This is impressive that you are doing all of this in the field. There is a "negative time" provision of 180 minutes for abx and blood cultures so if you document those as having happened you will get credit. I'm not sure anyone conceived of lactic acid in the field, so there's no similar provision. I would simply time and date the collection (and state the result since that matters) as arrival time in an LIP's note. As to fluids, it's going to be 30 ml/kg from arrival on top of whatever they got in the field.
Sean R. Townsend, MD Vice President of Quality & Safety California Pacific Medical Center 2330 Clay Street #301 San Francisco, CA 94115 [email protected]<mailto:[email protected]> 415-600-5770 office 415-600-1541 fax On Apr 10, 2015, at 6:08 AM, Sue Beswick <[email protected]<mailto:[email protected]>> wrote: I agree - we are drawing cultures, starting fluids, drawing LA, and giving abx in the field and wondering how this will impact. Sue Sue Beswick APRN, MS, CCNS, CCRN CNS Critical Care Greenville Health System 701 Grove Road l Greenville, SC 29605 Office: 864-455-4884 -----Original Message----- From: Sepsisgroups [mailto:[email protected]] On Behalf Of [email protected]<mailto:[email protected]> Sent: Wednesday, April 08, 2015 5:21 PM To: [email protected]<mailto:[email protected]> Subject: Sepsisgroups Digest, Vol 151, Issue 8 Send Sepsisgroups mailing list submissions to [email protected]<mailto:[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]<mailto:[email protected]> You can reach the person managing the list at [email protected]<mailto:[email protected]> When replying, please edit your Subject line so it is more specific than "Re: Contents of Sepsisgroups digest..." Today's Topics: 1. Sepsis CMS Core measure/lactate (Carlson, Barbara A. (Lincoln, NE)) 2. Re: CMS Abstraction for Severe Sepsis/Septic Shock PRESENTATION TIME (Townsend, Sean, M.D.) ---------------------------------------------------------------------- Message: 1 Date: Wed, 8 Apr 2015 16:16:42 +0000 From: "Carlson, Barbara A. (Lincoln, NE)" <[email protected]<mailto:[email protected]>> To: "'[email protected]<mailto:[email protected]>'" <[email protected]<mailto:[email protected]>> Subject: [Sepsis Groups] Sepsis CMS Core measure/lactate Message-ID: <35dbb1774783904fb66a013e4e110d3f367cd...@chiex011.chi.catholichealth.net<mailto:35dbb1774783904fb66a013e4e110d3f367cd...@chiex011.chi.catholichealth.net>> Content-Type: text/plain; charset="us-ascii" I saw a provision on Quality Net/CMS Sepsis Bundle Project to draw blood cultures and time IV antibiotics before time zero. Clarifications: 1. Is there a provision to draw the lactate before time zero i.e. in the field or acute care clinic? 2. If so, please share the timing. Thank you, Barbara Carlson RN, BAN, CPHQ Performance Improvement CHI Health St. Elizabeth 555 S 70th St, Lincoln, NE 68510 P 402-219-7332 F 402-219-8992 [email protected]<mailto:[email protected]><mailto:[email protected]> CHIhealthStElizabeth.com<http://CHIhealthStElizabeth.com> [cid:[email protected]] This email and attachments contain information that may be confidential or privileged. If you are not the intended recipient, notify the sender at once and delete this message completely from your information system. Further use, disclosure, or copying of information contained in this email is not authorized, and any such action should not be construed as a waiver of privilege or other confidentiality protections. -------------- next part -------------- An HTML attachment was scrubbed... URL: <http://lists.sepsisgroups.org/pipermail/sepsisgroups-sepsisgroups.org/attachments/20150408/11586f2d/attachment-0001.htm> -------------- next part -------------- A non-text attachment was scrubbed... Name: image001.jpg Type: image/jpeg Size: 4268 bytes Desc: image001.jpg URL: <http://lists.sepsisgroups.org/pipermail/sepsisgroups-sepsisgroups.org/attachments/20150408/11586f2d/attachment-0001.jpg> ------------------------------ Message: 2 Date: Wed, 8 Apr 2015 08:17:59 -0700 From: "Townsend, Sean, M.D." <[email protected]<mailto:[email protected]>> To: "Brown, Sheree" <[email protected]<mailto:[email protected]>> Cc: "[email protected]<mailto:[email protected]>" <[email protected]<mailto:[email protected]>> Subject: Re: [Sepsis Groups] CMS Abstraction for Severe Sepsis/Septic Shock PRESENTATION TIME Message-ID: <[email protected]<mailto:[email protected]>> Content-Type: text/plain; charset="utf-8" Good detective work! Still verifying details as I do not want to distribute misleading information here. Please stay tuned. Sean R. Townsend, MD Vice President of Quality & Safety California Pacific Medical Center 2330 Clay Street #301 San Francisco, CA 94115 [email protected]<mailto:[email protected]><mailto:[email protected]> 415-600-5770 office 415-600-1541 fax On Apr 8, 2015, at 8:11 AM, Brown, Sheree <[email protected]<mailto:[email protected]><mailto:[email protected]>> wrote: Good Morning All, I found all of this information in the Alphabetical Data Dictionary. <image004.jpg> For patients who enter the Emergency Department with septic shock, the Septic Shock Presentation Time is the time they were triaged in the Emergency Department. Hypotension and lactate are included in the definition of severe sepsis: In order to establish the presence of severe sepsis, there are three criteria, all three of which must be met within 6 hours of each other. a. Documentation of a suspected source of clinical infection. There may be reference to ?possible infection from xx?, ?suspect infection from xx?, or similar reference in progress notes, consult notes, or similar physician/APN/PA documentation b. Two or more manifestations of systemic infection according to the Systemic Inflammatory Response Syndrome (SIRS) criteria, which are: i. Temperature > 38.3 C or < 36.0 C ii. Heart rate (pulse) > 90 iii. Respiration > 20 per minute iv. White blood cell count > 12,000 or < 4,000 or > 10% bands c. Organ dysfunction, evidenced by any one of the following: i. Systolic blood pressure < 90, or mean arterial pressure < 65, or a systolic blood pressure decrease of more than 40 points ii. Creatinine > 2.0, or urine output < 0.5 mL/kg/hour for 2 hours iii. Bilirubin > 2 mg/dL (34.2 mmol/L) iv. Platelet count < 100,000 v. INR > 1.5 or aPTT > 60 sec vi. Lactate > 2 mmol/L (18.0 mg/dL) And the definition of septic shock: The criteria for determining that Septic Shock is present are as follows: a. There must be documentation of severe sepsis present. AND b. Tissue hypoperfusion persists after crystalloid fluid administration, evidenced by either ? systolic blood pressure < 90, or ? mean arterial pressure < 65 or ? a decrease in systolic blood pressure by > 40 points OR ? Lactate level is > 4 mmol/L Sheree Brown MSN, RN, CNL Manager, Performance Excellence Phone: 517 788-4800 ext. 4209 Pager: 517 534-0127 Fax: 517 788-4715 [email protected]<mailto:[email protected]><allegiancehealth.org<http://allegiancehealth.org>> <image001.gif> From: Sepsisgroups [mailto:[email protected]] On Behalf Of Andrew Markowski Sent: Wednesday, April 08, 2015 12:00 AM To: Ryan Arnold Cc: [email protected]<mailto:[email protected]><mailto:[email protected]> Subject: Re: [Sepsis Groups] CMS Abstraction for Severe Sepsis/Septic Shock PRESENTATION TIME Likewise, I didn't see, in the CMS core measure, clear definitions of elevated lactate or hypotension. -Andy ________________________________ Andrew Markowski, MD, MPH Department of Emergency Medicine Johns Hopkins | Suburban Hospital 214-766-0665<tel:214-766-0665> Sent from my iPhone On Apr 6, 2015, at 10:36 AM, Ryan Arnold <[email protected]<mailto:[email protected]><mailto:[email protected]>> wrote: Sean, There is no mention of ED triage time in the new CMS guidelines in my reading. Do you have a specific reference you found within CMS that refers to ED triage time? The guidelines mention ?presentation? of severe sepsis or septic shock, not arrival or triage time. The only time based reference they use is whether the patient has been hospitalized for ? 120 days. A patient who does not meet criteria for severe sepsis at ED triage does not have severe sepsis at ED triage, and would thus not meet the criteria for the CMS measure until they meet the clinical criteria for severe sepsis, whether it is in the ED or inpatient days later. Ryan ________________________________ Ryan Arnold, MD Research Director, Department of Emergency Medicine Clinical Investigator, Value Institute Christiana Care Health System Newark, DE On Apr 3, 2015, at 9:23 PM, Townsend, Sean, M.D. <[email protected]<mailto:[email protected]><mailto:[email protected]>> wrote: Jennifer, your interpretation is correct. For patients presenting to the ED, triage time is time zero under the CMS measure. 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]><mailto:[email protected]> office (415) 600-5770 fax (415) 600-1541 ________________________________ From: Sepsisgroups [[email protected]<mailto:[email protected]><mailto:[email protected]>] On Behalf Of Jennifer L Halligan [SJGH] [[email protected]<mailto:[email protected]><mailto:[email protected]>] Sent: Thursday, April 02, 2015 8:44 AM To: [email protected]<mailto:[email protected]><mailto:[email protected]> Subject: [Sepsis Groups] CMS Abstraction for Severe Sepsis/Septic Shock PRESENTATION TIME Question to the group. I have been and currently still am abstracting TRIAGE TIME for ?time zero?. With the release of the new measure specification manual/abstraction guidelines I want to clarify that I will still abstract TRIAGE time as severe sepsis/septic shock PRESENTATION TIME even though ALL the criterion may NOT be met yet at the time of triage, i.e. for severe sepsis -1) documentation of suspected source of infection, 2) 2 SIRS criteria, and 3) organ dysfunction? Thank you, Jennifer Jennifer Halligan, RN Quality Review Nurse San Joaquin General Hospital Tel: 209-468-7471 Fax: 209-468-7011 <image001.gif>_______________________________________________ Sepsisgroups mailing list [email protected]<mailto:[email protected]><mailto:[email protected]> http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org _______________________________________________ Sepsisgroups mailing list [email protected]<mailto:[email protected]><mailto:[email protected]> http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org ________________________________ This e-mail message and any attachment(s) is intended only for the individual(s) to whom it is addressed and may contain information that is privileged, confidential or proprietary in nature. Any unauthorized disclosure, copying or distribution of this e-mail or the content of this message is prohibited. 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