Re: [Sepsis Groups] Sepsisgroups Digest, Vol 287, Issue 3

[Thomas Westover]

I have always been puzzled by the fact that the Leadership of the sepsis 
community places “equal weight” on MAP and SBP...

MAP is obviously partly dependent on DBP which is not necessarily measured 
accurately using automated cuff BP measurement at least according to 
traditional korotkoff DBP definitions (especially at the lower end of DBP 
values )

(obviously using an A-line for DBP would give more reliable readings but most 
ED/ward pts dont have an A-line insitu)

I personally don’t understand why/how we started down this slippery slope  and 
why sepsis leadership didn’t focus our surveillance efforts on monitoring SBP 
and tissue perfusion deficits 

given that MAP = 
(2d +s) / 3

Or

1/3 Sbp plus 2/3 dbp

Then

100/60=map 73
90/60 = map 70
90/50= map 63 90/40=57

Automated cuff DBPs are being given too much weight in my medical opinion...


Respectfully

Thomas Westover MD
Cooper Medical School
Camden NJ


Sent from my iPhone

> On Apr 25, 2018, at 6:19 PM, sepsisgroups-requ...@lists.sepsisgroups.org 
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> Today's Topics:
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>   1. Re: [External]  Vasopressor administration (Mary Draper)
> 
> 
> --
> 
> Message: 1
> Date: Fri, 20 Apr 2018 17:47:13 +
> From: Mary Draper <mary.dra...@johnmuirhealth.com>
> To: Tara Miller <tara.mil...@infirmaryhealth.org>,
>"'sepsisgroups@lists.sepsisgroups.org'"
><sepsisgroups@lists.sepsisgroups.org>
> Subject: Re: [Sepsis Groups] [External]  Vasopressor administration
> Message-ID:
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> Content-Type: text/plain; charset="us-ascii"
> 
> We use BP < 90 and/or mean < 65. It doesn't have to be both.
> 
> 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@01D3D894.F08F9F20]
> "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 Tara Miller
> Sent: Thursday, April 19, 2018 7:39 AM
> To: 'sepsisgroups@lists.sepsisgroups.org' 
> <sepsisgroups@lists.sepsisgroups.org>
> Subject: [External] [Sepsis Groups] Vasopressor administration
> 
> 
> Caution: This email originated outside JMH. Do not open attachments or click 
> on links if you do not recognize the sender.
> 
> Is anyone having issues with patients who have persistent hypotension after 
> fluids defined as SBP < 90, but they still have a MAP of > or equal to 65 and 
> no vasopressors being ordered? My facility's vasopressor orders read to 
> initiate when the MAP is < 65. We have had two patients who did not meet that 
> criteria until after the 6 hour window was up for vasopressors.
> 
> Are other facility's changing their practice to start pressors for SBP < 90?
> 
> Thanks.
> 
> Tara R Miller, RN
> Team Leader, Quality Management
> Mobile Infirmary Medical Center
> Office: 435-5109
> Cell: 605-8270
> 
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Re: [Sepsis Groups] Sepsisgroups Digest, Vol 270, Issue 1

[Thomas Westover]

I find it interesting (and somewhat misguided) that people are trying to reduce 
the frequency of "false alarm" alerts... (acknowledging that alarm fatigue is a 
real entity!!!)

The whole point of a sepsis (or any) screening tool is to have a HIGH 
sensitivity (ie NOT miss true cases) at the expense of firing off false alarms 
(ie low specificity)

You dont want to reduce alerts.. you dont want to use "predictive analytics" to 
hone down who is affected vs who is false alarm... that is NOT the goal of the 
initial screening tool

You want the screening tool to be highly sensitive (ie "never" miss a true 
sepsis case); a positive screen will then aim the focus of the clinical 
team/physicians etc to more carefully evaluate the pt for progressive sepsis. 
So its the subsequent evaluation AFTER a positive screen that hones down who is 
true positive vs who is false positive

You can easily make the screening tool more specific (ie fewer false alarms) by 
creating a screening tool that will only pick up pts that are about to die from 
sepsis (altered mental status, grossly abnl vitals, severe shock, etc) but then 
the screening tool is ineffective at its intended goal; which is to alert the 
clinical team that the pt is starting to deteriorate NOT that the pt is about 
to arrest
the surviving sepsis campaign has struggled with these concepts for years 
(trying to balance sensitivity vs specificity); It's not their fault, its the 
nature of the beast of screening tools

Respectfully
Thomas Westover MD, FACOGAsst Professor MFM and ObgynCooper Medical School, 
Rowan University Vice Chair, NJ ACOGCo-Chair, NJ Hospital Association Statewide 
Perinatal Safety CollaborativeCamden NJ

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 To: sepsisgroups@lists.sepsisgroups.org 
 Sent: Monday, November 27, 2017 12:49 PM
 Subject: Sepsisgroups Digest, Vol 270, Issue 1
   
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Today's Topics:

  1. Re: [**External**] Re: Sepsis Best Practice Alerts
      (Barnes-Daly, Mary Ann, MS, RN, CCRN, DC)


--

Message: 1
Date: Fri, 17 Nov 2017 16:10:42 +
From: "Barnes-Daly, Mary Ann, MS, RN, CCRN, DC"
    <barne...@sutterhealth.org>
To: "Orth, Claudia" <cor...@mhc.net>, jenny clarke <j...@live.com>,
    "Tara Miller" <tara.mil...@infirmaryhealth.org>
Cc: "sepsisgroups@lists.sepsisgroups.org"
    <sepsisgroups@lists.sepsisgroups.org>
Subject: Re: [Sepsis Groups] [**External**] Re: Sepsis Best Practice
    Alerts
Message-ID:
    
<dm5pr11mb1372a81ff4e069ce10b616e1f3...@dm5pr11mb1372.namprd11.prod.outlook.com>
    
Content-Type: text/plain; charset="utf-8"

At Sutter Health we have several:
First is ?possible sepsis? for Infection (active culture, problem list) plus 
available SIRS
Second is ?possible severe sepsis? ? same as above plus available organ 
dysfunction (excludes BUN/Cr for example for ESRD)
Third is ?possible septic shock?  - above with Lactate > 4

1 and 2 fire only for RNs 3 fires for RN, and providers

We are moving toward predictive analytics(PA) ? and may or may not continue 
with BPAs ? or just go to PA alerts where the recipient doesn?t need to be in 
the chart to be notified, as with a BPA

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| barne...@sutterhealth.org<mailto:barne...@sutterhealth.org>

?Do the best you can until you know better. Then when you know better, do 
better? Maya Angelou
[https://newsplus.sutterhealth.org/peninsula-coastal/files/2017/04/SH_Pride_Plus400-002-177x177.gif]

From: Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On 
Behalf Of Orth, Claudia
Sent: Wednesday, November 15, 2017 12:50 PM
To: jenny clarke <j...@live.com>; Tara Miller <tara.mil...@infirmaryhealth.org>
Cc: sepsisgroups@lists.sepsisgroups.org
Subject: [**External**] Re: [Sepsis Groups] Sepsis Best Practice Alerts


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