Re: [Sepsis Groups] Respiratory rate for SIRS on ventilator
Was the vent set on 22 respirations? Or did the physician/nursing just document "therapeutic" for the patient. If the vent was not set on 22 then you could still use the 22 respiratory rate as SIRS. Tara -Original Message- From: Sepsisgroups On Behalf Of Jeanie Bollinger Sent: Friday, September 28, 2018 11:11 AM To: sepsisgroups@lists.sepsisgroups.org Subject: [Sepsis Groups] Respiratory rate for SIRS on ventilator Ventilator is considered as an organ dysfunction by CMS. However, the SIRS criteria to meet the definition occurred one day after intubation and ventilation. RR was 22 on ventilator and was therapeutic for this patient. Is there any consideration for excluding SIRS RR criteria for ventilated patients? This set time zero for CMS 24hours after sepsis was identified and appropriate bundle treatment was initiated. We missed the measure. Thoughts? 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 -Original Message- From: Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On Behalf Of sepsisgroups-requ...@lists.sepsisgroups.org Sent: Tuesday, September 25, 2018 2:24 PM To: sepsisgroups@lists.sepsisgroups.org Subject: [EXTERNAL] Sepsisgroups Digest, Vol 306, 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: Sepsisgroups Digest, Vol 304, Issue 2 (Tara Platt) 2. Re: Sepsisgroups Digest, Vol 304, Issue 2 (Tara Platt) -- Message: 1 Date: Fri, 21 Sep 2018 11:48:01 + From: Tara Platt To: "Belfi, Karen" , "Carlson, Brenda L" , "'sepsisgroups@lists.sepsisgroups.org'" Subject: Re: [Sepsis Groups] Sepsisgroups Digest, Vol 304, Issue 2 Message-ID: <5ae7d0b491654e21847644139ecc3...@mylrh.org> Content-Type: text/plain; charset="us-ascii" The inclusion guidelines for abstraction lists "does not want" as acceptable. Had the provider not included the patients response than I would agree that this would be an outlier. Per provider documentation the patient does not want the 30ml/kg. Tara Platt, RN MSN Strategic Performance and Quality 863-687-1100 ext. 2560 tara.pl...@mylrh.org + myLRH.org + facebook.com/LakelandRegionalHealth Together, our Promise is YOUR HEALTH. -Original Message- From: Belfi, Karen [mailto:bel...@mlhs.org] Sent: Friday, September 21, 2018 6:42 AM To: Tara Platt ; Carlson, Brenda L ; 'sepsisgroups@lists.sepsisgroups.org' Subject: RE: Sepsisgroups Digest, Vol 304, Issue 2 I wouldn't consider this an administrative contra based on the documentation, as they did not refuse anything. Karen Belfi, RN, MSN Quality Outcomes Coordinator Lankenau Medical Center (484)476-8092 -Original Message- From: Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On Behalf Of Tara Platt Sent: Monday, September 17, 2018 2:17 PM To: Carlson, Brenda L; 'sepsisgroups@lists.sepsisgroups.org' Subject: [EXTERNAL] Re: [Sepsis Groups] Sepsisgroups Digest, Vol 304, Issue 2 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 ** Would this not be considered an administrative contraindication to care due to the patient and daughter agreeing to gentle hydration and not a 30ml/kg bolus? Tara Platt, RN MSN Strategic Performance and Quality 863-687-1100 ext. 2560 tara.pl...@mylrh.org + myLRH.org + facebook.com/LakelandRegionalHealth Together, our Promise is YOUR HEALTH. -Original Message- From: Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On Behalf Of Carlson, Brenda L Sent: Thursday, September 13, 2018 10:39 AM To: 'sepsisgroups@lists.sepsisgroups.org' Subject: Re: [Sepsis Groups] Sepsisgroups Digest, Vol 304, Issue 2 Perhaps CMS would have accepted this as an appropriate exclusion if the provider had included wording such as "CHF with pulmonary edema and concerns for fluid overload" or "ESRD on HD with anasarca and concerns for fluid
Re: [Sepsis Groups] Respiratory rate for SIRS on ventilator
If the ventilator was set at 22 and is charted as such, you do not count the RR as part of the SIRS component. Here's the example from the definition: "SIRS criteria or a sign of organ dysfunction due to artificial interventions should not be used. Example: Mechanical ventilator rate set at 24 and respiratory rate is 24, the respiratory rate would not be used for SIRS criteria. " Beth Beth Knight, BSN, RN, OCN Clinical Outcomes Specialist Healthcare Quality Franciscan Health Indianapolis, Carmel, Mooresville Phone: 317-528-1470 elizabeth.kni...@franciscanalliance.org -Original Message- From: Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On Behalf Of Jeanie Bollinger Sent: Friday, September 28, 2018 12:11 PM To: sepsisgroups@lists.sepsisgroups.org Subject: [Sepsis Groups] Respiratory rate for SIRS on ventilator WARNING: This email is from an EXTERNAL source. Exercise caution. * Do not click on any links or attachments unless you are certain that they are safe and are required for business. * If you believe this is a suspicious email click the Phish Alert button in the toolbar to have it removed, or if you are on a mobile device just delete the email. Ventilator is considered as an organ dysfunction by CMS. However, the SIRS criteria to meet the definition occurred one day after intubation and ventilation. RR was 22 on ventilator and was therapeutic for this patient. Is there any consideration for excluding SIRS RR criteria for ventilated patients? This set time zero for CMS 24hours after sepsis was identified and appropriate bundle treatment was initiated. We missed the measure. Thoughts? 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 -Original Message- From: Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On Behalf Of sepsisgroups-requ...@lists.sepsisgroups.org Sent: Tuesday, September 25, 2018 2:24 PM To: sepsisgroups@lists.sepsisgroups.org Subject: [EXTERNAL] Sepsisgroups Digest, Vol 306, 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: Sepsisgroups Digest, Vol 304, Issue 2 (Tara Platt) 2. Re: Sepsisgroups Digest, Vol 304, Issue 2 (Tara Platt) -- Message: 1 Date: Fri, 21 Sep 2018 11:48:01 + From: Tara Platt To: "Belfi, Karen" , "Carlson, Brenda L" , "'sepsisgroups@lists.sepsisgroups.org'" Subject: Re: [Sepsis Groups] Sepsisgroups Digest, Vol 304, Issue 2 Message-ID: <5ae7d0b491654e21847644139ecc3...@mylrh.org> Content-Type: text/plain; charset="us-ascii" The inclusion guidelines for abstraction lists "does not want" as acceptable. Had the provider not included the patients response than I would agree that this would be an outlier. Per provider documentation the patient does not want the 30ml/kg. Tara Platt, RN MSN Strategic Performance and Quality 863-687-1100 ext. 2560 tara.pl...@mylrh.org + myLRH.org + facebook.com/LakelandRegionalHealth Together, our Promise is YOUR HEALTH. -Original Message- From: Belfi, Karen [mailto:bel...@mlhs.org] Sent: Friday, September 21, 2018 6:42 AM To: Tara Platt ; Carlson, Brenda L ; 'sepsisgroups@lists.sepsisgroups.org' Subject: RE: Sepsisgroups Digest, Vol 304, Issue 2 I wouldn't consider this an administrative contra based on the documentation, as they did not refuse anything. Karen Belfi, RN, MSN Quality Outcomes Coordinator Lankenau Medical Center (484)476-8092 -Original Message- From: Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On Behalf Of Tara Platt Sent: Monday, September 17, 2018 2:17 PM To: Carlson, Brenda L; 'sepsisgroups@lists.sepsisgroups.org' Subject: [EXTERNAL] Re: [Sepsis Groups] Sepsisgroups Digest, Vol 304, Issue 2 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 ** Would this not be considered an administrative contraindication to care due to
Re: [Sepsis Groups] Respiratory rate for SIRS on ventilator
Are you using the vent for organ dysfunction? If so it would be out of the window because it was initiated the prior day. I had asked CMS and you only use initiation of ventilator for organ dysfunction. Also, if the vent was set for 22, then you wouldn't use it. If the patient was breathing over the vent then you do use it. Karen Belfi, RN, MSN Quality Outcomes Coordinator Lankenau Medical Center (484)476-8092 -Original Message- From: Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On Behalf Of Jeanie Bollinger Sent: Friday, September 28, 2018 12:11 PM To: sepsisgroups@lists.sepsisgroups.org Subject: [EXTERNAL] [Sepsis Groups] Respiratory rate for SIRS on ventilator 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 ** Ventilator is considered as an organ dysfunction by CMS. However, the SIRS criteria to meet the definition occurred one day after intubation and ventilation. RR was 22 on ventilator and was therapeutic for this patient. Is there any consideration for excluding SIRS RR criteria for ventilated patients? This set time zero for CMS 24hours after sepsis was identified and appropriate bundle treatment was initiated. We missed the measure. Thoughts? 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 -Original Message- From: Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On Behalf Of sepsisgroups-requ...@lists.sepsisgroups.org Sent: Tuesday, September 25, 2018 2:24 PM To: sepsisgroups@lists.sepsisgroups.org Subject: [EXTERNAL] Sepsisgroups Digest, Vol 306, Issue 2 Send Sepsisgroups mailing list submissions to sepsisgroups@lists.sepsisgroups.org To subscribe or unsubscribe via the World Wide Web, visit https://urldefense.proofpoint.com/v2/url?u=http-3A__lists.sepsisgroups.org_listinfo.cgi_sepsisgroups-2Dsepsisgroups.org=DwICAg=qqcbk_QeabW4Z7GBhIMNtn_B7aQjktEuWNmUvrzri9o=9XT3K_nIvIIF-7Bh2TiB0g=K33XSRCC76vlmkeh4YJXsLuW-UFj_eDODPpyyffFly0=0d00YtPuDAoxqT5sfsPdWXWcpS5b0ygve5sO4gSMMCE= 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 304, Issue 2 (Tara Platt) 2. Re: Sepsisgroups Digest, Vol 304, Issue 2 (Tara Platt) -- Message: 1 Date: Fri, 21 Sep 2018 11:48:01 + From: Tara Platt To: "Belfi, Karen" , "Carlson, Brenda L" , "'sepsisgroups@lists.sepsisgroups.org'" Subject: Re: [Sepsis Groups] Sepsisgroups Digest, Vol 304, Issue 2 Message-ID: <5ae7d0b491654e21847644139ecc3...@mylrh.org> Content-Type: text/plain; charset="us-ascii" The inclusion guidelines for abstraction lists "does not want" as acceptable. Had the provider not included the patients response than I would agree that this would be an outlier. Per provider documentation the patient does not want the 30ml/kg. Tara Platt, RN MSN Strategic Performance and Quality 863-687-1100 ext. 2560 tara.pl...@mylrh.org + myLRH.org + facebook.com/LakelandRegionalHealth Together, our Promise is YOUR HEALTH. -Original Message- From: Belfi, Karen [mailto:bel...@mlhs.org] Sent: Friday, September 21, 2018 6:42 AM To: Tara Platt ; Carlson, Brenda L ; 'sepsisgroups@lists.sepsisgroups.org' Subject: RE: Sepsisgroups Digest, Vol 304, Issue 2 I wouldn't consider this an administrative contra based on the documentation, as they did not refuse anything. Karen Belfi, RN, MSN Quality Outcomes Coordinator Lankenau Medical Center (484)476-8092 -Original Message- From: Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On Behalf Of Tara Platt Sent: Monday, September 17, 2018 2:17 PM To: Carlson, Brenda L; 'sepsisgroups@lists.sepsisgroups.org' Subject: [EXTERNAL] Re: [Sepsis Groups] Sepsisgroups Digest, Vol 304, Issue 2 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
