There is no work around, the patient would need the correct amount ordered and administered. It is my understanding that even for a dialysis patient they would benefit more from the fluid than they would from overload prevention. If they get too much they can be dialyzed.
-----Original Message----- From: Sepsisgroups [mailto:[email protected]] On Behalf Of [email protected] Sent: Thursday, February 11, 2016 4:07 PM To: [email protected] Subject: [EXTERNAL] Sepsisgroups Digest, Vol 191, Issue 5 Send Sepsisgroups mailing list submissions to [email protected] To subscribe or unsubscribe via the World Wide Web, visit http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org or, via email, send a message with subject or body 'help' to [email protected] You can reach the person managing the list at [email protected] When replying, please edit your Subject line so it is more specific than "Re: Contents of Sepsisgroups digest..." Today's Topics: 1. Shock for dialysis patients (Rona Capps) 2. Re: Septic Shock presentation (Myran, Robin) ---------------------------------------------------------------------- Message: 1 Date: Mon, 8 Feb 2016 15:57:32 +0000 From: Rona Capps <[email protected]> To: "[email protected]" <[email protected]> Subject: [Sepsis Groups] Shock for dialysis patients Message-ID: <ab6072a4ed3a644eb3a086806663031e0145a97...@ex2k10-mbx1.jacksonhospital.net> Content-Type: text/plain; charset="us-ascii" Can someone please tell me the proper answer to a physician. A dialysis patient comes in with Septic Shock. A. If he orders the amount of fluid required but never starts it, will it pass? B. If he orders the correct amount and only administers 500ml of the total, will it pass? What is the work around for this part of the measure that is not taking into account physician clinical judgment? Thank you Rona Capps, RN Sepsis Coordinator Jackson Hospital Montgomery, AL 36106 [email protected] -----Original Message----- From: Sepsisgroups [mailto:[email protected]] On Behalf Of [email protected] Sent: Friday, February 05, 2016 2:08 PM To: [email protected] Subject: Sepsisgroups Digest, Vol 190, Issue 5 Send Sepsisgroups mailing list submissions to [email protected] To subscribe or unsubscribe via the World Wide Web, visit http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org or, via email, send a message with subject or body 'help' to [email protected] You can reach the person managing the list at [email protected] When replying, please edit your Subject line so it is more specific than "Re: Contents of Sepsisgroups digest..." Today's Topics: 1. Re: Septic Shock Presentation Time (DHILLON, ROOPINDER) 2. Septic Shock presentation (DHILLON, ROOPINDER) ---------------------------------------------------------------------- Message: 1 Date: Tue, 2 Feb 2016 13:19:56 +0000 From: "DHILLON, ROOPINDER" <[email protected]> To: "'Miller, Nicole'" <[email protected]>, "Belfi, Karen" <[email protected]>, "[email protected]" <[email protected]>, "[email protected]" <[email protected]>, "[email protected]" <[email protected]> Cc: "[email protected]" <[email protected]> Subject: Re: [Sepsis Groups] Septic Shock Presentation Time Message-ID: <[email protected]> Content-Type: text/plain; charset="utf-8" Hi Nicole, In answer to your following question regarding the Septic shock time, it will be 0751, in other words the Septic Shock time will be same as Severe Sepsis time. Thank you. -----Original Message----- From: Sepsisgroups [mailto:[email protected]] On Behalf Of Miller, Nicole Sent: Monday, February 01, 2016 12:16 PM To: Belfi, Karen; [email protected]; [email protected]; [email protected] Cc: [email protected] Subject: Re: [Sepsis Groups] Septic Shock Presentation Time Can I get some assistance on this presentation time for Severe Sepsis/Shock? Source of infection at 07:51 Two SIRS at 07:25 and 07:40 Organ dysfunction at 07:12 Severe Sepsis time=07:51---however, the organ dysfunction is a lactate of 5.1. Do I take the Septic Shock time as 07:51 since I can't say I have Septic Shock without a source of infection? Thank you! Nicole Miller, BSN, RN, CPHQ | PI Coordinator Edward-Elmhurst Healthcare | 801 South Washington, Naperville, IL 60540 (630) 527-5565 | HealthyDriven.com This message is intended for the use of the person or entity to which it is addressed and may contain information that is privileged and confidential, the disclosure of which is governed by applicable law. If the reader of this message is not the intended recipient, or the employee or agent responsible to deliver it to the intended recipient, you are hereby notified that any dissemination, distribution or copying of this information is STRICTLY PROHIBITED. If you have received this message in error, please notify us immediately and destroy the related message. CONFIDENTIALITY NOTICE: E-EH System Patient Safety Work Product (PSWP). For use by authorized individuals only. DO NOT COPY or DO NOT DISSEMINATE. -----Original Message----- From: Sepsisgroups [mailto:[email protected]] On Behalf Of Belfi, Karen Sent: Friday, January 29, 2016 5:16 AM To: [email protected]; [email protected]; [email protected] Cc: [email protected] Subject: Re: [Sepsis Groups] Septic Shock Presentation Time This is contradictory to everything they stated in both the power point and the Q&A. >From the Q&A: Question 61: If lactate is >4 and no crystalloid fluids are administered, do you answer ?Yes? or ?No? for Septic Shock present? Answer 61: The Septic Shock Present data element's Notes for Abstraction indicates that if crystalloid fluids were not administered after the presentation date and time of severe sepsis, to choose Value "2 (No)." Question 145: If initial lactate is >4, but no crystalloid fluids are given during the 6 hours after severe sepsis, do we answer "No" to septic shock? Answer 145: Not necessarily. You would select "No" for Septic Shock Present if no crystalloid fluids were given at all after presentation of severe sepsis. There is no time frame after severe sepsis presentation associated with this. If fluids were not given within 6 hours following presentation of severe sepsis but were given after 6 hours, then you would select "Yes." This is an all-or-none point for crystalloid fluids. Question 172: If the patient has severe sepsis and an initial lactate of 4.5 but does not receive any crystalloid fluids, would it still be "No" to Septic Shock Present due to not having any crystalloids given? Answer 172: Correct. This was from the transcript of the CMS presentation on October 26 (page 27): Now please note, in the septic shock present data element, there is a bullet point in the note for abstraction indicating that if crystalloid fluids were not administered after severe sepsis presentation date and time, that you would select allowable value 2 for septic shock present, which is equivalent to No. For purposes of SEP-1 measure, at this point in time, regardless of how septic shock is identified, if no crystalloid fluids were given after severe sepsis presentation, you will select allowable value 2, which is No, for septic shock present. Karen Belfi, RN, MSN Quality Outcomes Coordinator Lankenau Medical Center 484-476-8092 Pager: 5240 -----Original Message----- From: [email protected] [mailto:[email protected]] Sent: Thursday, January 28, 2016 4:04 PM To: [email protected]; [email protected]; Belfi, Karen Cc: [email protected] Subject: RE: [Sepsis Groups] Septic Shock Presentation Time 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. 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. _______________________________________________ Sepsisgroups mailing list [email protected]<mailto:[email protected]> https://urldefense.proofpoint.com/v2/url?u=http-3A__lists.sepsisgroups.org_listinfo.cgi_sepsisgroups-2Dsepsisgroups.org&d=CwIGaQ&c=MS-5dKql6qjhmD6zBX8NdQ&r=KQhQAyB28wX0ryHeUUrvHwtJt_LBhCc_ENWLFE_5OQM&m=MIOxJC-J0Hl7V8zraHmRvAJqUnUQxV84ioAAkoOtpPQ&s=PE9haHZiSt0lsaWrtXo79byWSukDpnw1Pcj-cZckiGI&e= _______________________________________________ Sepsisgroups mailing list [email protected] https://urldefense.proofpoint.com/v2/url?u=http-3A__lists.sepsisgroups.org_listinfo.cgi_sepsisgroups-2Dsepsisgroups.org&d=CwIGaQ&c=MS-5dKql6qjhmD6zBX8NdQ&r=KQhQAyB28wX0ryHeUUrvHwtJt_LBhCc_ENWLFE_5OQM&m=MIOxJC-J0Hl7V8zraHmRvAJqUnUQxV84ioAAkoOtpPQ&s=PE9haHZiSt0lsaWrtXo79byWSukDpnw1Pcj-cZckiGI&e= ---------------------------------------------------------------------- Confidential: This electronic message and all contents contain information from BayCare Health System which may be privileged, confidential or otherwise protected from disclosure. The information is intended to be for the addressee only. If you are not the addressee, any disclosure, copy, distribution or use of the contents of this message is prohibited. If you have received this electronic message in error, please notify the sender and destroy the original message and all copies. _______________________________________________ Sepsisgroups mailing list [email protected] http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org _______________________________________________ Sepsisgroups mailing list [email protected] http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org _______________________________________________ Sepsisgroups mailing list [email protected] http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org Visit us at www.UHhospitals.org. The enclosed information is STRICTLY CONFIDENTIAL and is intended for the use of the addressee only. University Hospitals and its affiliates disclaim any responsibility for unauthorized disclosure of this information to anyone other than the addressee. Federal and Ohio law protect patient medical information, including psychiatric_disorders, (H.I.V) test results, A.I.Ds-related conditions, alcohol, and/or drug_dependence or abuse disclosed in this email. Federal regulation (42 CFR Part 2) and Ohio Revised Code section 5122.31 and 3701.243 prohibit disclosure of this information without the specific written consent of the person to whom it pertains, or as otherwise permitted by law. ------------------------------ Message: 2 Date: Tue, 2 Feb 2016 15:04:00 +0000 From: "DHILLON, ROOPINDER" <[email protected]> To: "[email protected]" <[email protected]> Subject: [Sepsis Groups] Septic Shock presentation Message-ID: <[email protected]> Content-Type: text/plain; charset="us-ascii" Please see the following scenario... The Patient had severe sepsis based on the following... Source of infection, SIRs and Organ dysfunction (Hypotensive with Systolic 75). No initial lactate was done and the Crystalloid fluid administered was <30 ml/kg. What should I answer for the question Septic shock present, considering the patient was hypotensive even after conclusion of the fluid amount (rate was also <125 ml/hr). Thank you, Roopa Dhillon MBBS, MBA Clinical Quality Analyst I Quality Improvement/Clinical Outcomes University Hospitals Elyria Medical Centre 630 East River Elyria, Ohio 44035 T 440-329-4959 F 440-329-5971 Roopinder.Dhillon@UHhospitals<mailto:Roopinder.Dhillon@UHhospitals> .org Quality Assurance/Peer Review Privileged Pursuant to Ohio Rev. Code secs. 2305.24, 2305.25, 2305.251, 2305.252 and 2305.253 Visit us at www.UHhospitals.org. The enclosed information is STRICTLY CONFIDENTIAL and is intended for the use of the addressee only. University Hospitals and its affiliates disclaim any responsibility for unauthorized disclosure of this information to anyone other than the addressee. Federal and Ohio law protect patient medical information, including psychiatric_disorders, (H.I.V) test results, A.I.Ds-related conditions, alcohol, and/or drug_dependence or abuse disclosed in this email. Federal regulation (42 CFR Part 2) and Ohio Revised Code section 5122.31 and 3701.243 prohibit disclosure of this information without the specific written consent of the person to whom it pertains, or as otherwise permitted by law. -------------- next part -------------- An HTML attachment was scrubbed... URL: <http://lists.sepsisgroups.org/pipermail/sepsisgroups-sepsisgroups.org/attachments/20160202/5d39ba26/attachment.html> ------------------------------ Subject: Digest Footer _______________________________________________ Sepsisgroups mailing list [email protected] http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org ------------------------------ End of Sepsisgroups Digest, Vol 190, Issue 5 ******************************************** ------------------------------ Message: 2 Date: Fri, 5 Feb 2016 12:26:15 -0800 From: "Myran, Robin" <[email protected]> To: "DHILLON, ROOPINDER" <[email protected]>, <[email protected]> Subject: Re: [Sepsis Groups] Septic Shock presentation Message-ID: <[email protected]> Content-Type: text/plain; charset="us-ascii" I've attached a slide from the 10/26/15 webinar that (I believe) addresses the exact scenario you outline below. Septic Shock Present = No. Robin 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]> From: Sepsisgroups [mailto:[email protected]] On Behalf Of DHILLON, ROOPINDER Sent: Tuesday, February 02, 2016 7:04 AM To: [email protected] Subject: [Sepsis Groups] Septic Shock presentation Please see the following scenario... The Patient had severe sepsis based on the following... Source of infection, SIRs and Organ dysfunction (Hypotensive with Systolic 75). No initial lactate was done and the Crystalloid fluid administered was <30 ml/kg. What should I answer for the question Septic shock present, considering the patient was hypotensive even after conclusion of the fluid amount (rate was also <125 ml/hr). Thank you, Roopa Dhillon MBBS, MBA Clinical Quality Analyst I Quality Improvement/Clinical Outcomes University Hospitals Elyria Medical Centre 630 East River Elyria, Ohio 44035 T 440-329-4959 F 440-329-5971 Roopinder.Dhillon@UHhospitals .org Quality Assurance/Peer Review Privileged Pursuant to Ohio Rev. Code secs. 2305.24, 2305.25, 2305.251, 2305.252 and 2305.253 Visit us at www.UHhospitals.org. The enclosed information is STRICTLY CONFIDENTIAL and is intended for the use of the addressee only. University Hospitals and its affiliates disclaim any responsibility for unauthorized disclosure of this information to anyone other than the addressee. Federal and Ohio law protect patient medical information, including psychiatric_disorders, (H.I.V) test results, A.I.Ds-related conditions, alcohol, and/or drug_dependence or abuse disclosed in this email. Federal regulation (42 CFR Part 2) and Ohio Revised Code section 5122.31 and 3701.243 prohibit disclosure of this information without the specific written consent of the person to whom it pertains, or as otherwise permitted by law. 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 -------------- next part -------------- An HTML attachment was scrubbed... URL: <http://lists.sepsisgroups.org/pipermail/sepsisgroups-sepsisgroups.org/attachments/20160205/f2109ff8/attachment.htm> -------------- next part -------------- A non-text attachment was scrubbed... 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