This is even more confusing. You have one answer that say physician 
documentation is enough even with all the criteria is not present. Then you 
have an answer that if no fluid is given with clinical septic shock, sep1 does 
not recognize septic shock unless fluid bolus is given.

Not sure why there is this distinction for the measure. If the patient is 
hypertensive, we want to get the clinical team to give fluid and get the 
resuscitation completed. If there is no fluid given and the measure then counts 
the patient only as severe sepsis and allow the 6 hr measure to be skipped and 
not recognize the clinical shock then this is counter to what his been shown to 
work.
It seems to me that if hospitals design their sepsis protocol to meet the cms 
measure, put care would suffer in this instance.

Sent from Outlook Mobile<https://aka.ms/blhgte>



On Thu, Jan 28, 2016 at 12:39 PM -0800, "Mary Draper" 
<[email protected]<mailto:[email protected]>> wrote:

Thanks Dr. Townsend.

Mary Draper RN BSN
Coordinator Quality Improvement
Peer Review Support CV/CT
Quality Management JMH
Office (925) 674-2045
Cell (925) 451-8792
Fax (925) 674-2373
[email protected]

“O, let us always have a mountain within our soul,  with a peak so high that we 
never quite reach the top…
  For then we will always strive for greater things and will not be content  
with merely climbing hills.”     Ardath Rodale



-----Original Message-----
From: Sepsisgroups [mailto:[email protected]] On 
Behalf Of Townsend, Sean, M.D.
Sent: Tuesday, January 26, 2016 7:53 PM
To: Belfi, Karen
Cc: [email protected]
Subject: Re: [Sepsis Groups] Septic Shock Presentation Time

I have to retract my comment.  I think 10:47 is accurate.

On Jan 26, 2016, at 7:41 PM, Townsend, Sean, M.D. <[email protected]> 
wrote:

I don't see criteria met at 10:47.  MD say so is not enough.

On Jan 25, 2016, at 1:02 PM, Belfi, Karen 
<[email protected]<mailto:[email protected]>> wrote:

10:47 would be septic shock time. It’s the earliest time criteria is met.

Karen Belfi, RN, MSN
Quality Outcomes Coordinator
Lankenau Medical Center
484-476-8092
Pager: 5240
<image001.png>

From: Sepsisgroups [mailto:[email protected]] On 
Behalf Of [email protected]<mailto:[email protected]>
Sent: Wednesday, January 20, 2016 9:15 PM
To: 
[email protected]<mailto:[email protected]>
Subject: [Sepsis Groups] Septic Shock Presentation Time

Clinical criteria for severe sepsis is met at 1002. Crystalloid bolus completed 
at 1247. SBP=79 @ 1300. SBP=87 @1330.
Initial lactic acid =4.0 resulted at 1126.
ED physician note started at 1047 containing documentation of possible septic 
shock.
Would septic shock presentation time be 1047, 1126 or 1300?

Karen King, RN MSN
Quality Management Core Measures Specialist, Lead Lakeview Regional Medical 
Center
95 Judge Tanner Boulevard
Covington, LA  70433
Office: (985) 867-4467
Cell:  (985) 788-0585
Fax: (985) 867-4263
Email: [email protected]<mailto:[email protected]>

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