Thank you Dr. Townsend, In my scenario septic shock WAS present. I abstracted MD documentation. Soon after the crystalloids completed, and BP was still < 90, they diagnosed /"documented" Shock and started Levophed. You are right, though, the case will fail the crystalloids part of the bundle because 30ml/kg was NOT given. I think that is how other abstractors are reading into this too. The recent IQR Webinar (Part2) the presenter, Bob, had a slide in which it states that 30ml/kg needed to be given in order to determine shock was PRESENT using the clinical criteria. So it sounds like if the abstractor can't determine (using the clinical criteria definition) you will have to resort to MD documentation (in cases that do indeed end up shock/vasopressors, etc.) Of course I asked QNET this question. I will let you know what the response is! Jennifer
________________________________________ From: Townsend, Sean, M.D. [[email protected]] Sent: Tuesday, September 29, 2015 5:20 PM To: Jennifer L Halligan [SJGH] Cc: [email protected] Subject: Re: [Sepsis Groups] Determining Septic Shock PRESENT -if 30ml/kg not given In thinking about this more, although it feels clinically odd, by the CMS definition we cannot formally declare shock. While I agree any clinician after a prolonged period of hypotension even if under-resuscitated would eventually call that shock (and it probably would be given prolonged hypoperfusion) for purposes of this measure it's not shock. Of course it doesn't clearly matter however because the measure will be failed for not giving the fluid. So it's a failure in any event. It's just that the bucket it would be assigned to is a severe sepsis failure rather than shock if you had the ability to parse these out. On Sep 29, 2015, at 2:34 PM, Jennifer L Halligan [SJGH] <[email protected]<mailto:[email protected]>> wrote: Hi, This question is for those abstractors out there (or maybe Dr. Townsend knows the answer), Am I correct to say that I cannot determine using "clinical criteria" if Septic Shock was PRESENT (septic shock present data element) if the crystalloids given did not total 30ml/kg needed? In my scenario the pt weight is 68.8 kg. (requires 2064 ml to meet 30ml/kg). Pt received 2 liters NS and in the hour after receiving this 2 L the BP did not respond (remained less than 90/map<65). In this scenario I can only use MD documentation of septic shock present, correct??? Thank you!! Jennifer Halligan, RN Quality Review Nurse San Joaquin General Hospital Tel: 209-468-7471 Fax: 209-468-7011 _______________________________________________ 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
