FYI...
Subject Vasopressor Administration Discussion Thread Response Via Email (Bob Dickerson) 12/14/2015 06:42 PM Hi Robin, Thank you for your questions. Most patients that are going to respond to crystalloid fluids will exhibit a response after 30 mL/kg. There are some that respond to less, some that require more and many that do not respond. It is virtually impossible to build a measure that takes into account every possible variation in how patients may respond. As such the measure was designed to account for the majority of cases. If in the clinical judgment of the treating physician they feel that giving more crystalloid fluids as opposed to starting vasopressors is in the best interest of the patient and not doing so may be detrimental to the patient then clinical judgment should be used. I hope this helps. Auto-Response 10/30/2015 04:56 PM 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&b lobwhere=1228890481688&blobheader=multipart%2Foctet-stream&blobheadernam e1=Content-Disposition&blobheadervalue1=attachment%3Bfilename%3DHos_Seps is-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_We binar-August_SEP-1-Part-I-20150824-vFINAL-5081.pdf> , and Q&As <http://www.qualityreportingcenter.com/wp-content/uploads/2015/09/8-24-1 5-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_We binar-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_Sep is_series-Flyer-vFINAL-1508.pdf <http://www.qualityreportingcenter.com/wp-content/uploads/2015/08/IQR_Se pis_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 (Robin Myran) 10/30/2015 04:56 PM The sepsis protocol at our hospital includes the administration of 30 cc/kg crystalloid for hypotension or lactate >=4. If the patient remains hypotensive after the initial bolus, we have the option of administering an additional 30 cc/kg. Often this second bolus works to achieve a sustained MAP >=65. According to the specifications manual for SEP-1, we *must* start a vasopressor by the 6th hour if the patient remains hypotensive in the hour after the initial bolus is complete, correct? The Surviving Sepsis Campaign's recommendations include "a minimum of 30 mL/kg of crystalloids" and that "greater amounts of fluid may be needed in some patients." They go on to say that "fluid administration is continued as long as there is hemodynamic improvement". My physicians will always go to more fluids first (if the patient remains fluid responsive) before starting vasopressors. Can you provide additional information/clarification so I can educate my physicians? Question Reference #151030-000140 Escalation Level: 5 Business Days Product Level 1: Inpatient Quality Reporting Date Created: 10/30/2015 04:56 PM Last Updated: 12/14/2015 06:42 PM Status: Solved Discharge Period: 10/01/2015 - 06/30/2016 CCN: Robin Myran, MSN, RN, PCCN Sepsis Coordinator Hoag Memorial Hospital Presbyterian One Hoag Drive Newport Beach, CA 92658 Office: (949) 764-4588 Fax: (949) 764-5387 Cell: (949) 300-9137 [email protected] <mailto:[email protected]> Please note that the information contained in this message and any files transmitted with it are privileged and confidential and are protected from disclosure under the law, including the Health Insurance Portability and Accountability Act (HIPAA). If the reader of this message is not the intended recipient, or an employee or agent responsible for delivering this message to the intended recipient, you are hereby notified that any dissemination, distribution or copying of this communication is strictly prohibited and may subject you to criminal or civil penalties. If you have received this communication in error, please notify the sender by replying to the message and delete the material from any computer. Thank you, Hoag Memorial Hospital Presbyterian and its Affiliates
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