I think for the issue that Rick is having with the resistance to administering Antibiotics without a source is similar to the education we utilize with Stroke processes (i.e. if a patient comes in altered regardless if you are sure it's stroke or not you still want all the same orders STAT). We are really limited for the most part in what antibiotics we have and for sepsis we are treating with at least one broad spectrum. The whole point is that we don't always find a source, regardless if you think is pneumonia or UTI its still levaquin, rocephin or zosyn and if you suspect GI zosyn and flagyl. You really aren't going to change much even if you have a source and in the mean time the patient deteriorates while they wait. They wouldn't allow a patient to code when they see an opportunity to stop it for the simple reason once they code mortality is 95% (last study I saw). Every hour a patient goes without the antibiotic the mortality rate increased by 7%. Hope that is helpful. By the way how is everyone handling H1N1 SEPTIC SHOCK BATTLE? Thanks, Leslie Mitchell,RN Concurrent Care Intervention Nurse Education/Quality Departments Sutter Solano Medical Center 300 Hospital Drive Vallejo, CA 94590 office: 707-554-5026 cell: 573-825-7656
-----Original Message----- From: [email protected] [mailto:[email protected]] On Behalf Of [email protected] Sent: Sunday, January 12, 2014 12:07 PM To: [email protected] Subject: Sepsisgroups Digest, Vol 91, Issue 5 Send Sepsisgroups mailing list submissions to [email protected] 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 [email protected] You can reach the person managing the list at [email protected] 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 91, Issue 1 (Brochis, Dale.) ---------------------------------------------------------------------- Message: 1 Date: Fri, 10 Jan 2014 18:37:52 -0500 From: "Brochis, Dale." <[email protected]> To: "Wendy A. Nieman" <[email protected]>, "Robyn Haddock Crosswhite" <[email protected]>, <[email protected]> Subject: Re: [Sepsis Groups] Sepsisgroups Digest, Vol 91, Issue 1 Message-ID: <[email protected]> Content-Type: text/plain; charset="iso-8859-1" I agree with you Wendy. Patients admitted to hospice units are not inpatients. Inpatients with status changed to hospice are still inpatients - and are included in mortality. It's a fine line of differentiation, but an inpatient is an inpatient. ? Dale Brochis BA Gainsharing Project Coordinator Case Management Department Robert Wood Johnson University Hospital?at Rahway 865 Stone Street Rahway, NJ 07065 732-499-6217 Office / 732-428-2108 Cell [email protected] -----Original Message----- From: [email protected] [mailto:[email protected]] On Behalf Of Wendy A. Nieman Sent: Friday, January 10, 2014 8:47 AM To: Robyn Haddock Crosswhite; [email protected] Subject: Re: [Sepsis Groups] Sepsisgroups Digest, Vol 91, Issue 1 Hello everyone If the patient dies while an inpatient they would be included in our mortality rate, regardless of Hospice status. Wendy Nieman RN ICU and Medical Quality Coordinator St. Joeseph Mercy Hospital Ann Arbor Michigan 48104 ________________________________________ From: [email protected] [[email protected]] on behalf of Robyn Haddock Crosswhite [[email protected]] Sent: Wednesday, January 08, 2014 12:03 PM To: [email protected] Subject: Re: [Sepsis Groups] Sepsisgroups Digest, Vol 91, Issue 1 Our hospital includes hospice discharges regarding sepsis patients in our mortality rates, I just wanted to know if other hospitals are doing this as well? Thanks -----Original Message----- From: [email protected] [mailto:[email protected]] On Behalf Of [email protected] Sent: Monday, January 06, 2014 2:07 PM To: [email protected] Subject: Sepsisgroups Digest, Vol 91, Issue 1 Send Sepsisgroups mailing list submissions to [email protected] 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 [email protected] You can reach the person managing the list at [email protected] When replying, please edit your Subject line so it is more specific than "Re: Contents of Sepsisgroups digest..." Today's Topics: 1. Re: Mortality (Angela Craig) 2. Re: First Dose Antibiotics (Rick Rutherford) ---------------------------------------------------------------------- Message: 1 Date: Fri, 3 Jan 2014 13:31:38 -0600 From: Angela Craig <[email protected]> To: "'Michelle Corder'" <[email protected]>, "Philip S. Barie" <[email protected]>, Hesham Hassaballa <[email protected]>, "<[email protected]>" <[email protected]> Subject: Re: [Sepsis Groups] Mortality Message-ID: <343E31412FC9094487B54371286ADDA003D404B937@D109EXCHMB.crmchealth.hospital> Content-Type: text/plain; charset="windows-1252" I think of it as "All Cause Mortality" so, no matter where they are when they expire it counts Angela Craig APN,MS,CCNS Clinical Nurse Specialist Intensive Care Unit Cookeville Regional Medical Center 931-783-5035 ________________________________ From: [email protected] [mailto:[email protected]] On Behalf Of Michelle Corder Sent: Thursday, January 02, 2014 9:36 AM To: Philip S. Barie; Hesham Hassaballa; <[email protected]> Subject: Re: [Sepsis Groups] Mortality I have a question for the establishing mortality rate: Do you include a patient that is transfered out of the ICU but later expires on the floor in the mortality rate? or Do you only count the patients that expire while in the ICU? Michelle Corder PIH Health ________________________________ From: [email protected] [[email protected]] On Behalf Of Philip S. Barie [[email protected]] Sent: Friday, December 27, 2013 10:39 AM To: Hesham Hassaballa; <[email protected]> Subject: Re: [Sepsis Groups] Mortality Yes, unless you can prove it to be completely unrelated. Which, it seems as though you cannot. ________________________________ From: [email protected] [[email protected]] on behalf of Hesham Hassaballa [[email protected]] Sent: Tuesday, December 24, 2013 4:28 PM To: <[email protected]> Subject: [Sepsis Groups] Mortality I have a question: A patient was admitted with septic shock, and we successfully treated him and he survived to ICU discharge. Approximately 17 days later, he codes and dies on the floor (unknown reason why) the day before he was slated to be discharged from the hospital. Does this really count against our sepsis mortality? Hesham A. Hassaballa, MD Program Medical Director Critical Care Rush-Copley Medical Center Assistant Professor of Medicine Rush University Medical Center Phone: (331) 454-6572 ### CONFIDENTIALITY NOTICE ### This message and any included attachments are from Cogent HMG and are intended only for the addressee. The contents in this message contain confidential information belonging to the sender that is legally protected. Unauthorized forwarding, printing, copying, distribution, or use of such information is strictly prohibited and may be unlawful. If you are not the addressee, please promptly delete this message and notify the sender of the delivery error by e-mail or contact the Cogent HMG Privacy Officer at [email protected]<mailto:[email protected]>. ### CONFIDENTIALITY NOTICE ### This message and any included attachments are from Cogent HMG and are intended only for the addressee. The contents in this message contain confidential information belonging to the sender that is legally protected. 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URL: <http://lists.sepsisgroups.org/pipermail/sepsisgroups-sepsisgroups.org/attachments/20140103/76983d4f/attachment.html> ------------------------------ Message: 2 Date: Sat, 4 Jan 2014 07:25:40 -0800 From: Rick Rutherford <[email protected]> To: Sepsis List Serve <[email protected]> Subject: Re: [Sepsis Groups] First Dose Antibiotics Message-ID: <[email protected]> Content-Type: text/plain; charset="iso-8859-1" Hello All, We are seeing resistance to giving antibiotics early in patients who meet criteria for severe sepsis but do not have a source. The argument often goes like this: "The patient is not critically ill and I do not have a source. Antibiotics will cloud an unclear picture further and have side effects such as liver and renal failure and breed resistance. I am going to hold off on antibiotics unless a source becomes apparent." Often, but not always, these patients will get their positive urine or blood culture 2-3 days later and we will have been out of compliance and put the patient at risk. Antibiotics noncompliance in nonshock septic patients is our most common miss in the bundles. I would appreciate help in formulating counterarguments to these concerns. Especially useful would be articles demonstrating the safety of single doses of antibiotics and the consequences of incorrect antibiotics in sepsis and severe sepsis (Not Septic Shock which Dr. Kumar and others have addressed nicely). Thanks, RIck RutherfordSepsis Task Force ChairVentura County Medical Center -------------- next part -------------- An HTML attachment was scrubbed... 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