We are aware of the seeming contradiction. We intend to update the CMS data dictionary to fix this. The bolus should be given for hypotension or lactate >=4. While we all shorthand this for shock, to read the guidelines and measure consistently, we have to think of that as simply hypotension. Lactate doesn't matter here -- greater than equal to 4 is shock and we don't expect the bolus to rectify that initial lactate and take away the diagnosis of shock during the 6 hour bundle time frame. But hypotension becomes shock when refractory to fluids. So what's on pages 1-15 will get reworded to give it for hypotension.
The obvious difficulty is we are assigning hard times to what is clearly a spectrum of disease. So, it will be artificial at times. 90+ percent of the time it's smooth enough, but you can define flawed spaces in such a measure. On Jun 9, 2015, at 4:56 AM, Jeanie Bollinger <[email protected]<mailto:[email protected]>> wrote: This list serve has been very helpful for those of us working on sepsis and the CMS core measure. The SCCM guidelines state that 30ml/kg is to be given for severe sepsis (organ dysfunction and 2 SIRS due to a suspected or documented infection) at a rate of 30ml/kg. See table page 596 of the SCCM guidelines. If hypotension persists or LA >4, the SCCM defines this as septic shock. This is where I am confused. On page 1-15 of the CMS rules, our team is interpreting that that fluids 30ml/kg are given after presentation of septic shock. This seems to contradict the SCCM new bundle guidelines. How is CMS defining septic shock? Any other 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 ________________________________ ________________________________ This message and its attachments may contain confidential and/or legally-sensitive information that is intended for the sole use of the addressee(s). Any unauthorized review, use, disclosure, or distribution of the information contained in this message and its attachments is prohibited. If you have received this message or any of its attachments in error, please destroy all originals and copies of the same and notify the sender immediately. _______________________________________________ Sepsisgroups mailing list [email protected]<mailto:[email protected]> http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org _______________________________________________ Sepsisgroups mailing list [email protected] http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org
