1. EPIC: Mt Sinai in NY - has a "Sepsis Ticket" within EPIC. The results have been published. We are utilizing the "Ticket" - in anticipation of implementation of EPIC. This should be within EPIC library currently. CMAJ February 4, 2014 vol. 186 no. 2 First published January 6, 2014, doi: 10.1503/cmaj.109-468 2. Fluid Resuscitation - The most current evidence would point toward a balanced salt solution or LR; and reducing NS infusion for reasons already stated - increased incidence of AKI, Mortality - and costs - the use of NS is associated with increased utilization of laboratory tests to rule out other causes of metabolic acidosis. Annals of Surgery. 255(5):821-829, May 2012. DOI: 10.1097/SLA.0b013e31825074f5 JAMA. 2012;308(15):1566-1572. doi:10.1001/jama.2012.13356
Stuart Reynolds, MD, FRCPE, FCCP Director of Critical Care Services Spartanburg Regional Healthcare System -----Original Message----- From: Sepsisgroups [mailto:[email protected]] On Behalf Of [email protected] Sent: Wednesday, May 20, 2015 8:43 AM To: [email protected] Subject: Sepsisgroups Digest, Vol 157, Issue 2 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. Sepsis screen in Epic (Fiona Winterbottom) 2. Re: Fluid resuscitation (Izard, Kimberly) 3. CMS criteria/definitions for severe sepsis (Kelly Kragenbrink) ---------------------------------------------------------------------- Message: 1 Date: Wed, 20 May 2015 10:49:39 +0000 From: Fiona Winterbottom <[email protected]> To: "[email protected]" <[email protected]> Subject: [Sepsis Groups] Sepsis screen in Epic Message-ID: <co2pr0601mb744df18e017b11f5283dd5fba...@co2pr0601mb744.namprd06.prod.outlook.com> Content-Type: text/plain; charset="us-ascii" Good morning, I was wondering if anyone had a sepsis screen built in Epic that they would be willing to share? We have MEWS built into our EMR. Our Epic team is now ready to build a sepsis alert and is looking for screen shots and input from other people who have experience with sepsis alerts Any advice appreciated Thanks Fiona Fiona Winterbottom RN,MSN, APRN, ACNS-BC, CCRN Lead Clinical Nurse Specialist Critical Care Medicine Ochsner Health System [email protected] iphone 985 9667426 -----Original Message----- From: Sepsisgroups [mailto:[email protected]] On Behalf Of [email protected] Sent: Thursday, May 14, 2015 9:22 AM To: [email protected] Subject: Sepsisgroups Digest, Vol 156, Issue 3 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: Fluid resuscitation (Barnes-Daly, Mary Ann) 2. Re: Fluid resuscitation (Mascioli, Charles MD) 3. Re: Fluid resuscitation (Izard, Kimberly) ---------------------------------------------------------------------- Message: 1 Date: Wed, 13 May 2015 21:46:45 -0700 From: "Barnes-Daly, Mary Ann" <[email protected]> To: "'Savino, Terri'" <[email protected]>, "'[email protected]'" <[email protected]> Subject: Re: [Sepsis Groups] Fluid resuscitation Message-ID: <e6878da068c4dd4699740e87596a168b0c48032...@dcbl115vx.root.sutterhealth.org> Content-Type: text/plain; charset="utf-8" Hi Terri; You are correct; the CMS specs seem to establish a ?second time zero? as it were. It seems that the ?shock clock? for beginning the bundle elements that we used to call the 6 hour bundle - starts at the time that the 30ml/kg bolus is started indicating the time that shock was recognized and treated with the initial fluid bolus. It seems that we now have 6 hours from that shock time zero to comply with the shock elements in the all-or-none bundle. Thanks, MARY ANN BARNES-DALY RN BSN CCRN DC | Clinical Performance Improvement Consultant Sutter Health - Clinical Integration Department | 2200 River Plaza Drive, Sacramento, CA 95833 Mobile 916.200.5604| Office 916.286.6717 | [email protected] ?You never change things by fighting the existing reality. To change something, build a new model that makes the existing model obsolete.? ~R. Buckminster Fuller From: Sepsisgroups [mailto:[email protected]] On Behalf Of Savino, Terri Sent: Friday, May 08, 2015 5:16 PM To: [email protected] Subject: [Sepsis Groups] Fluid resuscitation I was wondering if anyone could clarify what time CMS is looking for fluid administration? It looks like to me they want the time it was hung (appropriate order for fluid resuscitation), but isn't it important to know the time the 30ml/kg are infused, not when they are hung? What time does the surviving sepsis campaign use? Thank you in advance for your response. Terri Terri Savino MSN, RN, CPHQ Core Measure Specialist Quality Improvement Coordinator Trauma Coordinator Middlesex Hospital 28 Crescent St Middletown, CT 06457 office: 860-358-3026 fax: 860-358-4088 www.middlesexhospital.org<http://www.middlesexhospital.org> [http://middlesexhospital.org/wsimages/logo-header.png] This e-mail message may be protected by the attorney client privilege and the work product doctrines. This e-mail may also be protected by section 19a-17b of the CT General Statutes. If you have received this message in error, please notify Middlesex Health System by sending a reply email to the sender or calling the Middlesex Hospital Privacy Office Hotline at 860-358-4630 and then delete this email and all attachments. The information contained in this email and any attached files from Middlesex Health System are confidential under federal and state law and are intended only for the person to whom they are addressed. If you are not the intended recipient, you are hereby notified that any inappropriate use or reproduction of the information is strictly prohibited and may subject you to civil or criminal penalties. -------------- next part -------------- An HTML attachment was scrubbed... URL: <http://lists.sepsisgroups.org/pipermail/sepsisgroups-sepsisgroups.org/attachments/20150513/76debd23/attachment-0001.htm> ------------------------------ Message: 2 Date: Thu, 14 May 2015 01:24:13 +0000 From: "Mascioli, Charles MD" <[email protected]> To: "Savino, Terri" <[email protected]>, "[email protected]" <[email protected]> Subject: Re: [Sepsis Groups] Fluid resuscitation Message-ID: <377bc8cd01783b4bb3d0a2e7044a283d2045a...@mailstore102.covhlth.net> Content-Type: text/plain; charset="iso-8859-1" Hello, The sepsis "consultant" stated that we need to use NS or RL......for fluid resuscitation, that "balanced solutions" such as plasmalyte wer not approved??? Does anybody know what the actual CMS rule is? Thanks C Mascioli MD, MMC ,Oak Ridge Tn ________________________________ From: Sepsisgroups [[email protected]] on behalf of Savino, Terri [[email protected]] Sent: Friday, May 08, 2015 8:16 PM To: [email protected] Subject: [Sepsis Groups] Fluid resuscitation I was wondering if anyone could clarify what time CMS is looking for fluid administration? It looks like to me they want the time it was hung (appropriate order for fluid resuscitation), but isn't it important to know the time the 30ml/kg are infused, not when they are hung? What time does the surviving sepsis campaign use? Thank you in advance for your response. Terri Terri Savino MSN, RN, CPHQ Core Measure Specialist Quality Improvement Coordinator Trauma Coordinator Middlesex Hospital 28 Crescent St Middletown, CT 06457 office: 860-358-3026 fax: 860-358-4088 www.middlesexhospital.org<http://www.middlesexhospital.org> [http://middlesexhospital.org/wsimages/logo-header.png] This e-mail message may be protected by the attorney client privilege and the work product doctrines. This e-mail may also be protected by section 19a-17b of the CT General Statutes. If you have received this message in error, please notify Middlesex Health System by sending a reply email to the sender or calling the Middlesex Hospital Privacy Office Hotline at 860-358-4630 and then delete this email and all attachments. The information contained in this email and any attached files from Middlesex Health System are confidential under federal and state law and are intended only for the person to whom they are addressed. If you are not the intended recipient, you are hereby notified that any inappropriate use or reproduction of the information is strictly prohibited and may subject you to civil or criminal penalties. ----------------------------------------- This E-mail contains PRIVILEGED AND CONFIDENTIAL INFORMATION intended only for the use of the Individual(s) named above. If you are not the intended recipient of this E-mail, or the employee or agent responsible for delivering it to the intended recipient, you are hereby notified that any dissemination or copying of this E-mail is strictly prohibited. If you have received this E-mail in error, please immediately notify us at (865)374-4900 or notify us by E-mail at [email protected] ------------------------------ Message: 3 Date: Wed, 13 May 2015 22:10:43 +0000 From: "Izard, Kimberly" <[email protected]> To: "Savino, Terri" <[email protected]>, "[email protected]" <[email protected]> Subject: Re: [Sepsis Groups] Fluid resuscitation Message-ID: <[email protected]> Content-Type: text/plain; charset="utf-8" Yes, it is important to note when the fluids complete in order to answer the Hypotension question. This data element looks at 1 hour after the fluid is administered. We have been submitting questions to the IQR and we are receiving responses. I have attached one for your reference. Thank you, Kim Kim Izard, BS, RN Supervisor Clinical Outcomes/Core Measures SSM Health - St. Louis Network 1015 Corporate Square Drive Suite 240 Creve Coeur, MO 63132 Office ? 314-989-2137 Cell ? 618-670-3616 [email protected]<mailto:[email protected]> [cid:[email protected]] ?Change is a challenge and an opportunity; not a threat? -Prince Phillip of England This e-mail message is confidential, intended only for the named recipient(s) above and may contain information that is privileged or exempt from disclosure under applicable law. If you are not the intended recipient(s), you are notified that the dissemination, distribution or copying of this message is strictly prohibited. If you received this message in error, or are not the named recipient(s) please notify the sender at the e-mail address or telephone number above and delete this e-mail from your computer. Thank you! From: Sepsisgroups [mailto:[email protected]] On Behalf Of Savino, Terri Sent: Friday, May 08, 2015 7:16 PM To: [email protected] Subject: [Sepsis Groups] Fluid resuscitation I was wondering if anyone could clarify what time CMS is looking for fluid administration? It looks like to me they want the time it was hung (appropriate order for fluid resuscitation), but isn't it important to know the time the 30ml/kg are infused, not when they are hung? What time does the surviving sepsis campaign use? Thank you in advance for your response. Terri Terri Savino MSN, RN, CPHQ Core Measure Specialist Quality Improvement Coordinator Trauma Coordinator Middlesex Hospital 28 Crescent St Middletown, CT 06457 office: 860-358-3026 fax: 860-358-4088 www.middlesexhospital.org<http://www.middlesexhospital.org> [http://middlesexhospital.org/wsimages/logo-header.png] This e-mail message may be protected by the attorney client privilege and the work product doctrines. This e-mail may also be protected by section 19a-17b of the CT General Statutes. If you have received this message in error, please notify Middlesex Health System by sending a reply email to the sender or calling the Middlesex Hospital Privacy Office Hotline at 860-358-4630 and then delete this email and all attachments. The information contained in this email and any attached files from Middlesex Health System are confidential under federal and state law and are intended only for the person to whom they are addressed. If you are not the intended recipient, you are hereby notified that any inappropriate use or reproduction of the information is strictly prohibited and may subject you to civil or criminal penalties. ________________________________ Confidentiality Notice: This email message, including any attachments, is for the sole use of the intended recipient(s) and may contain confidential and privileged information. Any unauthorized review, use, disclosure or distribution is prohibited. If you are not the intended recipient, please contact the sender by reply email and destroy all copies of the original message. -------------- next part -------------- An HTML attachment was scrubbed... URL: <http://lists.sepsisgroups.org/pipermail/sepsisgroups-sepsisgroups.org/attachments/20150513/55b06b25/attachment.htm> -------------- next part -------------- A non-text attachment was scrubbed... Name: image001.png Type: image/png Size: 10295 bytes Desc: image001.png URL: <http://lists.sepsisgroups.org/pipermail/sepsisgroups-sepsisgroups.org/attachments/20150513/55b06b25/attachment.png> -------------- next part -------------- A non-text attachment was scrubbed... Name: Fluid Administration.docx Type: application/vnd.openxmlformats-officedocument.wordprocessingml.document Size: 12849 bytes Desc: Fluid Administration.docx URL: <http://lists.sepsisgroups.org/pipermail/sepsisgroups-sepsisgroups.org/attachments/20150513/55b06b25/attachment.bin> ------------------------------ Subject: Digest Footer _______________________________________________ Sepsisgroups mailing list [email protected] http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org ------------------------------ End of Sepsisgroups Digest, Vol 156, Issue 3 ******************************************** ------------------------------ Message: 2 Date: Tue, 19 May 2015 21:28:56 +0000 From: "Izard, Kimberly" <[email protected]> To: "Kramer, George C." <[email protected]>, "Mascioli, Charles MD" <[email protected]> Cc: "Savino, Terri" <[email protected]>, "[email protected]" <[email protected]> Subject: Re: [Sepsis Groups] Fluid resuscitation Message-ID: <[email protected]> Content-Type: text/plain; charset="iso-8859-1" The only accepted fluids by CMS for the core measure are 0.9% NS and full strength LR. Plasmalyte is not an option according to the specifications manual. Thank you, Kim Kim Izard, BS, RN Supervisor Clinical Outcomes/Core Measures SSM Health - St. Louis Network 1015 Corporate Square Drive Suite 240 Creve Coeur, MO 63132 Office - 314-989-2137 Cell - 618-670-3616 [email protected] "Change is a challenge and an opportunity; not a threat" -Prince Phillip of England This e-mail message is confidential, intended only for the named recipient(s) above and may contain information that is privileged or exempt from disclosure under applicable law. If you are not the intended recipient(s), you are notified that the dissemination, distribution or copying of this message is strictly prohibited. If you received this message in error, or are not the named recipient(s) please notify the sender at the e-mail address or telephone number above and delete this e-mail from your computer. Thank you! -----Original Message----- From: Sepsisgroups [mailto:[email protected]] On Behalf Of Kramer, George C. Sent: Friday, May 15, 2015 6:12 AM To: Mascioli, Charles MD Cc: Savino, Terri; [email protected] Subject: Re: [Sepsis Groups] Fluid resuscitation LR is a balanced solution. Most evidence of the superiority of plasmalyte has been compared to NS. NS can cause renal failure and hypochloremic acidosis and many believe it should be avoided in high doses. Using either PLT or LR as solution should be equivalent. imho George Kramer, PhD Professor Director Resuscitation Research Lab Dept. of Anesthesiology UTMB, Galveston 409-939-3040 > On May 13, 2015, at 8:24 PM, Mascioli, Charles MD <[email protected]> > wrote: > > Hello, The sepsis "consultant" stated that we need to use NS or RL......for > fluid resuscitation, that "balanced solutions" such as plasmalyte wer not > approved??? Does anybody know what the actual CMS rule is? > Thanks C Mascioli MD, MMC ,Oak Ridge Tn > ________________________________ > From: Sepsisgroups [[email protected]] on > behalf of Savino, Terri [[email protected]] > Sent: Friday, May 08, 2015 8:16 PM > To: [email protected] > Subject: [Sepsis Groups] Fluid resuscitation > > I was wondering if anyone could clarify what time CMS is looking for fluid > administration? It looks like to me they want the time it was hung > (appropriate order for fluid resuscitation), but isn't it important to know > the time the 30ml/kg are infused, not when they are hung? What time does the > surviving sepsis campaign use? > > Thank you in advance for your response. > > Terri > > Terri Savino MSN, RN, CPHQ > Core Measure Specialist > Quality Improvement Coordinator > Trauma Coordinator > > Middlesex Hospital > 28 Crescent St > Middletown, CT 06457 > office: 860-358-3026 > fax: 860-358-4088 > www.middlesexhospital.org<http://www.middlesexhospital.org> > > [http://middlesexhospital.org/wsimages/logo-header.png] > > > > > This e-mail message may be protected by the attorney client privilege and the > work product doctrines. This e-mail may also be protected by section 19a-17b > of the CT General Statutes. > > > If you have received this message in error, please notify Middlesex Health > System by sending a reply email to the sender or calling the Middlesex > Hospital Privacy Office Hotline at 860-358-4630 and then delete this email > and all attachments. > > The information contained in this email and any attached files from Middlesex > Health System are confidential under federal and state law and are intended > only for the person to whom they are addressed. If you are not the intended > recipient, you are hereby notified that any inappropriate use or reproduction > of the information is strictly prohibited and may subject you to civil or > criminal penalties. > > ----------------------------------------- > This E-mail contains PRIVILEGED AND CONFIDENTIAL INFORMATION intended > only for the use of the Individual(s) named above. If you are not the > intended recipient of this E-mail, or the employee or agent > responsible for delivering it to the intended recipient, you are > hereby notified that any dissemination or copying of this E-mail is > strictly prohibited. If you have received this E-mail in error, > please immediately notify us at (865)374-4900 or notify us by E-mail > at [email protected] _______________________________________________ > Sepsisgroups mailing list > [email protected] > http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.o > rg _______________________________________________ Sepsisgroups mailing list [email protected] http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org ________________________________ Confidentiality Notice: This email message, including any attachments, is for the sole use of the intended recipient(s) and may contain confidential and privileged information. Any unauthorized review, use, disclosure or distribution is prohibited. If you are not the intended recipient, please contact the sender by reply email and destroy all copies of the original message. ------------------------------ Message: 3 Date: Tue, 19 May 2015 12:53:15 +0000 From: Kelly Kragenbrink <[email protected]> To: "[email protected]" <[email protected]> Subject: [Sepsis Groups] CMS criteria/definitions for severe sepsis Message-ID: <82ae119de0e39b4d92cafbf2c6625d230237fd7...@nmhexdb01.nmh.nmrhs.net> Content-Type: text/plain; charset="us-ascii" Is CMS going to be using Surviving Sepsis definitions and criteria for determining sepsis, severe sepsis, and septic shock? Kelly Kragenbrink, RN Peer Review Coordinator McLaren Northern Michigan 416 Connable Avenue Petoskey, MI 49770 Phone: 231.487.3474 Fax: 231.487.3139 [web-FINAL-032012]<http://northernhealth.org/>[FINAL-facebook]<http://www.facebook.com/northernhealthsystem/>[magnet-icon]<http://www.mclaren.org/northernmichigan/MagnetRecognitionnm.aspx> P Please consider the environment before printing this email. Confidentiality Notice: This e-mail message, including any attachments, may contain confidential information or privileged peer information protected by law. The information is intended only for the use of the individual(s) or entity named above. If you are not the intended recipient, you are notified that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this e-mail information is prohibited. If you have received this e-mail in error, please contact the sender by reply e-mail and destroy all copies of the original message. 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