I sent the question regarding fluids and septic shock presentation to CMS and this is the response I received in November:
Gena, There are three ways to determine if Septic Shock is present. 1. Severe Sepsis present AND Hypotension persists in the hour after crystalloid fluid administration 2. Severe Sepsis present AND Initial Lactate level >= 4mmol/L 3. Physician documentation of septic shock For #2 - Crystalloid fluid administration is not required to determine whether the patient has septic shock if using the presence of severe sepsis and the lactate level to determine. Thanks, Gena Henriques, MSN, RN Quality Review Coordinator - Sepsis Tulane Medical Center 1415 Tulane Ave. New Orleans, LA 70112 Phone: 504-988-3195 Think Sepsis: Save A Life This email and any files transmitted with it may contain PRIVILEGED or CONFIDENTIAL information and may be read or used only by the intended recipient. If you are not the intended recipient of the email or any of its attachments, please be advised that you have received this email in error and that any use, dissemination, distribution, forwarding, printing, or copying of this email or any attached files is strictly prohibited. If you have received this email in error, please immediately purge it and all attachments and notify the sender by reply email or contact the sender at the number listed. -----Original Message----- From: Sepsisgroups [mailto:[email protected]] On Behalf Of Cobb, Amy L. Sent: Thursday, January 28, 2016 5:45 AM To: Townsend, Sean, M.D.; Belfi, Karen Cc: [email protected] Subject: [EXTERNAL] Re: [Sepsis Groups] Septic Shock Presentation Time Has something changed in the Spec Manual since the v5.0b came out? This is copied and pasted from the manual: *If criteria for Septic Shock are not met, but there is physician/APN/PA documentation of Septic Shock, choose Value “1.” Allowable Values: 1 (Yes) There is documentation of Septic Shock 2 (No) There is no documentation of Septic Shock, or unable to determine Dr. Townsend, can you clarify this if physician documentation is not enough and let us know if this was changed/updated? Thank you Amy Cobb RN, BSN Sepsis Coordinator Research Outcomes Morton Plant Hospital MS #73 300 Pinellas St. Clearwater, FL 33756 727-298-6953 (Desk) 727-462-3638 (Fax) [email protected] -----Original Message----- From: Sepsisgroups [mailto:[email protected]] On Behalf Of Townsend, Sean, M.D. Sent: Monday, January 25, 2016 4:12 PM To: Belfi, Karen Cc: [email protected] Subject: Re: [Sepsis Groups] Septic Shock Presentation Time 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]> This email and any files transmitted with it may contain privileged or confidential information and may be read or used only by the intended recipient. If you are not the intended recipient of the email or any of its attachments, please be advised that you have received this email in error and that any use, dissemination, distribution, forwarding, printing, or copying of this email or any attached files is strictly prohibited. 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