I had submitted this question since one of our infectious disease physicians questioned giving additional antibiotics if patients were known to have C Diff or MRSA. Here's a copy of the response from CMS:
Gena, Thank you for your questions. There is no exclusion for C diff infections. The initial antibiotic options for Severe Sepsis are appropriate and based on guidelines for Severe Sepsis. There are a number of factors to take into consideration. Generally speaking, the antibiotic that resulted in C diff should be stopped and oral Flagyl or oral Vancomycin given. Either of these can certainly be given along with any of the antibiotics options for Severe Sepsis. Severity of C diff may also dictate treatment. The antibiotics for severe sepsis are ONLY for initial empiric treatment to ensure all possible causative organisms are covered. As soon as the causative organism is identified antibiotic therapy should be adjusted accordingly. It would also not be good practice to withhold antibiotics necessary to treat a severe infection if a patient also has C diff. Antibiotics may need to be changed to meet the patient's needs. Also, according to Table 5.0 Antibiotic Monotherapy, Sepsis in Appendix C of the IQR program specifications manual, Vancomycin is not acceptable as monotherapy. Patients should never be treated to meet a measure. Patients should be treated according to their individual needs based on the best available clinical evidence. Some patients will have multiple conditions for which no single guideline can adequately address their needs. Clinical practice guidelines are designed to meet the needs of the majority of patients with a given condition. There will always be complex cases that fall outside of the intent of the guidelines and cannot be treated according to guidelines. The quality measures are based upon clinical practice guidelines. CMS recognizes the complexity of care and that a measure cannot be designed to meet every possible scenario that may present. As such there is not an expectation that all cases will meet every component of the measure. There will be a small number of outlier cases that fall outside of the scope of the guidelines and the measures and will not meet the measure. Building exclusions for all of these possible scenarios is not possible. Thanks, Gena Henriques, MSN, RN Sepsis Coordinator Tulane Medical Center 1415 Tulane Ave. New Orleans, LA 70112 Phone: 504-988-3195 Think Sepsis: Save A Life From: Sepsisgroups [mailto:[email protected]] On Behalf Of Gluckner, Rhonda Sent: Tuesday, October 20, 2015 8:00 AM To: [email protected] Subject: [EXTERNAL] [Sepsis Groups] anbitiotic choice I have a question posed to me about antibiotic choices by one of our physicians. I apologize if this has already been asked, but there is so much confusion around certain aspects of this new metric. This scenario was presented to me: A patient arrives at the hospital (whether direct admit or through the ED) for admission to the hospital for positive blood cultures (previously drawn and results called to PCP) and the organism has been identified with sensitivities completed. If the sensitivities indicate an effective antibiotic that is not listed on the monotherapy, do we still have to administer the second antibiotic to fall in line with the metric despite what would obviously be over-use of an antibiotic and poor stewardship? I understand this scenario is probably not very realistic as one of the monotherapy antibiotics is probably going to be listed as an effective antibiotic on the sensitivities, but I was asked to pose this question to the group. Thanks everyone for you input! Rhonda Gluckner, BSN, RN Sepsis Coordinator, Mercy Health-Youngstown Co-Chair, Mercy Health Sepsis Management Advisory Team Office: 330.480.2935 Pager: 330.229.2035 Fax: 330.480.3177 [email protected]<mailto:[email protected]> CONFIDENTIALITY NOTICE: This message, including any attachments, is for the sole use of the intended recipient(s) and may contain confidential and privileged information. Any unauthorized review, use, disclosure or distribution is prohibited. If you are not the intended recipient, please contact the sender by reply e-mail and destroy all copies of the original message.
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