There is a thread of confusion in this string. As regards consensus definitions of shock, lactate > 4 has long been considered a criterion when accompanied by all the other criteria meeting severe sepsis.
Are their differential considerations? Of course. Please be assured, however, experts in the campaign and those who devised the core measure didn't inadvertently include lactate as a criterion for shock. This is very unlikely to be seriously challenged or changed. On Nov 18, 2015, at 8:23 AM, Stephanie Wilson <[email protected]<mailto:[email protected]>> wrote: Thank you for the link and your response. We have had conversation with the physicians at our facility about the value and appropriate use of Lactate levels. However, it is still part of the Surviving Sepsis Campaign and we're stuck with Lactate levels being part of the criteria for determining Septic Shock in the Core Measures world, at least for the time being. How are others dealing with a perceived discrepancy between current literature and the Sepsis Core Measure guidelines? Not everything that counts can be counted, and not everything that can be counted counts. Stephanie Wilson, BSN Jordan Valley Medical Center Quality Reviewer/Core Measures 3870 West 9000 South West Jordan, Utah 84088 Office 801.561.8888 xt. 4526 Cell 801.580.8320 [email protected]<mailto:[email protected]> From: [email protected]<mailto:[email protected]> To: "Harkey,Jessica" <[email protected]<mailto:[email protected]>> Cc: sepsisgroups <[email protected]<mailto:[email protected]>>, "Tribuiani, Barbara" <[email protected]<mailto:[email protected]>> Date: 11/17/2015 06:55 AM Subject: Re: [Sepsis Groups] Septic Shock Present Sent by: "Sepsisgroups" <[email protected]<mailto:[email protected]>> ________________________________ This is the consensus definition of septic shock.It’s not about lab results but rather response to fluid. "Septic shock: sepsis with persisting arterial hypotension or hypoperfusion despite adequate fluid resuscitation.” Lactic acid is a measure of tissue hypoxia indicating severe sepsis defined as sepsis with organ dysfunction, hypotension or hypoperfusion. This is a good reference showing all of the lab indicators and their meaning. http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/infectious-disease/sepsis/ Lewis Holmes, MD, MPH Porter Medical Center On Nov 13, 2015, at 1:03 PM, Harkey,Jessica <[email protected]<mailto:[email protected]>> wrote: This patient has already coded out with a sepsis diagnosis, therefore the elevated lactate would be the criteria for septic shock. The way I understand the intent of the treatment, the measure and criteria, is that even if there were other types of lactic acidosis, the sepsis will more than likely be higher risk of mortality therefore treat the septic shock without delaying while other sources of lactic acidosis are considered. So infection + SIRS+ shock (lactate >4)= implement the bundle timely and treat sepsis first regardless of other potential sources of lactate. Then evaluate after the bundle has been completed. Jessica Harkey, MSN, RN, ACCNS, CCRN Sepsis Program Coordinator San Joaquin Community Hospital Sent from my iPad using Mail+ for Outlook<http://taps.io/mailplus> From: Mary ann David Sent: 11/12/15, 9:48 PM To: 'Barnes-Daly, Mary Ann', 'Tribuiani, Barbara', sepsisgroups Subject: Re: [Sepsis Groups] Septic Shock Present However, there are other reasons lactate can be elevated but not septic shock such as cardiac arrest, ischemia, burns, liver failure, etc. Shouldn’t those be considered? Thanks, Mary Ann David, MSN, RN, CNS, ACNS-BC Clinical Nurse Specialist, MICU/SICU/RRT Sharp Chula Vista Medical Center Tel. No. 619-502-3165 Hospital Cell No. 619-502-5578 Pager No. 619-688-7124 Fax. No. 619-502-4076 Email. [email protected]<mailto:[email protected]> From: Sepsisgroups [mailto:[email protected]] On Behalf Of Barnes-Daly, Mary Ann Sent: Tuesday, November 10, 2015 10:30 AM To: 'Tribuiani, Barbara'; '[email protected]<mailto:[email protected]>' Subject: Re: [Sepsis Groups] Septic Shock Present Physician documentation is used only if the other criteria are not found. In this case, severe sepsis is present – so the Lactate of 4.3 = septic shock 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 Tribuiani, Barbara Sent: Wednesday, November 04, 2015 10:21 AM To: '[email protected]<mailto:[email protected]>' Subject: [Sepsis Groups] Septic Shock Present Hello All- I have a patient who meets criteria for septic shock due to the initial lactate of 4.3 however the physicians clearly document that the patient has “severe sepsis without shock” How do I answer the question “septic shock present” in this case?? Thank you, Barb Barbara Tribuiani, RN, BSN Quality Improvement Department Phone: 610-237-4208 Fax: 610-237-4264 T Together E Everyone A Achieves M More Confidentiality Notice: This e-mail, including any attachments is the property of Trinity Health and is intended for the sole use of the intended recipient(s). It may contain information that is privileged and confidential. Any unauthorized review, use, disclosure, or distribution is prohibited. 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