I would think that one of the criteria for lower level care for those patients would be the ability to get q 2 hours vital signs for at least 24 hours, and do serial lactates q 6 hours for 24 hours as well. If staffing or new technology in a step-down or telemetry would support this, then deterioration would be able to be picked up more quickly and it should be safe to admit the patient there, rather than ICU.
Martie Martie Mattson, RN, MSN, CNS, CCRN(a) Critical Care Consultant and Educator <mailto:[email protected]> [email protected] (415) 412-2364 From: [email protected] [mailto:[email protected]] On Behalf Of Mary Draper Sent: Friday, September 27, 2013 7:32 AM To: Jamie Roney Cc: [email protected] Subject: Re: [Sepsis Groups] Where Does Severe Sepsis Belong? If they are hemodynamically stable and have responded to fluids, they could go to a telemetry unit but those nurses have 4-5 patients and subtle changes leading to instability can get missed. Mary Draper RN BSN CCRN Quality Manager-Best Practice Support Quality Management Supervisor Office (925) 674-2045 <tel:(925)%20674-2045> Cell (925) 451-8792 <tel:(925)%20451-8792> Fax (925) 674-2373 <tel:(925)%20674-2373> <mailto:[email protected]> [email protected] On Sep 27, 2013, at 7:05 AM, "Jamie Roney" <[email protected] <mailto:[email protected]> > wrote: Dr. Townsend, Is there a sepsis specific risk/treatment stratification tool available to assist in answering your question of placement in a possible lower level of care? Or is there a tool to assist with septic patients who can be discharged home versus admitted due to probable deterioration into severe sepsis? Thank you, Jamie Jamie Roney, BSN, RN-BC, BSHCM, CCRN COVENANT HEALTH SEPSIS COORDINATOR "Be a yardstick of quality. Some people aren't used to an environment where excellence is expected." ~Steve Jobs 3615 19th Street, Lubbock, TX 79410 T: (806) 725-4689 C: (806) 773-1914 www.covenanthealth.org <http://www.covenanthealth.org> ...................................................................................... -----Original Message----- From: [email protected] <mailto:[email protected]> [mailto:[email protected]] On Behalf Of Townsend, Sean, M.D. Sent: Friday, March 15, 2013 1:32 AM To: '[email protected] <mailto:[email protected]> ' Subject: [Sepsis Groups] Where Does Severe Sepsis Belong? It's been a long time since I've had to ask this question. I used to think I knew the answer. Here it is: do all patients who meet severe sepsis criteria need to be admitted to the ICU ? Examples: 1. Pneumonia, fever, tachycardia, INR 1.5. 2. Cellulitis, leukocytosis, fever, creatinine 2.0. 3. UTI, leukocytosis, fever, lactate 3.0. Where do people put these patients in reality? What mind of monitoring do they deserve? By prevailing bundles, each gets lactate checked, blood cultures, broad spectrum antibiotics. That's it. Good enough? Good enough for the floor? Need the ICU? Why? Sean Sean R. Townsend, M.D. Vice President of Quality & Safety California Pacific Medical Center 2330 Clay Street, #301 San Francisco, CA 94115 email [email protected] <mailto:[email protected]> office (415) 600-5770 fax (415) 600-1541 _______________________________________________ Sepsisgroups mailing list [email protected] <mailto:[email protected]> http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org Notice from St. Joseph Health System: Please note that the information contained in this message may be privileged and confidential and protected from disclosure. _______________________________________________ Sepsisgroups mailing list [email protected] <mailto:[email protected]> http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org
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