Yes this is very confusing to me. What is the definition of "some" SSC as feb 2016 does not require SIRS criteria. Task force found t to be "unhelpful". I am wondering when CMS will not require it as well. Still researching.
On Tue, Mar 1, 2016 at 4:04 PM, <[email protected] > wrote: > 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. Sepsis coordinator (Carter, Anne) > 2. Re: Crystalloid Fluids (Belfi, Karen) > > > ---------------------------------------------------------------------- > > Message: 1 > Date: Tue, 1 Mar 2016 16:58:55 +0000 > From: "Carter, Anne" <[email protected]> > To: "[email protected]" > <[email protected]> > Subject: [Sepsis Groups] Sepsis coordinator > Message-ID: > < > blupr07mb068dfa8a8c6e58b272bb6cbca...@blupr07mb068.namprd07.prod.outlook.com > > > > Content-Type: text/plain; charset="us-ascii" > > After much trial and error to get on top of the Sepsis core measure, our > institution would like to institute a "code sepsis" that alerts housewide > providers of a potentially septic patient. I have been tasked to find out > how other institutions have accomplished this who do not have an alert in > their EMR. Would anyone be willing to share a policy, protocol or > description of their code sepsis procedure at their institution? > Also, do you have a dedicated sepsis coordinator? If so, who do they > report to and how do they function in that role? I'd love that job > description as well. > Thanks in advance. > > Anne Carter MS, ACNS-BC, CEN > Coordinator > Outcomes Management > Riverview Medical Center > 732-450-2735 > [email protected]<mailto:[email protected]> > > > "This document and the information attached is Patient Safety Work Product > & as such, is privileged and confidential pursuant to the N.J. Patient > Safety Act and the Federal Patient Safety & Quality Improvement Act of 2005 > and should not be further disclosed except as permitted by law." > > -------------- next part -------------- > An HTML attachment was scrubbed... > URL: < > http://lists.sepsisgroups.org/pipermail/sepsisgroups-sepsisgroups.org/attachments/20160301/66b1b090/attachment-0001.htm > > > > ------------------------------ > > Message: 2 > Date: Wed, 24 Feb 2016 09:08:46 -0500 > From: "Belfi, Karen" <[email protected]> > To: "[email protected]" <[email protected]>, > "[email protected]" > <[email protected]> > Subject: Re: [Sepsis Groups] Crystalloid Fluids > Message-ID: > <[email protected]> > Content-Type: text/plain; charset="us-ascii" > > >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. 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. > > > > -------------- next part -------------- > An HTML attachment was scrubbed... > URL: < > http://lists.sepsisgroups.org/pipermail/sepsisgroups-sepsisgroups.org/attachments/20160224/a30583c2/attachment.htm > > > -------------- next part -------------- > A non-text attachment was scrubbed... > Name: image001.png > Type: image/png > Size: 40233 bytes > Desc: image001.png > URL: < > http://lists.sepsisgroups.org/pipermail/sepsisgroups-sepsisgroups.org/attachments/20160224/a30583c2/attachment.png > > > > ------------------------------ > > Subject: Digest Footer > > _______________________________________________ > Sepsisgroups mailing list > [email protected] > http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org > > > ------------------------------ > > End of Sepsisgroups Digest, Vol 194, Issue 1 > ******************************************** > -- Carol Lovelace RN, CCRN (ret) Physician Peer Review Analyst 577-2335
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