Any part? The guidelines only specify antibiotics, blood draw, or fluids. Karen Belfi, RN, MSN Quality Outcomes Coordinator Lankenau Medical Center 484-476-8092 Pager: 5240 [cid:[email protected]]
From: Sepsisgroups [mailto:[email protected]] On Behalf Of Barnes-Daly, Mary Ann Sent: Wednesday, October 21, 2015 5:15 PM To: 'Prabhakar, Brenda'; '[email protected]' Subject: Re: [Sepsis Groups] DNR, DNI, and comfort care with regards to the septic shock requirements If patients are refusing any part of the required severe sepsis or septic shock bundle and there is documentation to that effect they are excluded due to "administrative reasons" Thanks, MARY ANN BARNES-DALY RN BSN CCRN DC | Clinical Performance Improvement Consultant Sutter Health - Office of Patient Experience | 2200 River Plaza Drive, Sacramento, CA 95833 Mobile 916.200.5604| Office 916.286.6717 | [email protected]<mailto:[email protected]> "You never change things by fighting the existing reality. To change something, build a new model that makes the existing model obsolete." ~R. Buckminster Fuller From: Sepsisgroups [mailto:[email protected]] On Behalf Of Prabhakar, Brenda Sent: Wednesday, October 21, 2015 4:50 AM To: [email protected]<mailto:[email protected]> Subject: [Sepsis Groups] DNR, DNI, and comfort care with regards to the septic shock requirements Hello everyone. Thank you all for you questions and answers online. They've been very helpful. My physicians are wondering how to handle those patients who have advanced directives but are not yet comfort care. * If they are refusing vasopressors, is it correct that they would NOT be included in the measure for septic shock with persistent hypotension? They are refusing one the measure components to give vasopressors. * If they are a DNI (Do Not Intubate), often times the physicians are concerned they could put their patients into CHF if they order the full 30ml/kg fluid bolus without the ability to intubate if required. I've read the prior lively discussions about fluid resuscitation and the lack of data reporting any harm from administering the boluses, but Dr. Townsend also brought up the good point that intubation isn't always an adverse outcome. Any insight with how to manage these patients would be greatly appreciated. Thank you, Brenda Prabhakar RN BSN Sepsis Steering Committee Co-Chair Doylestown Hospital Doylestown, PA
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