So has CMS changed the definition of septic shock from "infection + 2 sirs + hypotension or lactate > 4" to "infection + 2 sirs + hypotension or lactate > 4 that persists after 30ml/kg of fluid"? Or is this how is the definition was meant to be intended all along since the beginnings of Surviving Sepsis?
Daniel Gerard RPh Critical Care Pharmacist McLaren Northern Michigan 231-487-4770 FAX: 213-487-4817 ________________________________________ From: Sepsisgroups <[email protected]> on behalf of [email protected] <[email protected]> Sent: Thursday, June 4, 2015 1:15:34 PM To: [email protected] Subject: Sepsisgroups Digest, Vol 159, Issue 11 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 (Izard, Kimberly) 2. Re: CMS fluid metric (Izard, Kimberly) ---------------------------------------------------------------------- Message: 1 Date: Tue, 2 Jun 2015 20:52:15 +0000 From: "Izard, Kimberly" <[email protected]> To: "Gerard, Daniel" <[email protected]>, "[email protected]" <[email protected]> Subject: Re: [Sepsis Groups] Sepsisgroups Digest, Vol 158, Issue 6 Message-ID: <[email protected]> Content-Type: text/plain; charset="iso-8859-1" The criteria you list below would not equal time 0 for severe sepsis. The manual states septic shock presentation (time 0) is determined by two criteria: MD documentation of septic shock AND tissue hypoperfusion persisting after fluid administration ( they list metrics for identifying hypoperfusion) Typically we see MD documentation of septic shock and that starts the clock. As far as I can tell, CMS does not track time from hypotension to fluid bolus. It does track time fluids finished; up to one hour after completion. That is used to determine persistent hypotension. Which then calls for the rest of the bundle. 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 Gerard, Daniel Sent: Friday, May 29, 2015 3:29 PM To: [email protected] Subject: Re: [Sepsis Groups] Sepsisgroups Digest, Vol 158, Issue 6 We changed triage time to time of onset of hypotension/lactate >4 a while back as time zero. It made sense and that is what our state quality improvement project had been collecting. I have the same concerns about time 0 in a pt with clear septic shock being AFTER fluid administration and BP status is known. Time from hypotension to fluid bolus seems like one of the most important parts of the bundle. i assume the time after the fluid bolus if lactate > 4 would also be considered time 0 regardless of blood pressure? Daniel Gerard RPh Critical Care Pharmacist McLaren Northern Michigan 231-487-4770 FAX: 213-487-4817 ________________________________________ From: Sepsisgroups <[email protected]> on behalf of [email protected] <[email protected]> Sent: Friday, May 29, 2015 8:30 AM To: [email protected] Subject: Sepsisgroups Digest, Vol 158, Issue 6 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. 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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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. CONFIDENTIALITY NOTICE: This email message and any attachments are intended solely for the intended recipient(s), may contain confidential and/or privileged information and may be legally protected from disclosure. If you are not the intended recipient of this message, or if this message has been addressed to you in error, immediately alert the sender by reply email and delete this message and any attachments. If you are not the intended recipient, you are hereby notified that any use, dissemination, copying, or storage of this message or its attachments is strictly prohibited. CONFIDENTIALITY NOTICE: This email message and any attachments are intended solely for the intended recipient(s), may contain confidential and/or privileged information and may be legally protected from disclosure. If you are not the intended recipient of this message, or if this message has been addressed to you in error, immediately alert the sender by reply email and delete this message and any attachments. If you are not the intended recipient, you are hereby notified that any use, dissemination, copying, or storage of this message or its attachments is strictly prohibited. _______________________________________________ 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: 2 Date: Tue, 2 Jun 2015 20:57:23 +0000 From: "Izard, Kimberly" <[email protected]> To: Jeanie Bollinger <[email protected]>, "'[email protected]'" <[email protected]> Subject: Re: [Sepsis Groups] CMS fluid metric Message-ID: <[email protected]> Content-Type: text/plain; charset="utf-8" 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]> [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 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. 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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. CONFIDENTIALITY NOTICE: This email message and any attachments are intended solely for the intended recipient(s), may contain confidential and/or privileged information and may be legally protected from disclosure. If you are not the intended recipient of this message, or if this message has been addressed to you in error, immediately alert the sender by reply email and delete this message and any attachments. If you are not the intended recipient, you are hereby notified that any use, dissemination, copying, or storage of this message or its attachments is strictly prohibited. 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