First we defined what constituted a positive finding. After much debate, we agreed upon SIRS+ with a suspected infection, regardless of definitive lab findings (lactate, +C/S). We track our patients breaking them down into 3 lactate categories: 1. less than or equal to 1.0 2. between 1.0 to less than 4.0 3. 4.0
We use 3 different ways to obtain time zero, depending on where the patient is located: 1. When patient is treated in ED, time zero is determined when the patient hits triage which is the first recorded time. 2. When a patient is officially admitted to I/P status, the nurse performs a SIRS assessment every 4 hours. If the first time the patient is assessed to be SIRS+ w/suspected infection is upon admission, then we use the admission time as time zero. So if the nurse doesn't assess the patient upon discharge, and they are positive, we will be that far behind on meeting the elements of the bundles. 3. When a patient is already admitted and they convert to SIRS+ w/suspected infection, then that assessment time is considered time zero. Part of what drove our decision for these 3 different times was our EHR's recording of times and our ability to mine that data. We also had to match that with what makes the most sense. We are able to monitor our inpatients in real time (updated every 15mins) this way. Our discharged patients are broken down in the same manner but we have coded data to identify the patients w/sepsis w/and w/o shock. We are able to identify patients who never ruled in but were coded as septic so we can go back and figure out where we went wrong. Peggy Rice, RN, BSN, MBA Assistant Chief Nursing Officer Good Samaritan Hospital 2425 Samaritan Drive San Jose, CA 95124 (408) 559-2329 (office) (408) 438-0986 (cell) (408) 559-2620 (fax) [email protected] -----Original Message----- From: [email protected] [mailto:[email protected]] On Behalf Of Ron Daniels Sent: Friday, February 01, 2013 2:08 PM To: Jones Jacqui (RTR) South Tees NHS Trust Cc: Gonzalez Isabel (SOUTH TEES HOSPITALS NHS FOUNDATION TRUST); Fang Gao Smith; <[email protected]> Subject: Re: [Sepsis Groups] Time Zero Fang, this sounds like an opportunity for a global sampling of volunteer organizations. Ron Dr Ron Daniels Chair: UK Sepsis Trust CEO: Global Sepsis Alliance Sent on the move from my iPhone, excuse brevity! On 1 Feb 2013, at 13:40, "Jones Jacqui (RTR) South Tees NHS Trust" <[email protected]> wrote: > Hi Dr Fang Gao > > I would be very interested in participating in your next prospective > cohort study on behalf of South Tees NHS Trust. I currently collect > data on around 35 of our patients with severe sepsis each month. I > look at the time to each element of the sepsis six from time zero > alongside factors which influence the standards of care delivery. > > > > Regards > > Jacqui > > Jacqui Jones > Sepsis Specialist Nurse > South Tees Hospitals NHS Foundation Trust > 01642 850850 ext 56969 bleep 1008 > email [email protected] > > Suspect Sepsis: save someone's life today. > > > Sign our e-petition at http://epetitions.direct.gov.uk/petitions/19602 > > > > > -----Original Message----- > From: [email protected] > [mailto:[email protected]] On Behalf Of Fang > Gao Smith > Sent: 31 January 2013 21:01 > To: Jessica Harkey; [email protected] > Cc: Melody Teresa > Subject: Re: [Sepsis Groups] Time Zero > > Dear Jessica > We did a prospective cohort study on determining 'time zero' of severe > sepsis amongst critical care team 3-4 years ago with very interesting > results. Teresa, our dept manage should be able to feed you with more > information. Your suggestion has prompted us to consider to repeat > this study after 3-4 years sepsis education. Would you be interested > to participate? > > Best wishes > Fang > > > Fang Gao > Professor in Anaesthesia, Critical Care and Pain Perioperative, > Critical Care and Trauma Trials Group School of Clinical and > Experimental Medicine University of Birmingham > > Academic Department of Anaesthesia, Critical Care, Pain and > Resuscitation MIDRU Building Birmingham Heartlands Hospital Heart of > England NHS Foundation Trust > > > [email protected]; > [email protected]<mailto:[email protected]>; > 07711823212 > > Patricia Mponela: 0121 3713243; > [email protected]<mailto:[email protected]> > > Dawn Hill: 0121 424 2966; > [email protected]<mailto:[email protected] > > > > > > From: Jessica Harkey <[email protected]<mailto:[email protected]>> > Date: Thu, 31 Jan 2013 17:10:03 +0000 > To: > "[email protected]<mailto:[email protected] > ro > ups.org>" > <[email protected]<mailto:[email protected] > ro > ups.org>> > Subject: [Sepsis Groups] Time Zero > > Hello, all- > We had some very good discussion at our last team meeting about > defining "time zero" for the bundle. Currently for the ED we use triage time. > Would anyone be willing to share what you use as time zero to begin > implementation of the bundle? > Thank you, > > > Jessica Harkey, RN, BSN, CCRN > Sepsis Program Coordinator > San Joaquin Community Hospital > 2615 Chester Avenue > Bakersfield, CA 93303 > 661-869-6874 > [email protected]<mailto:[email protected]> > > [cid:MBFOHERTDJDT.IMAGE_5.BMP] > _______________________________________________ > Sepsisgroups mailing list > [email protected] > http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.o > rg _______________________________________________ Sepsisgroups mailing list [email protected] http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org _______________________________________________ Sepsisgroups mailing list [email protected] http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org
