This is the latest response we have received. Hope it helps!
Subject Septic Shock Present Discussion Thread Response Via Email (Mary Cox) 11/17/2015 03:44 PM Please refer to the specifications notes for abstraction. Based on V5.0b, Septic Shock - We are aware there are some cases were 2 different notes for abstraction "fit" the case, and one indicates Value "1" while the other indicates Value "2". There will be some changes for 7/1/16 discharges, which CMS is aware of. At this time, we are not able to make them effective until that time. The 2 are: * If crystalloid fluids were not administered after the presentation date and time of severe sepsis, choose Value "2." ---- In this case, there must have been NO crystalloid fluids administered. If there are some, but not the 30mL/kg requirement, this cannot be used. It could be that the criteria were not met and there IS physician/APN/PA documentation of Septic Shock. If NO crystalloid fluids were given, select this response. * If criteria for Septic Shock are not met, but there is physician/APN/PA documentation of Septic Shock, choose Value "1." --- If ANY crystalloid fluids were given, select this response. Customer By Web Form 11/13/2015 06:39 AM Question #3. Does this mean no crystalloids or just not the full amount of 30ml/kg? Also, the specs manual does say if the criteria are not met but there is documentation of septic shock, answer value 1. Your answer seems to contradict that dot point but does the dot point "if crystalloid fluids are not administered after the presence of severe sepsis choose value 2" come into play? Please clarify. Thank you. Response Via Email (Mary Cox) 11/12/2015 05:42 PM 1. If the patient does not receive a crystalloid bolus in the full amount of 30ml/kg after presentation of severe sepsis, I would answer NO to septic shock present even if the initial lactate was equal to or greater than 4.0? No. If Severe Sepsis is present and the Initial Lactate level is >=4, that meets the criteria for Septic Shock. 2. If the patient met criteria for severe sepsis but did not receive crystalloid bolus in the full amount of 30ml/kg, I would answer NO to Septic Shock Present. Yes. They cannot meet the Hypotention persists in the hour after conclusion of the 30mL/kg Crystalloid Fluid administration if the fluid amount is not given. Therefore, unless they have the Initial Lactate >=4, they cannot meet the criteria for Septic Shock. 3. If the patient has physician documentation of septic shock but did not meet criteria and did not receive the 30 ml/kg crystalloid fluids, I would answer NO to septic shock? Please give rationale for your responses. You are correct. This goes to the inability to determine persistent hypotension since no fluids were given. 09/23/2015 09:28 AM . Customer By Web Form 09/23/2015 09:02 AM I have had several responses regarding septic shock present, 150608-000083, 150626-00014 and 150601-000032 to mention a few. The responses seem to be conflicting. The specs manual states, "If crystalloid fluids were NOT administered after the presentation date and time of Severe Sepsis, select Allowable Value "2 (No)." and " If criteria for Septic Shock are not met, but there is physician/APN/PA documentation of Septic Shock, choose Value "1 (Yes)" I have two examples and please tell me if I am correct in my assumptions. 1. If the patient does not receive a crystalloid bolus in the full amount of 30ml/kg after presentation of severe sepsis, I would answer NO to septic shock present even if the initial lactate was equal to or greater than 4.0? 2. If the patient met criteria for severe sepsis but did not receive crystalloid bolus in the full amount of 30ml/kg, I would answer NO to Septic Shock Present. 3. If the patient has physician documentation of septic shock but did not meet criteria and did not receive the 30 ml/kg crystalloid fluids, I would answer NO to septic shock? Please give rationale for your responses. Question Reference #150923-000018 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: 09/23/2015 09:02 AM Last Updated: 11/17/2015 03:44 PM Status: Resolved (IP only) Discharge Period: N/A CCN: Thank you, Kim Kim Izard | Team Leader - Clinical Outcomes SSMHealth - St. Louis/Southern Illinois Regions 1015 Corporate Square Drive Suite 240 Creve Coeur, MO 63132 Office - 314-989-2137 Cell - 618-670-3616 kimberly_iz...@ssmhc.com<mailto:kimberly_iz...@ssmhc.com> [MSC:SYS:SYS_15_8403_2015_SSMHealth_StyleGuide:images:SSMHealth_Standard_EmailSignature2.jpg] This e-mail message is confidential, intended only for the named recipient(s) above and may contain information that is privileged or exempt from disclosure under applicable law. If you are not the intended recipient(s), you are notified that the dissemination, distribution or copying of this message is strictly prohibited. If you received this message in error, or are not the named recipient(s) please notify the sender at the e-mail address or telephone number above and delete this e-mail from your computer. Thank you! From: Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On Behalf Of Belfi, Karen Sent: Tuesday, November 24, 2015 6:22 AM To: 'sepsisgroups@lists.sepsisgroups.org' <sepsisgroups@lists.sepsisgroups.org> Subject: Re: [Sepsis Groups] Septic Shock Present [Incident: 151007-000178] 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:25FFED76-F7F0-4047-910F-0D7077ED1E1E] 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). 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