Hi. Not sure about what the CMS exclusions are off hand, but just a few thoughts.. While source control is key, if I am not mistaken the goals are to use least invasive method of source control once initial resuscitation takes place (most importantly antibiotics and fluids). The assessment of lactate and blood cultures are no less important just because the source is known...just like a known UTI or Pneumonia with sepsis. You still want to achieve lactate clearance post-operatively and promote antibiotic stewardship with cultures. It doesn't seem like poor utilization of resources to me at all. Just from reviewing cases I have seen outcomes that are much worse in patients who quickly go to the OR in severe sepsis without receiving the bundle...especially the intrabdominal cases with severe lactic acidosis, they tend to come out of surgery in shock and progress to multiple organ failure. We do not exclude urgent/emergent surgical cases from receiving the bundle.
Jessica Harkey, MSN, RN, ACCNS-AG, CCRN Manager of Clinical Practice and Sepsis Program Coordinator San Joaquin Community Hospital Bakersfield, CA 661-869-6874 [email protected]<mailto:[email protected]> [wr] From: Sepsisgroups [mailto:[email protected]] On Behalf Of Gerolamo, Jeannine Sent: Wednesday, June 03, 2015 1:12 PM To: [email protected] Subject: [Sepsis Groups] Surgical patients Does anyone know how the sepsis core measures will apply to patients with obvious need for emergency surgery (ex. Perforated viscus, infected diverticulitis, perforated appendix). Will we still be expected to obtain blood cultures, lactic acid when we know the cause of sepsis? Could be an enormous delay in treatment and poor utilization of resources. Thanks, Jeannine ________________________________ ****************** CONFIDENTIALITY NOTICE ********************** This e-mail contains LEGALLY PRIVILEGED AND CONFIDENTIAL INFORMATION intended only for the use of the recipient named above. If you are not 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 notify the transmitting hospital by telephone or e-mail and delete the original e-mail received in error. THIS INFORMATION HAS BEEN DISCLOSED TO YOU FROM RECORDS WHOSE CONFIDENTIALITY IS PROTECTED BY STATE AND FEDERAL LAW. ANY FURTHER DISCLOSURE, COPYING, DISTRIBUTION OR ACTION TAKEN IN RELIANCE ON THE CONTENTS OF THESE DOCUMENTS WITHOUT THE PRIOR WRITTEN CONSENT OF THE PERSON TO WHOM IT PERTAINS IS PROHIBITED. YOU ARE REQUIRED TO DESTROY THE INFORMATION AFTER THE STATED NEED HAS BEEN FULFILLED.
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