The guidelines (hypotensive and/or lactate greater than 4) are for shock treatment. This does not mean that you should wait for shock to treat sepsis or severe sepsis.....we want to avoid shock if possible. Survivability goes down once shock is reached. Early administration of antibiotics and fluid (before shock sets in) may prevent progression into shock. Prevent shock and improve patient survival rates. That is the goal of this entire exercise.
The CMS measure looks at fluids within 3 hours of septic shock presentation (not within 3 hours after diagnosis/hypotension/lactate). If the fluids (30 ml/kg) are administered during the sepsis/severe sepsis phase, and within 3 hours of shock presentation/diagnosis, they will count towards the measure. We may have to repeat the fluid administration if the patient goes hypotensive/lactate >4 more than 3 hours after the initial 30 ml/kg fluids. If a patient goes hypotensive after that time, they probably need another fluid bolus! Our intensivist says "You can treat fluid overload; you can't treat dead." Give the fluids! The patient may not develop septic shock if provided early abx and fluids. Isn't that our goal? Prevent shock and we don't have to worry about provider documented passive leg raise assessments or central line placements. Unfortunately, the CMS focus on septic shock assessment and treatment is sending us down a different path from the surviving sepsis focus of early identification and intervention. We administer empiric antibiotics rather than waiting for lab and micro results, tailoring the antibiotics to the specific pathogen once it is identified. We have worked so hard to get the providers to give the fluids and antibiotics early! I will consider our program successful as we reduce the avoidable conversions from sepsis/severe sepsis into septic shock. That will translate into real lives saved. I have not figured out how I will identify these cases, or validate the avoidance of septic shock in individual cases - though tracking our case denominators and mortality rates may show the rate reduction over time. Lactic acid levels and fluid administration volumes and times are much easier metrics to track. It is very hard to report septic shock that was averted by timely clinical interventions. So....we are stuck with metrics that are problematic. Kathy The Patient Comes First. Does this put the Patient First? Kathryn L. Tucker RN BS JD Quality Improvement Coordinator FF Thompson Health Canandaigua, NY 14424 Office 585-919-3880 Cell (personal) 585-748-5279 CONFIDENTIALITY NOTICE This e-mail message, including any attachments, is for the sole use of the intended recipient(s) and may contain information that is proprietary, confidential, and exempt from disclosure under applicable law. Any unauthorized review, use, disclosure, or distribution is prohibited. If you are not the intended recipient or agent responsible for delivering the message to the intended recipient, or if you have received this communication in error, please notify the sender by return e-mail and destroy all copies of the original message Thompson Health Named One of the 150 Great Places to Work in Healthcare by Becker's Hospital Review -----Original Message----- From: Sepsisgroups [mailto:[email protected]] On Behalf Of [email protected] Sent: Friday, October 16, 2015 1:20 PM To: [email protected] Subject: Sepsisgroups Digest, Vol 175, Issue 6 Send Sepsisgroups mailing list submissions to [email protected] To subscribe or unsubscribe via the World Wide Web, visit https://urldefense.proofpoint.com/v2/url?u=http-3A__lists.sepsisgroups.org_listinfo.cgi_sepsisgroups-2Dsepsisgroups.org&d=BQICAg&c=4sF48jRmVAe_CH-k9mXYXEGfSnM3bY53YSKuLUQRxhA&r=r9TCrDIO6gDxR5pVxvLp6ZMJGAIAi5mk7P1ps_740bbyThcvO6h4qg7bxcQGH6s1&m=_z7fB4iXzLkKo1dYpocAn_K2YlToiV3_SVdI1P5agHs&s=yUaKSEigBWPMzGigYZDzRPTUa5T7594FydUHbGbmzjA&e= 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. fluids ([email protected]) ---------------------------------------------------------------------- Message: 1 Date: Fri, 16 Oct 2015 15:09:34 +0000 From: <[email protected]> To: <[email protected]> Subject: [Sepsis Groups] fluids Message-ID: <23319868f1cf9c4ca1a7ba82cfd61315114b4...@fwdcwpmsghcmd4b.hca.corpad.net> Content-Type: text/plain; charset="us-ascii" Ok, simple question...so, to clarify.....we give fluid when the patient screens positive for severe sepsis? Or we specifically wait to give fluids when the patient is hypotensive and/or lactate greater than 4 - which is septic shock already. Just want to make sure I'm teaching this correctly because I'm constantly asked in the ER. The guidelines say when the patient is hypotensive and/or lactate greater than 4. Thank you, 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]] -------------- next part -------------- An HTML attachment was scrubbed... URL: <https://urldefense.proofpoint.com/v2/url?u=http-3A__lists.sepsisgroups.org_pipermail_sepsisgroups-2Dsepsisgroups.org_attachments_20151016_a4575f17_attachment.htm&d=BQICAg&c=4sF48jRmVAe_CH-k9mXYXEGfSnM3bY53YSKuLUQRxhA&r=r9TCrDIO6gDxR5pVxvLp6ZMJGAIAi5mk7P1ps_740bbyThcvO6h4qg7bxcQGH6s1&m=_z7fB4iXzLkKo1dYpocAn_K2YlToiV3_SVdI1P5agHs&s=VTPUS4U60R7K2nmDY6yYzeHAemQNnjnFVDIG7xzw8u4&e= > -------------- next part -------------- A non-text attachment was scrubbed... Name: image003.jpg Type: image/jpeg Size: 18061 bytes Desc: image003.jpg URL: <https://urldefense.proofpoint.com/v2/url?u=http-3A__lists.sepsisgroups.org_pipermail_sepsisgroups-2Dsepsisgroups.org_attachments_20151016_a4575f17_attachment.jpg&d=BQICAg&c=4sF48jRmVAe_CH-k9mXYXEGfSnM3bY53YSKuLUQRxhA&r=r9TCrDIO6gDxR5pVxvLp6ZMJGAIAi5mk7P1ps_740bbyThcvO6h4qg7bxcQGH6s1&m=_z7fB4iXzLkKo1dYpocAn_K2YlToiV3_SVdI1P5agHs&s=oTBhwE5GqypTTL9T5DkGVq5IWj30KOYF2dG5D6Livq8&e= > ------------------------------ Subject: Digest Footer _______________________________________________ Sepsisgroups mailing list [email protected] https://urldefense.proofpoint.com/v2/url?u=http-3A__lists.sepsisgroups.org_listinfo.cgi_sepsisgroups-2Dsepsisgroups.org&d=BQICAg&c=4sF48jRmVAe_CH-k9mXYXEGfSnM3bY53YSKuLUQRxhA&r=r9TCrDIO6gDxR5pVxvLp6ZMJGAIAi5mk7P1ps_740bbyThcvO6h4qg7bxcQGH6s1&m=_z7fB4iXzLkKo1dYpocAn_K2YlToiV3_SVdI1P5agHs&s=yUaKSEigBWPMzGigYZDzRPTUa5T7594FydUHbGbmzjA&e= ------------------------------ End of Sepsisgroups Digest, Vol 175, Issue 6 ******************************************** _______________________________________________ Sepsisgroups mailing list [email protected] http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org
