To: Rohrbach, Dawn dawn.rohrb...@providence.org Cc: sepsisgroups@lists.sepsisgroups.org sepsisgroups@lists.sepsisgroups.org Subject: Re: [Sepsis Groups] Sepsisgroups Digest, Vol 76, Issue 3 Message-ID: 386a9113-3818-466d-8962-84061da89...@yahoo.com Content-Type: text/plain; charset=us-ascii Very valid point. To whom does the septic patient belong? Where should be a septic patient treated? The septic patient belongs to intensivist Ownership should be with ICU team. This will give them much deserved comprehensive care. They should be treated in ICU inclined to aggresive sepsis care On 28-Sep-2013, at 0:49, Rohrbach, Dawn dawn.rohrb...@providence.org wrote: We recommend admitting patients with a lactate 3 to our ICU in our facility. Most of the time this is the case. The other elements are only if patient is ubstable. -Original Message- From: sepsisgroups-boun...@lists.sepsisgroups.org [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On Behalf Of sepsisgroups-requ...@lists.sepsisgroups.org Sent: Friday, September 27, 2013 1:09 PM To: sepsisgroups@lists.sepsisgroups.org Subject: Sepsisgroups Digest, Vol 76, Issue 3 Send Sepsisgroups mailing list submissions to sepsisgroups@lists.sepsisgroups.org To subscribe or unsubscribe via the World Wide Web, visit http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups. org or, via email, send a message with subject or body 'help' to sepsisgroups-requ...@lists.sepsisgroups.org You can reach the person managing the list at sepsisgroups-ow...@lists.sepsisgroups.org When replying, please edit your Subject line so it is more specific than Re: Contents of Sepsisgroups digest... Today's Topics: 1. Re: Where Does Severe Sepsis Belong? (Jamie Roney) - - Message: 1 Date: Thu, 26 Sep 2013 16:05:06 -0500 From: Jamie Roney jro...@covhs.org To: Townsend, Sean, M.D. towns...@sutterhealth.org, 'sepsisgroups@lists.sepsisgroups.org' sepsisgroups@lists.sepsisgroups.org Subject: Re: [Sepsis Groups] Where Does Severe Sepsis Belong? Message-ID: cb901ca1ec8d2340a5cc967135b59200013a5a2...@sjsnt-txmail01.stjoe.org Content-Type: text/plain; charset=us-ascii Dr. Townsend, Is there a sepsis specific risk/treatment stratification tool available to assist in answering your question of placement in a possible lower level of care? Or is there a tool to assist with septic patients who can be discharged home versus admitted due to probable deterioration into severe sepsis? Thank you, Jamie Jamie Roney, BSN, RN-BC, BSHCM, CCRN COVENANT HEALTH SEPSIS
Re: [Sepsis Groups] Where Does Severe Sepsis Belong?
If they are hemodynamically stable and have responded to fluids, they could go to a telemetry unit but those nurses have 4-5 patients and subtle changes leading to instability can get missed. Mary Draper RN BSN CCRN Quality Manager-Best Practice Support Quality Management Supervisor Office (925) 674-2045tel:(925)%20674-2045 Cell (925) 451-8792tel:(925)%20451-8792 Fax (925) 674-2373tel:(925)%20674-2373 mary.dra...@johnmuirhealth.commailto:mary.dra...@johnmuirhealth.com On Sep 27, 2013, at 7:05 AM, Jamie Roney jro...@covhs.orgmailto:jro...@covhs.org wrote: Dr. Townsend, Is there a sepsis specific risk/treatment stratification tool available to assist in answering your question of placement in a possible lower level of care? Or is there a tool to assist with septic patients who can be discharged home versus admitted due to probable deterioration into severe sepsis? Thank you, Jamie Jamie Roney, BSN, RN-BC, BSHCM, CCRN COVENANT HEALTH SEPSIS COORDINATOR 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.orghttp://www.covenanthealth.org .. -Original Message- From: sepsisgroups-boun...@lists.sepsisgroups.orgmailto:sepsisgroups-boun...@lists.sepsisgroups.org [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On Behalf Of Townsend, Sean, M.D. Sent: Friday, March 15, 2013 1:32 AM To: 'sepsisgroups@lists.sepsisgroups.orgmailto:sepsisgroups@lists.sepsisgroups.org' Subject: [Sepsis Groups] Where Does Severe Sepsis Belong? It's been a long time since I've had to ask this question. I used to think I knew the answer. Here it is: do all patients who meet severe sepsis criteria need to be admitted to the ICU ? Examples: 1. Pneumonia, fever, tachycardia, INR 1.5. 2. Cellulitis, leukocytosis, fever, creatinine 2.0. 3. UTI, leukocytosis, fever, lactate 3.0. Where do people put these patients in reality? What mind of monitoring do they deserve? By prevailing bundles, each gets lactate checked, blood cultures, broad spectrum antibiotics. That's it. Good enough? Good enough for the floor? Need the ICU? Why? Sean Sean R. Townsend, M.D. Vice President of Quality Safety California Pacific Medical Center 2330 Clay Street, #301 San Francisco, CA 94115 email towns...@sutterhealth.orgmailto:towns...@sutterhealth.org office (415) 600-5770 fax (415) 600-1541 ___ Sepsisgroups mailing list Sepsisgroups@lists.sepsisgroups.orgmailto:Sepsisgroups@lists.sepsisgroups.org http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org Notice from St. Joseph Health System: Please note that the information contained in this message may be privileged and confidential and protected from disclosure. ___ Sepsisgroups mailing list Sepsisgroups@lists.sepsisgroups.orgmailto:Sepsisgroups@lists.sepsisgroups.org http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org ___ Sepsisgroups mailing list Sepsisgroups@lists.sepsisgroups.org http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org
Re: [Sepsis Groups] Sepsisgroups Digest, Vol 50, Issue 7
No we do not draw it. Mary Draper RN BSN CCRN Quality Manager-Best Practice Support Quality Management Supervisor Office (925) 674-2045tel:(925)%20674-2045 Cell (925) 451-8792tel:(925)%20451-8792 Fax (925) 674-2373tel:(925)%20674-2373 mary.dra...@johnmuirhealth.commailto:mary.dra...@johnmuirhealth.com On Mar 28, 2013, at 8:15 AM, Angela Long long...@memorialhealth.commailto:long...@memorialhealth.com wrote: I have a topic - Is Procalcitonin routinely drawn in the ED? I just was reading an article that there is no data on routine Procalcitonin level evaluation in the ED. Just wondering if other hospitals get this level while in the ED. sepsisgroups-requ...@lists.sepsisgroups.orgmailto:sepsisgroups-requ...@lists.sepsisgroups.org 3/27/2013 6:24 PM Send Sepsisgroups mailing list submissions to sepsisgroups@lists.sepsisgroups.orgmailto:sepsisgroups@lists.sepsisgroups.org To subscribe or unsubscribe via the World Wide Web, visit http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org or, via email, send a message with subject or body 'help' to sepsisgroups-requ...@lists.sepsisgroups.orgmailto:sepsisgroups-requ...@lists.sepsisgroups.org You can reach the person managing the list at sepsisgroups-ow...@lists.sepsisgroups.orgmailto:sepsisgroups-ow...@lists.sepsisgroups.org When replying, please edit your Subject line so it is more specific than Re: Contents of Sepsisgroups digest... Today's Topics: 1. Re: EPIC facilities and ED Sepsis (Miller, Kevin - SFMH) -- Message: 1 Date: Wed, 27 Mar 2013 13:47:30 -0700 From: Miller, Kevin - SFMH kevin.mil...@dignityhealth.orgmailto:kevin.mil...@dignityhealth.org To: Hunter, Patricia phun...@mercydesmoines.orgmailto:phun...@mercydesmoines.org, Alexander O. Sy a...@wakehealth.edumailto:a...@wakehealth.edu, that stampoutsep...@aol.commailto:stampoutsep...@aol.com, ryan.s.luginb...@osfhealthcare.orgmailto:ryan.s.luginb...@osfhealthcare.org ryan.s.luginb...@osfhealthcare.orgmailto:ryan.s.luginb...@osfhealthcare.org, Sepsisgroups@lists.sepsisgroups.orgmailto:Sepsisgroups@lists.sepsisgroups.org Sepsisgroups@lists.sepsisgroups.orgmailto:Sepsisgroups@lists.sepsisgroups.org Subject: Re: [Sepsis Groups] EPIC facilities and ED Sepsis Message-ID: 14d6990dd3b8104c82254ccd1826f9f31471ce0...@phx-msg-006-n1.chw.edumailto:14d6990dd3b8104c82254ccd1826f9f31471ce0...@phx-msg-006-n1.chw.edu Content-Type: text/plain; charset=us-ascii We currently have a Sepsis screening tool in Cerner. It does have a smart template which pulls in abnormal vital signs, and abnormal labs within the last 16 hours on the screening form. Another smart template pulls in antibiotics that are currently ordered on the patient. The tool we developed in Cerner is built on conditional logic. The first question is Signs of Infection, if the nurse documents None, then they are done with the Sepsis screening. The other options are Suspected Infection, Known infection, Failed outpatient therapy, On antibiotic therapy, if they choose any of these on the first question the SIRS box opens with all of the SIRS criteria (this is where the labs and vital signs are useful to have in the smart template). If the patient meets 2 or more SIRS criteria, the Organ Dysfunction Signs and Symptoms box lights up. If they document Signs of Organ dysfunction, when signing the form they receive a Discern Alert which instructs them to notify the physician immediately of the positive Sepsis screen. This tool has inherent problems: 1.If the nurse does not suspect infection, they will not get to the SIRS or Organ dysfunction screens 2. Some clinicians are more focused on overall presenting picture of patient, than others which can lead to different assessments between different clinicians. 3. This alert is based upon human entry and is not automated from the system to identify from data points a patient that might meet SIRS or Sepsis. [cid:image002.jpg@01CE2AF1.0D227510mailto:jpg@01CE2AF1.0D227510] Procrastination is the thief of time Kevin P. Miller, RN, BSN Manager, Risk Management Saint Francis Memorial Hospital Phone: (415) 353-6296 Fax: (415) 353-6177 Right Fax: (415) 591-6364 kevin.mil...@dignityhealth.orgmailto:kevin.mil...@dignityhealth.org [cid:image003.jpg@01CE2AF1.0D227510mailto:jpg@01CE2AF1.0D227510] Confidentiality Notice: This message and any attachments are for the sole use of the intended recipient(s) and may contain information that is legally privileged and/or confidential. This message may also contain confidential health information. If you are not the intended recipient or a person responsible for delivering this message to an intended recipient, you are hereby notified that any review, dissemination, distribution, or copying of this communication is strictly prohibited. If you are not the intended recipient or a person responsible for delivering
Re: [Sepsis Groups] use of vasopressors
Our facility continues to bolus an additional 3-5 liters if the lactate comes back ≥ 4. If after that and we have a CVP that is still 8, we would continue to bolus. Thanks. Mary Draper RN BSN CCRN Quality Manager-Best Practice Support Quality Management Supervisor Office (925) 674-2045 Cell (925) 451-8792 Fax (925) 674-2373 mary.dra...@johnmuirhealth.commailto:mary.dra...@johnmuirhealth.com [cid:image001.png@01CDC703.5F5333D0] From: sepsisgroups-boun...@lists.sepsisgroups.org [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On Behalf Of Hefton, Suzanne Sent: Monday, November 19, 2012 5:55 PM To: sepsisgroups@lists.sepsisgroups.org Subject: [Sepsis Groups] use of vasopressors New to the list serve so I apologize if this has been asked previouslyCurrently, we report Fluid Bolus of 20ml/kg, CVP for lactate 4 or inability to maintain MAP and initiation of vasopressors if MAP 65 as separate measures. Some of our ED physicians have questioned if we should wait to start pressors until we have gotten to a CVP of 8. Example: pt has a MAP of 60 and a CVP of 4 after the fluid bolus -we look for the physician to start pressors. I'm wondering what other facilities are doing? Thanks! inline: image001.png___ Sepsisgroups mailing list Sepsisgroups@lists.sepsisgroups.org http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org
Re: [Sepsis Groups] Extended Infusion Beta Lactam Antibiotics
Do you have access to these studies? Our sepsis committee has not heard about this. Thanks. Please note: Will be on PTO June 12-20, returning the 21st Mary Draper RN BSN CCRN Quality Manager-Best Practice Support Quality Management Supervisor Office (925) 674-2045 Cell (925) 451-8792 Fax (925) 674-2373 mary.dra...@johnmuirhealth.commailto:mary.dra...@johnmuirhealth.com [cid:image001.png@01CD43D3.9BF668B0] From: sepsisgroups-boun...@lists.sepsisgroups.org [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On Behalf Of Shawver, Stephanie Sent: Friday, June 01, 2012 2:55 PM To: sepsisgroups@lists.sepsisgroups.org Subject: [Sepsis Groups] Extended Infusion Beta Lactam Antibiotics Colleagues, I am curious to hear feedback on the recent studies indicating that extended or continuous infusion of certain beta-lactam antibiotics have shown better outcomes for severe sepsis and septic shock patients. Our hospital's Sepsis Committee is considering changing the antibiotic regime on our protocol to have the applicable beta-lactam antibiotics infused over an extended period of time, if not continuous. Are there any other facilities out there going this route? Stephanie Shawver BSN, RN Infection Prevention Practitioner SLMV Sepsis Coordinator St. Luke's Magic Valley 801 Pole Line Road West | Twin Falls, ID 83301 Office: (208) 814.3052 | Email: stephani...@slhs.orgmailto:stephani...@slhs.org Infection Prevention Line: (208)-814-5120 We are what we repeatedly do. Excellence then, is not an act but a habit. - Aristotle mg.slrmc.org made the following annotations - This message is intended for the use of the person or entity to which it is addressed and may contain information that is confidential or privileged, the disclosure of which is governed by applicable law. If the reader of this message is not the intended recipient, you are hereby notified that any dissemination, distribution, or copying of this information is strictly prohibited. If you have received this message by error, please notify us immediately and destroy the related message. - inline: image001.png___ Sepsisgroups mailing list Sepsisgroups@lists.sepsisgroups.org http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org
