Jeanie,
We have been sending questions through the IQR and receiving responses. I have 
attached a response we received regarding your questions below. According to 
this answer we can take fluids prior, even from EMS. The challenge for us; the 
amount received is not consistently documented by EMS or ED RN. Difficult to 
“count” in for the amount to be given if no amount documented.
Hope this helps.

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]>

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From: Sepsisgroups [mailto:[email protected]] On 
Behalf Of Jeanie Bollinger
Sent: Tuesday, June 02, 2015 11:22 AM
To: '[email protected]'
Subject: [Sepsis Groups] CMS fluid metric

Hello all,
I wanted to ask a question pertaining to the fluid metric.  It appears that CMS 
is not giving any “credit” to any fluid given prior to hypotension or lactate 
>4.  The issue we are having is that if a patient presents with severe sepsis 
and organ dysfunction, is tachycardiac and is given a fluid bolus proactively 
prior to hypotension or getting the lactate results back, that fluid is not 
counted in the resuscitation bolus compliance metric.  What are everyone 
thoughts on this issue?  Also if patient is hypotensive for EMS and receives 
fluid PTA, these fluids are not counted either.  Thoughts?

Jeanie Bollinger RN,MSN,ACCNS-AG, CCRN
Sepsis Clinical Nurse Specialist
Center For Nursing Excellence
Mission Health
Asheville, NC.

Phone 828-213-7171
Pager 207-2363

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Attachment: Fluid Administration.docx
Description: Fluid Administration.docx

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