Hello, It is my interpretation from the CMS algorithm, In the scenario below the patient would not fail fluids because they would be excluded from that component. In the algorithm you would have to answer no to shock present (because enough fluid was not given) and the case would not make it to the fluid step. It looks like in the algorithm first you determine if shock is present and then evaluate fluids. It seems backwards.
Correct? It definitely does not make sense. Cindy Cynthia Wells Steward Health Care Director of Clinical Performance Analytics (508) 404-8647 -----Original Message----- From: Sepsisgroups [mailto:[email protected]] On Behalf Of Townsend, Sean, M.D. Sent: Tuesday, September 29, 2015 8:20 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 _______________________________________________ Sepsisgroups mailing list [email protected] http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org
