We determine from both subjective signs (breathing patterns, changes in LOC, 
UOP-which are totally dependent on documentation), as well as lab values and 
VS. For example, if a patient has a morning CMP drawn and the bili and/or creat 
has a new value >2 and there is not any history of liver or renal disease, then 
this is organ dysfunction. Same for the BP, Respiratory needs, etc. If you 
waited until WBC/lactic acid, other specific labs, more specific to sepsis are 
resulted, this might be a delay in recognition.


Sara Valentine, BSN, RN, CNRN
Clinical Sepsis Coordinator
Medical Center Hospital
ph: 432.640.2198

From: [email protected] 
[mailto:[email protected]] On Behalf Of Sullivan, 
Cynthia
Sent: Monday, June 17, 2013 5:51 PM
To: 'Rohrbach, Dawn'; [email protected]
Cc: Estill, Pamela
Subject: Re: [Sepsis Groups] How do you determine the time zero for " not 
present on arrival patients"

I would be interested in member response as well.  We recently had this happen, 
so do you go by the WBC?  The webinars discourage this though because they want 
the early recognition.

Cynthia Sullivan RN, VA-BC, CCRN, MSN
PICC Team Coordinator
 (607) 274-4466

From: 
[email protected]<mailto:[email protected]>
 [mailto:[email protected]] On Behalf Of Rohrbach, 
Dawn
Sent: Tuesday, June 11, 2013 4:08 PM
To: 
[email protected]<mailto:[email protected]>
Cc: Estill, Pamela
Subject: [Sepsis Groups] How do you determine the time zero for " not present 
on arrival patients"

Can anyone tell us what you use to determine the time zero for your not present 
on arrival severe sepsis patients?

Dawn Rohrbach RN/ CCRN
Assistant Clinical Manager ICU/ STAT RNS
Saint Patrick Hospital
500 West Broadway
Missoula , MT. 59802
[email protected]<mailto:[email protected]>
406 329-2814
" The single most problem with communication is the illusion that it has taken 
place"



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