This answer doesn't address crystalloid fluids, however. In the CMS power point, Bob stated that the patient needed to receive crystalloid fluids in order to select septic shock if only criteria is lactate.
Karen Belfi, RN, MSN Quality Outcomes Coordinator Lankenau Medical Center 484-476-8092 Pager: 5240 [cid:image001.png@01D12688.DA9B3EB0] From: Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On Behalf Of Tribuiani, Barbara Sent: Friday, November 20, 2015 10:54 AM To: 'sepsisgroups@lists.sepsisgroups.org' Subject: [Sepsis Groups] FW: Septic Shock Present [Incident: 151007-000178] Hello All- Please see below response form Qnet re: septic shock present. I found this to be very helpful. Barb From: IQR Q&A System [mailto:cms...@mailps.custhelp.com] Sent: Friday, November 20, 2015 10:11 AM To: Tribuiani, Barbara Subject: Septic Shock Present [Incident: 151007-000178] Recently you requested personal assistance from our on-line support center. Below is a summary of your request and our response. If this issue is not resolved to your satisfaction, you may reopen it within the next 2 days. Thank you for allowing us to be of service to you. To access your question from our support site, click here.<https://cms-ip.custhelp.com/app/account/questions/detail/i_id/267055> Subject Septic Shock Present Discussion Thread Response Via Email (Deb Lindner) 11/20/2015 10:10 AM Barbara, An addendum to the Specifications Manual for the National Hospital Inpatient Quality Reporting (IQR) Program (5.0b) has been posted to QualityNet at www.qualitynet.org/dcs/ContentServer?c=Page&pagename=QnetPublic%2FPage%2FQnetTier2&cid=1141662756099<http://www.qualitynet.org/dcs/ContentServer?c=Page&pagename=QnetPublic%2FPage%2FQnetTier2&cid=1141662756099>. There are 3 ways Septic Shock can be present: 1. Documentation of severe sepsis present and persistent hypotension in the hour after the conclusion of the 30 mL/kg Crystalloid Fluid Administration 2. Documentation of severe sepsis present and an initial lactate level is >= 4 mmol/L 3. Physician/APN/PA documentation of Septic Shock If you have documentation of severe sepsis being present and an initial lactate >= 4 mmol/L then you can answer "Yes" to Septic Shock Present. Response Via Email (Martha Boese) 10/08/2015 09:19 AM Due to the volume of inquires related to the SEP-1 measure we are experiencing a response lag time. Responses to SEP-1 questions are being answered daily. Please be reminded that Q&As are available in the QualityNet knowledge base tool<https://cms-ip.custhelp.com/app/answers/list/c/576> and a SEP-1 fact sheet <https://www.qualitynet.org/dcs/BlobServer?blobkey=id&blobnocache=true&blobwhere=1228890481688&blobheader=multipart%2Foctet-stream&blobheadername1=Content-Disposition&blobheadervalue1=attachment%3Bfilename%3DHos_Sepsis-FactSheet_082015.pdf&blobcol=urldata&blobtable=MungoBlobs> is posted on QualityNet. A recording<http://qualityreportingcenter.com/media/eventrecordings/IQR/IQR08242015/index.html>, slides<http://www.qualityreportingcenter.com/wp-content/uploads/2015/08/IQR_Webinar-August_SEP-1-Part-I-20150824-vFINAL-5081.pdf> , and Q&As<http://www.qualityreportingcenter.com/wp-content/uploads/2015/09/8-24-15-IQR-Q-A-Transcript_Responses.pdf> from the August 24th National Provider call are available for review. The recording<https://cc.readytalk.com/play?id=g35che> and slides<http://www.qualityreportingcenter.com/wp-content/uploads/2015/09/IQR_Webinar-September_SEP-1-PartII_FINAL2015-09-21_508.pdf> for September 21st are available for review. The following link will give you more information on the upcoming October 26th National Provider call and the opportunity to register for the event: http://www.qualityreportingcenter.com/wp-content/uploads/2015/08/IQR_Sepis_series-Flyer-vFINAL-1508.pdf. Please close your question if it is answered by these resources. We will continue working diligently to reduce response lag time in replying to questions. Customer By Web Form (barbara tribuiani) 10/07/2015 05:56 PM Hello, For this data element is lactate >4 (initial or repeat) enough to say "yes"? I know the other criteria is "peristent hypotension after 30ml/kg" but I am somewhat confused about how the lactate plays into this. Is it necessary to have "severe sepsis present" via all three criteria to answer "yes"? Thank you very much Question Reference #151007-000178 Escalation Level: 5 Business Days Product Level 1: Hospital Inpatient Quality Reporting Category Level 1: Hospital Inpatient - Sepsis Category Level 2: Septic Shock Present Date Created: 10/07/2015 05:56 PM Last Updated: 11/20/2015 10:10 AM Status: Resolved (IP only) Discharge Period: N/A CCN: [---001:002376:40406---] 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. If you are not the intended recipient, please delete this message, and reply to the sender regarding the error in a separate email.
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