An initial lactate >4 is, by definition, >2. The purpose of measuring the lactate is not to "define" the degree of sepsis, though in this algorithm it is a metric that is used to establish the presence of septic shock. It is to measure the body's physiological response and to monitor the effectiveness of the treatments. Serial lactate levels, showing a steady decline of lactate, demonstrate that the treatment is probably effective. Providers may order more than two serial lactate levels to aid their clinical treatment decisions. Serial lactates (more than two) are not a requirement under this algorithm, but they are still valid tests in the treatment of sepsis.
The sepsis metrics that we abstract for are the minimum treatments required. Many patients will require more testing and treatment than we report to stabilize. We don't want providers to stop treating when they have "passed" the abstraction requirements.....we want them to start with these measures and go beyond the metrics to save the patient's life. Kathy The Patient Comes First. Does this put the Patient First? Kathryn L. Tucker RN BS JD Quality Improvement Coordinator FF Thompson Health Canandaigua, NY 14424 Office 585-919-3880 Cell (personal) 585-748-5279 CONFIDENTIALITY NOTICE This e-mail message, including any attachments, is for the sole use of the intended recipient(s) and may contain information that is proprietary, confidential, and exempt from disclosure under applicable law. Any unauthorized review, use, disclosure, or distribution is prohibited. If you are not the intended recipient or agent responsible for delivering the message to the intended recipient, or if you have received this communication in error, please notify the sender by return e-mail and destroy all copies of the original message Thompson Health Named One of the 150 Great Places to Work in Healthcare by Becker's Hospital Review -----Original Message----- From: Sepsisgroups [mailto:[email protected]] On Behalf Of [email protected] Sent: Wednesday, February 24, 2016 9:01 AM To: [email protected] Subject: Sepsisgroups Digest, Vol 193, Issue 4 Send Sepsisgroups mailing list submissions to [email protected] To subscribe or unsubscribe via the World Wide Web, visit https://urldefense.proofpoint.com/v2/url?u=http-3A__lists.sepsisgroups.org_listinfo.cgi_sepsisgroups-2Dsepsisgroups.org&d=BQICAg&c=4sF48jRmVAe_CH-k9mXYXEGfSnM3bY53YSKuLUQRxhA&r=r9TCrDIO6gDxR5pVxvLp6ZMJGAIAi5mk7P1ps_740bbyThcvO6h4qg7bxcQGH6s1&m=mLat7rdRuxoXQe1meZkoyA9al8jcuFK_9hLar9dX6_c&s=Bd7fIvbIkjKe8TwMB-SzUczvbOeo4W8dRLtXoL7at2o&e= 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: Repeat Lactate (PAMELA J. ANDERSON) 2. Re: Clarifying Question-Broad Spectrum or OtherAntibiotic Selection (Myran, Robin) ---------------------------------------------------------------------- Message: 1 Date: Mon, 22 Feb 2016 14:39:55 +0000 From: "PAMELA J. ANDERSON" <[email protected]> To: "Bruce S. Bainbridge" <[email protected]>, "'DHILLON, ROOPINDER'" <[email protected]>, "'[email protected]'" <[email protected]> Subject: Re: [Sepsis Groups] Repeat Lactate Message-ID: <ac508240ef24e743a1e86965de72ace28b2a4...@sb01mstmbx07.sb.trinity-health.org> Content-Type: text/plain; charset="us-ascii" I believe the rationale is to determine if the current treatment plan is working - in other words, if your initial lactate is >4, and then your repeat lactate is higher than the initial lactate, it is an indication that there may be something more occurring or that additional treatment needs to be considered. In addition, if the repeat lactate is lower, it could be an indication that what is being done is working. Hope this helps! Pam Pamela Anderson, BSN, RN Clinical Data Abstractor Interim Sepsis Coordinator Loyola University Health System Center for Clinical Excellence Maguire Center | Bldg 105-3909 | Maywood, IL 60153 (O) 708-216-5544 | (F) 708-216-7867 | (E) [email protected]<mailto:[email protected]> NOTE: The information contained in this message may be privileged and confidential and protected from disclosure. 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. If you believe you have received this communication in error, please notify us immediately by replying to the message and deleting it from your computer. Thank you. Loyola University Health System From: Sepsisgroups [mailto:[email protected]] On Behalf Of Bruce S. Bainbridge Sent: Friday, February 19, 2016 1:07 PM To: 'DHILLON, ROOPINDER'; '[email protected]' Subject: Re: [Sepsis Groups] Repeat Lactate Thanks. I see that the repeat Lactate is required if initial Lactate is >2. I see no justification of the repeat value if the initial Lactate is >4. So if we already have met criteria for Septic Shock, why should we fail for not drawing an unneeded lab? Am I missing something? From: DHILLON, ROOPINDER [mailto:[email protected]] Sent: Friday, February 19, 2016 10:14 AM To: Bruce S. Bainbridge; '[email protected]' Subject: RE: Repeat Lactate Yes, Repeat lactate has to be done any time the Initial Lactate is >2. I found out today if Initial Lactate is >4 and even if there is no persistent hypotension we still need to have documentation for All of the Focus Exam criteria or 2 of the Hemodynamic monitoring. If not we fail the measure despite the fact patient does not have persistent hypotension after the conclusion of right amount of fluids. From: Sepsisgroups [mailto:[email protected]] On Behalf Of Bruce S. Bainbridge Sent: Tuesday, February 16, 2016 5:28 PM To: '[email protected]' Subject: [Sepsis Groups] Repeat Lactate I may have missed this discussion, but I had a patient fail SEP-1 when no repeat Lactate level was ordered. If the initial Lactate was >4, I see no guideline that necessitates a repeat draw in this case. Is a repeat draw still required if the initial Lactate is already >4? I appreciate all your help with this. 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URL: <https://urldefense.proofpoint.com/v2/url?u=http-3A__lists.sepsisgroups.org_pipermail_sepsisgroups-2Dsepsisgroups.org_attachments_20160222_e7c3ac23_attachment-2D0001.htm&d=BQICAg&c=4sF48jRmVAe_CH-k9mXYXEGfSnM3bY53YSKuLUQRxhA&r=r9TCrDIO6gDxR5pVxvLp6ZMJGAIAi5mk7P1ps_740bbyThcvO6h4qg7bxcQGH6s1&m=mLat7rdRuxoXQe1meZkoyA9al8jcuFK_9hLar9dX6_c&s=KidoCQ0QFI65Jx3XGP8362aQv03aGVUK5ucs41R3iT8&e= > ------------------------------ Message: 2 Date: Mon, 22 Feb 2016 11:44:39 -0800 From: "Myran, Robin" <[email protected]> To: "Rebecca Rosario" <[email protected]>, <[email protected]> Subject: Re: [Sepsis Groups] Clarifying Question-Broad Spectrum or OtherAntibiotic Selection Message-ID: <[email protected]> Content-Type: text/plain; charset="us-ascii" Rebecca - I'm assuming you are referring to the Broad Spectrum or Other Antibiotic Selection data element. I share your confusion about this one. I found this Q&A from the 10/26/15 presentation: Question 59: With combination therapy, do both ABX have to be given within a 3 hour time window after presentation? What if they are given shortly before the presentation time? Answer 59: The only time you compare the antibiotics given to the antibiotic tables is if the only antibiotics the patient received are in the 3 hours following presentation. In the question, the patient received an antibiotic prior to presentation. Because of this, the Broad Spectrum or Other Antibiotic Administration Selection data element is not abstracted. However, the Notes for Abstraction for this data element include the following: * If no antibiotics were administered in the three hour time window, choose Value "2." I agree with you that answering "2" would fail the measure. I have submitted this question to the IQR Q&A system and am waiting for a response. I'll let you know what they say. 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 Rebecca Rosario Sent: Friday, February 19, 2016 11:48 AM To: [email protected] Subject: [Sepsis Groups] Clarifying Question-Broad Spectrum or OtherAntibiotic Selection Hello everyone! I hope you are all doing well. I would like to clarify with everyone how they are answering this question to make sure I am doing it correctly. Are you answering yes or no if severe sepsis presentation time is at 12noon and the broad spectrum antibiotic (only antibiotic) was given at 11:45am and then again at 18:00? Previously, someone posted that if you answer "no" that the case will not fail unless there are other reasons for the case to fail. When I look at the algorithm if you answer "2" you proceed to J but it does not say to add one to the sepsis three hour counter. Page SEP-1-11 The last algorithm shows that if the sepsis three hour counter is <3 then it goes to SEP-1 D. Page SEP-1-27. Thank you for your feedback! Rebecca Rebecca Rosario MSN, RN, NE-BC | Coordinator | Quality Cleveland Clinic Akron General | 1 Akron General Avenue | Akron, OH 44307 P: 330-344-5809 | F: 330-344-6116 | [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). 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