Have any institutions begun earlier protocols w use of ems poc lactate testing or the like? We're looking at it in western Ma and would be interested to know if there was a precedent out there. Thanks...
Richard Levrault DO Medical director ICU Cooley Dickinson Hospital Sent from Rich's iPhone On Feb 18, 2013, at 6:00 AM, "Jones Jacqui \(RTR\) South Tees NHS Trust" <[email protected]> wrote: > > > Hi Fang > > > I will try to answer your question, by telling you a little about what I do > and I will also enter the time zero debate all in the one email! > > At present one of my roles as sepsis nurse is to collect data for audit > purposes. Each month I get a list of patients coded A419 sepsis. I then > retrospectively determine time zero. Then I review their notes until I find > 20 patients from the list with severe sepsis. This is very labour intensive, > but at present, I cannot find an easier way of identifying these patients. > > > I also review patients admitted with pneumonia as diagnosis, yearly for 3 > months April to June. I review each set of notes with pneumonia admission > diagnosis over the 3 month period to see if the patient has triggered for > severe sepsis. This again is very time consuming. > > Once I have the data of those patients triggering for severe sepsis from > those 20 sets coded as A419 sepsis and for the pneumonia admission diagnosis, > I examine the time to each element of the sepsis six, against patient outcome. > > > As my main role as sepsis nurse is education we are interested to find out if > education, screening tools and awareness of sepsis early diagnosis and > management are improving in our organisation. > > For my masters dissertation I am also examining factors which influence time > delays into antibiotic administration. > > > Regarding time zero, I have interestingly read the debates on the sepsis > groups over time zero. > > Here is how I determine time zero, which I believe most of the people in the > UK follow (correct me if I am wrong) > Time zero is the first point at which the patient fulfils the criteria for > severe sepsis: SIRS + Infection + Organ dysfunction. > This first point may be at triage in A & E or it may be on admission to the > Acute Admission Units, however it may also occur anywhere at anytime within > any area of the hospital. > > My general rules and which I pass onto our clinical staff is that: > SIRS: for various reasons there may not be 2 SIRS criteria met, but do not > wait for 2 SIRS criteria if a patient has/may have an infection and for e.g. > a lactate of 8 TREAT NOW! The screening tool is a guide to help identify > sepsis, not to replace clinical judgement. > Infection is not dependant on a doctor’s examination of the patient or > imaging, lab results, etc; we must treat patients as soon as we suspect > infection. If staff are sending a sample, suspected infection is part of the > differential diagnosis. > Organ dysfunction: once a patient has sepsis you must actively screen for > severe sepsis to find it, you cannot rule out severe sepsis until you have > completed all tests. By not doing a lactate is not assurance that a patient > does not have severe sepsis, remember cryptic shock. Severe Sepsis diagnosis > implies most of the times initiation of the sepsis six as soon as you know > the diagnosis of sepsis because the sepsis six involves ruling out severe > sepsis. For audit purposes we audit sepsis six timing against severe sepsis > cases. > > We also use time of the investigation performed (time of blood taken from > patient) for the purpose of time zero diagnosis; there could be delayed > diagnosis of severe sepsis if you use time of awareness of results of blood > test. We are assuming that blood test in particular are done as soon as > possible from admission or, if in patient, as soon as suspected sepsis. > > > My role as sepsis specialist nurse was funded to educate and promote the > survive sepsis campaign. I have been in this role for almost 3 years. I now > carry a pager and encourage areas to inform me when they have a patient with > sepsis, and then I will deploy education at the bedside. I will audit these > patients, prospectively and this will equate to approximately 50% of the > audit. Ultimately, this prospective auditing does have an effect on the data > as I will ensure the sepsis six is complete and within one hour as time > allows. > > I have concentrated on the sepsis six predominantly, and not moved onto > auditing further bundles because I believe we need to get the basics right > first. Again, I have stressed here about cases of severe sepsis, I do not > audit time to sepsis six from all cases of sepsis, simply because there would > be too many and in cases of uncomplicated sepsis many go home. We do not > discourage the sepsis six in sepsis. > > I now have data from about 900 sepsis cases and dramatic improvements have > been made, but there is still so much work to be done and raising awareness > is the forefront of my daily work. So although it is not research as such, I > am well accustomed with data collection, I am GCP trained and have worked on > the SPOT(light) and ProMISe study among others. I am very willing to > collaborate and I have the support of my medical colleagues to use our trust > as an extra site for your research. > > > > 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. > > > > -----Original Message----- > From: Fang Gao Smith [mailto:[email protected]] > Sent: 04 February 2013 16:37 > To: Jones Jacqui (RTR) South Tees NHS Trust > Cc: Melody Teresa > Subject: Re: [Sepsis Groups] Time Zero > > Thank you and what is your research question for this? Fang > > On 01/02/2013 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] > >ups.org>" > ><[email protected]<mailto:[email protected] > >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.org
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