We did have this same issue, and made changes to accommodate the core measure requirement of 2.0. Now our system recognizes 2.0 as elevated and anyone with a lactate ≥ 2.0 gets an auto generated order for a repeat within 3 hours of the result.
Tammy Lightner RN, MHA, MSPM Director of Performance Improvement Research Medical Center 2316 E Meyer Blvd Kansas City, MO 64132 [email protected] 816- 276-3948 (o)/816-304-5898 ( c ) CONFIDENTIAL - Contains proprietary information. Not intended for external distribution. -----Original Message----- From: Sepsisgroups [mailto:[email protected]] On Behalf Of [email protected] Sent: Thursday, March 03, 2016 2:26 PM To: [email protected] Subject: [EXTERNAL] Sepsisgroups Digest, Vol 194, Issue 8 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. lactate normal levels (Maupin, Christina) 2. Re: Sepsisgroups Digest, Vol 194, Issue 1 (Carol Lovelace) ---------------------------------------------------------------------- Message: 1 Date: Wed, 2 Mar 2016 01:55:35 +0000 From: "Maupin, Christina" <[email protected]> To: Kathryn Tucker <[email protected]>, "'[email protected]'" <[email protected]> Subject: [Sepsis Groups] lactate normal levels Message-ID: <083e7cbc7587074ea2cd9480da94b8a20123a...@ausp01dag0303.collaborationhost.net> Content-Type: text/plain; charset="us-ascii" Hello All, Our lactate level is considered normal unless >2.2. I am wondering if others have this situation also and if you use the CMS definition of 2.0 or the standardized test normal per facility? If we use 2.0 it would still be normal based on our calibrations. Thanks! Chris Christina Maupin, MN, RN, CCNS Clinical Outcomes Specialist Bakersfield Heart Hospital 3001 Sillect Avenue Bakersfield, CA 93308 "Courage is the most important of all the virtues, because without courage you can't practice any other virtue consistently." Maya Angelou -- NOTICE -- This communication, including any attachments, is intended solely for the use of the addressee and may contain information which is privileged, confidential, exempt from disclosure under applicable law or subject to copyright. If you are not an intended recipient, any use, disclosure, distribution, reproduction, review or copying is unauthorized and may be unlawful. If you have received this transmission in error, please notify the sender immediately. Thank you. ________________________________________ From: Sepsisgroups [[email protected]] on behalf of Kathryn Tucker [[email protected]] Sent: Wednesday, February 24, 2016 7:23 AM To: '[email protected]' Subject: Re: [Sepsis Groups] Sepsisgroups Digest, Vol 193, Issue 4 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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Any unauthorized review, use, disclosure or distribution is prohibited. If you are not the intended recipient, please contact the sender by reply e-mail and destroy all copies of the original message. ------------------------------ Message: 2 Date: Wed, 2 Mar 2016 14:04:26 -0700 From: Carol Lovelace <[email protected]> To: [email protected] Subject: Re: [Sepsis Groups] Sepsisgroups Digest, Vol 194, Issue 1 Message-ID: <CAHorBh-xwouwQ=h6jvngyoemzyjbjhynnkn1fz+fouwbtza...@mail.gmail.com> Content-Type: text/plain; charset="utf-8" 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.o > rg > > 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.outlo > ok.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. 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