>From what they've stated, in the power point as well as the Q&A, you don't >need the full 30 mL/kg of crystalloid fluids in order to say "yes" to septic >shock when the criteria is physician documentation or lactate >4. The patient >just needs to receive SOME crystalloid fluids-any amount. So if you have a physician documenting septic shock, and the patient receives any crystalloid fluids, you say yes. However if the patient doesn't get the full 30 mL/kg, you would say no to the crystalloid fluids question. Here are some Q&As from the Oct 26 presentation that addresses this.
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 144: On slide 103, the Specifications Manual says: "If there has not been crystalloid administration, select "No" for septic shock. Patients with initial lactate >4 and severe sepsis present have septic shock without the administration of crystalloids." Is this being addressed in the manual page 1-332? Answer 144: For purposes of the SEP-1 measure, if crystalloid fluids were not given following presentation of severe sepsis, you should select "No" for Septic Shock Present. This allows the case to be excluded from the crystalloid fluid data elements. The case would fail if crystalloid fluids were not given. This does not mean the patient does not clinically have septic shock. 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 157: Based on documentation in the note which indicates, "Septic Shock" (is time zero as no other criteria present to support earlier time) as the reason patient already on pressors, MAP>65, not hypotensive, lactate <4, so why would the patient require a 30cc/kg bolus? Answer 157: If the MAP is >65 and SBP is >90 and the lactate is <4, the 30 ml/kg bolus is not indicated. However if the physician documented septic shock, then it might be indicated. According to your question, the patient is on vasopressors, which may indicate crystalloid fluids were already given. If so, then crystalloid fluids given prior to presentation of septic shock should be taken into consideration. If no crystalloid fluids were given after presentation time of severe sepsis, the Septic Shock Present data element's Notes for Abstraction indicate to select Value "2 (No)." There is not enough information in the question to comment further. Question 159: If no crystalloid fluids were administered, the answer to septic shock present is no even if the physician documents septic shock? Answer 159: Correct. Question 161: If there is MD documentation of "possible septic shock" but no crystalloid fluids were administered or were not administered at 30 ml/kg, would I answer the "Septic Shock Present" data element as a "No?" Answer 161: If no fluids were given after the presentation of severe sepsis, you would select "No" for Septic Shock Present, regardless of physician documentation or clinical criteria. If fluids were given but not 30 ml/kg, you would select "Yes" for Septic Shock Present because of the physician documentation of possible septic shock. Question 163: Would you please clarify slide 103: If crystalloid fluids were not administered after the presentation date and time of Severe Sepsis, select Allowable Value "2 (No)," does this mean any crystalloid fluid or does this only apply if 30ml/kg was not given? Answer 163: This means any crystalloid fluid. Question 176: If the physician states septic shock in their notes but no crystalloid fluids were administered, do we select "Yes" or "No" for septic shock? Answer 176: If no crystalloid fluids were given after presentation of severe sepsis, you would select "No" for Septic Shock Present, regardless of how septic shock is identified. Karen Belfi, RN, MSN Quality Outcomes Coordinator Lankenau Medical Center 484-476-8092 Pager: 5240 [cid:[email protected]] From: Sepsisgroups [mailto:[email protected]] On Behalf Of [email protected] Sent: Tuesday, February 23, 2016 10:21 PM To: [email protected] Subject: [Sepsis Groups] Crystalloid Fluids Slide 25 in the September 21,2015 CMS webinar states "If crystalloid fluids not administered after presentation date and time of severe sepsis, select NO" to Septic Shock Present. This is also indicated on page 92 of the specs manual version 5.0b.How would this be abstracted if the full volume of crystalloid fluids were not administered after severe sepsis presentation date/time even if there is physician documentation of septic shock? 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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