We are a small hospital with no intensivist coverage. We are looking for a sepsis order set/ protocol from an institution with this situation... anyone able to help?
Emily Bradshaw RN, BSN, CCRN Clinical Educator, Critical Care and Acute Care WellStar Paulding Hospital [email protected] 470-245-3536 -----Original Message----- From: Sepsisgroups [mailto:[email protected]] On Behalf Of [email protected] Sent: Tuesday, June 02, 2015 12:41 PM To: [email protected] Subject: Sepsisgroups Digest, Vol 159, 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: Sepsisgroups Digest, Vol 158, Issue 6 TIME ZERO (Richards, Ann) 2. Re: Joint Commission Performance Measure Time Zero (Brandy Cuevas) ---------------------------------------------------------------------- Message: 1 Date: Fri, 29 May 2015 12:38:34 +0000 From: "Richards, Ann" <[email protected]> To: "[email protected]" <[email protected]> Subject: Re: [Sepsis Groups] Sepsisgroups Digest, Vol 158, Issue 6 TIME ZERO Message-ID: <[email protected]> Content-Type: text/plain; charset=WINDOWS-1252 In response the question about time zero, we have concerns about this as well. The way the abstraction process is written for CMS it does not focus on what is the right thing clinically. Also, it creates a bit of a paradox in that you don't have to start timing administration of fluids until they meet the septic shock definition. However, they can't meet the septic shock definition until the fail fluid resusitiation so it is very unclear. I expect this to change again before the measure is finalized. We have decieded in our ED not to change anything at this time and keep time zero as ED triage because that keeps the focus on early recognition and early goal directed therapy. I don't want my front line staff getting confused and worked out over the specifics of time zero, I want them focused on providing the best care for the patient, which we have seen starts when you walk in the door. Ann M. Richards, RN, BSN, CIC Special Projects Coordinator - Infection Prevention & Quality Improvement Departments Infection Control Practitioner - Infection Prevention Department Overlook Medical Center - Atlantic Health System Office 908-522-2129 IP Fax 908-598-2368 QI Fax 908-522-5315 Cell 973-294-8330 The information contained in this email is intended only for the use of the person(s) identified above.? This communication may contain work product which is privileged and confidential, and may contain content which is regulated by Federal law.? If you are not an intended recipient or the employee or agent responsible to deliver this to the intended recipient, you have received this message in error and any review, distribution or copying of it by you is prohibited.? If you have received this message in error, please notify the sender immediately, and delete the message.? E-mail and communication system messages generated by members of the Atlantic Health System workforce may not necessarily reflect the views of Atlantic Health System, its officers, directors or management. Today's Topics: 1. Joint Commission Performance Measure Time Zero (Angela Craig) 2. Re: Joint Commission Performance Measure (Angela Craig) 3. Re: CMS Guidelines (Brandy Cuevas) ---------------------------------------------------------------------- Message: 1 Date: Thu, 28 May 2015 10:32:10 -0500 From: Angela Craig <[email protected]> To: "'[email protected]'" <[email protected]>, "[email protected]" <[email protected]> Subject: [Sepsis Groups] Joint Commission Performance Measure Time Zero Message-ID: <343E31412FC9094487B54371286ADDA01F2B14CB48@D109EXCHMB.crmchealth.hospital> Content-Type: text/plain; charset="utf-8" OK so most of us have changed to time of triage for time zero I would assume. I had a meeting with our data abstractor for Sepsis Core Measures yesterday and she mentioned time zero would be changing. She then showed me the manual for the data abstractors. It stated for Septic Shock Present the following: Criteria There must be documentation of severe sepsis present AND Tissue hypoperfusion persists after crystalloid fluid administration evidenced by either SBP <90, or MAP<65, or a decrease in SBP by >40points OR Lactate level is >4 Soooo My abstractor was under the impression this would be the new time zero based on this. There was a sheet on Severe Sepsis Present as well. What concerns me is that based on documentation is what will que them for time zero. I am worried that there will be delays in care if that is how it will be determined. What are everyone's thoughts? Am I missing something? Will everyone just stay with time zero that we feel is "clinically correct" and consistent across the country and just let core measures monitor something different? Can someone help me understand this. I really hope I am not reading something correctly or just not understanding. Thank you in advance - I am soo grateful for this List serve!!! Angela Craig APN,MS,CCNS Clinical Nurse Specialist Intensive Care Unit Cookeville Regional Medical Center 931-783-5035 This email message has been delivered safely and archived online by Mimecast. For more information please visit http://www.mimecast.com -------------- next part -------------- An HTML attachment was scrubbed... URL: <http://lists.sepsisgroups.org/pipermail/sepsisgroups-sepsisgroups.org/attachments/20150528/389fe4eb/attachment-0001.htm> ------------------------------ Message: 2 Date: Thu, 28 May 2015 10:22:49 -0500 From: Angela Craig <[email protected]> To: "'[email protected]'" <[email protected]>, "[email protected]" <[email protected]> Subject: Re: [Sepsis Groups] Joint Commission Performance Measure Message-ID: <343E31412FC9094487B54371286ADDA01F2B14CB47@D109EXCHMB.crmchealth.hospital> Content-Type: text/plain; charset="utf-8" We just certified and I think the 3 hour bundle compliance is great. We also chose to look at screening compliance. We have the units on all the floors screen a sampling to make sure they are done accurately. 2 other areas we chose to look at were time to goal with CVP and SCVO2. Just a few ideas for you. Angela Craig APN,MS,CCNS Clinical Nurse Specialist Intensive Care Unit Cookeville Regional Medical Center 931-783-5035 From: Sepsisgroups [mailto:[email protected]] On Behalf Of [email protected] Sent: Wednesday, May 27, 2015 2:29 PM To: [email protected] Subject: [Sepsis Groups] Joint Commission Performance Measure Good Afternoon, I will be recertifying for the second time and curious to see what is "IN" right now for the Joint Commission performance measures. I was leaning towards 3 hour bundle compliance, lactate clearance but am looking for any other suggestions to get me to 4 measures. Thank you! Megan Borden, BSN, RN, CEN Sepsis Coordinator Memorial Hospital Jacksonville 3625 University Blvd South Jacksonville, FL 32216 Office: 904-702-6080 Mobile: 904-334-7079 Notice: This email contains confidential or proprietary information which may be legally privileged. It is intended only for the named recipient (s). If an addressing or transmission error has misdirected the email, please notify the author by replying to this message. If you are not the named recipient, you are not authorized to use, disclose, distribute, copy, print or rely on this email, and should immediately delete it from your computer system. This email message has been delivered safely and archived online by Mimecast. For more information please visit http://www.mimecast.com -------------- next part -------------- An HTML attachment was scrubbed... URL: <http://lists.sepsisgroups.org/pipermail/sepsisgroups-sepsisgroups.org/attachments/20150528/bff72c25/attachment-0001.htm> ------------------------------ Message: 3 Date: Thu, 28 May 2015 10:03:11 -0500 From: Brandy Cuevas <[email protected]> To: "[email protected]" <[email protected]> Cc: "[email protected]" <[email protected]> Subject: Re: [Sepsis Groups] CMS Guidelines Message-ID: <[email protected]> Content-Type: text/plain; charset="us-ascii" Hi Debbie, It is my understanding that a patient with severe sepsis only has to have a repeat lactate within 6 hours if initial lactate is elevated. Only in septic shock patients does the patient need the focused exam or two of the other items. Maybe I am misunderstanding the measure? My perception is if after the initial 3 hour requirement (lactate, blood culture, abx, and fluid), if the "repeat exam" shows hypotension and the patient is placed on a vasopressor, then at that time (which is the re-assessment) they need the focused exam or two of the other items. If they are not hypotensive/on vasopressors, then they are only severe sepsis and not septic shock which does not require the additional testing?! If you find out differently, please let me know! I have attached a sepsis guideline sheet that a hospital shared on the listserv that has been helpful to me. Brandy Brandy Cuevas, BSN, RN Quality Improvement Coordinator William Newton Hospital 1300 E. 5th Ave. Winfield, KS 67156 620-222-6225 [email protected]<mailto:[email protected]> CONFIDENTIALITY NOTICE: This email communication may contain private, confidential, or legally privileged information intended for the sole use of the designated and/or duly authorized recipient(s). If you are not the intended recipient or have received this email in error, please notify the sender immediately by email and permanently delete all copies of this email including all attachments without reading them. If you are the intended recipient, secure the contents in a manner that conforms to all applicable state and/or federal requirements related to privacy and confidentiality of such information. From: Sepsisgroups [mailto:[email protected]] On Behalf Of [email protected] Sent: Wednesday, May 27, 2015 2:25 PM To: [email protected] Subject: [Sepsis Groups] CMS Guidelines So, I've read through the new CMS Guidelines and it states that a repeat assessment must be completed within 6 hrs with either a focused exam (including VS, cardiopulmonary exam, cap refill, peripheral pulse eval and skin exam) or any two of the four: CVP, SV02, bedside cardiovascular ultrasound, passive leg raise or fluid challenge. At our hospital, we have the "shift evaluation" and "shift re-evaluation." If the nurse documents the "shift re-evaluation" they are basically saying nothing has changed since the last evaluation. I'm wondering if that will suffice, or if they actually have to do another complete head-to-toe assessment. Any thoughts?? Thanks, Debbie Debbie Chambless, MSN, RN, ARNP-C Sepsis Coordinator Osceola Regional Medical Center Kissimmee, Fl 34741 Office: 407-518-3949 Cell: 772-807-0525 ~~Recognizing sepsis as a global enemy. Hoping for global unity in finding a solution~~ [cid:[email protected]] ________________________________ The materials in this email are private and may contain Protected Health Information. If you are not the intended recipient, be advised that any unauthorized use, disclosure, copying, distribution or the taking of any action in reliance on the contents of this information is strictly prohibited. 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Name: Sepsis Core Measure Requirements.docx Type: application/vnd.openxmlformats-officedocument.wordprocessingml.document Size: 32422 bytes Desc: Sepsis Core Measure Requirements.docx URL: <http://lists.sepsisgroups.org/pipermail/sepsisgroups-sepsisgroups.org/attachments/20150528/86488c05/attachment.bin> ------------------------------ Subject: Digest Footer _______________________________________________ Sepsisgroups mailing list [email protected] http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org ------------------------------ End of Sepsisgroups Digest, Vol 158, Issue 6 ******************************************** The information contained in this email is intended only for the use of the person(s) identified above. This communication may contain work product which is privileged and confidential, and may contain content which is regulated by Federal law. If you are not an intended recipient or the employee or agent responsible to deliver this to the intended recipient, you have received this message in error and any review, distribution or copying of it by you is prohibited. If you have received this message in error, please notify the sender immediately, and delete the message. E-mail and communication system messages generated by members of the Atlantic Health System workforce may not necessarily reflect the views of Atlantic Health System, its officers, directors or management. ------------------------------ Message: 2 Date: Fri, 29 May 2015 07:54:58 -0500 From: Brandy Cuevas <[email protected]> To: Angela Craig <[email protected]>, "'[email protected]'" <[email protected]>, "[email protected]" <[email protected]> Subject: Re: [Sepsis Groups] Joint Commission Performance Measure Time Zero Message-ID: <[email protected]> Content-Type: text/plain; charset="utf-8" I am also confused on Time Zero as it says patients entering through the ED, the time of presentation is the time the patient is triaged. Also, Can anyone clarify the 30ml/kg for me. Is it your understanding that any patient that presents with sepsis will get 30ml/kg regardless if they are in septic shock or severe sepsis? Thanks in advance!! Brandy Cuevas, BSN, RN Quality Improvement Coordinator William Newton Hospital 1300 E. 5th Ave. Winfield, KS 67156 620-222-6225 [email protected]<mailto:[email protected]> CONFIDENTIALITY NOTICE: This email communication may contain private, confidential, or legally privileged information intended for the sole use of the designated and/or duly authorized recipient(s). If you are not the intended recipient or have received this email in error, please notify the sender immediately by email and permanently delete all copies of this email including all attachments without reading them. If you are the intended recipient, secure the contents in a manner that conforms to all applicable state and/or federal requirements related to privacy and confidentiality of such information. From: Sepsisgroups [mailto:[email protected]] On Behalf Of Angela Craig Sent: Thursday, May 28, 2015 10:32 AM To: '[email protected]'; [email protected] Subject: [Sepsis Groups] Joint Commission Performance Measure Time Zero OK so most of us have changed to time of triage for time zero I would assume. I had a meeting with our data abstractor for Sepsis Core Measures yesterday and she mentioned time zero would be changing. She then showed me the manual for the data abstractors. It stated for Septic Shock Present the following: Criteria There must be documentation of severe sepsis present AND Tissue hypoperfusion persists after crystalloid fluid administration evidenced by either SBP <90, or MAP<65, or a decrease in SBP by >40points OR Lactate level is >4 Soooo My abstractor was under the impression this would be the new time zero based on this. There was a sheet on Severe Sepsis Present as well. What concerns me is that based on documentation is what will que them for time zero. I am worried that there will be delays in care if that is how it will be determined. What are everyone?s thoughts? Am I missing something? Will everyone just stay with time zero that we feel is ?clinically correct? and consistent across the country and just let core measures monitor something different? Can someone help me understand this. I really hope I am not reading something correctly or just not understanding. Thank you in advance - I am soo grateful for this List serve!!! Angela Craig APN,MS,CCNS Clinical Nurse Specialist Intensive Care Unit Cookeville Regional Medical Center 931-783-5035 ________________________________ The materials in this email are private and may contain Protected Health Information. If you are not the intended recipient, be advised that any unauthorized use, disclosure, copying, distribution or the taking of any action in reliance on the contents of this information is strictly prohibited. If you have received this email in error, please immediately notify the sender. -------------- next part -------------- An HTML attachment was scrubbed... URL: <http://lists.sepsisgroups.org/pipermail/sepsisgroups-sepsisgroups.org/attachments/20150529/ea10e163/attachment.htm> ------------------------------ Subject: Digest Footer _______________________________________________ Sepsisgroups mailing list [email protected] http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org ------------------------------ End of Sepsisgroups Digest, Vol 159, Issue 1 ******************************************** ________________________________ This email and any files transmitted with it may contain confidential and /or proprietary information in the possession of WellStar Health System, Inc. ("WellStar") and is intended only for the individual or entity to whom addressed. 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