I agree that I am learning so much and finding answers to my questions. Things that make me go "HMMMMMM"
Anita Siscoe-Hapshie Anita Siscoe-Hapshie, RN, MSN, CCRN Sepsis Coordinator [email protected]<mailto:[email protected]> Citrus Memorial Hospital 502 W. Highlands Blvd. Inverness, FL 34452 Office 352.560.6214 Fax 352.726.9119 Nurses are true [sh-logo[1]] [image001] P please consider the environment before printing this email 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 the 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. CONFIDENTIAL-This email may contain proprietary information. Not intended for external distribution. From: Sepsisgroups [mailto:[email protected]] On Behalf Of PAMELA J. ANDERSON Sent: Tuesday, March 22, 2016 1:42 PM To: Belfi, Karen <[email protected]>; Clement, Joseph (DPH) <[email protected]>; [email protected] Subject: [EXTERNAL] Re: [Sepsis Groups] [EXTERNAL] Re: Severe Sepsis with Initial Lactate <4, repeat 3hrs later >4-?Shock or not Thanks for taking the time to locate this for us - so it appears that for the sake of compliance for abstraction, we would answer "No" to septic shock present if based only on the repeat lactate, but for the sake of our patients, we should still give the fluid bolus. Can I just say how much I appreciate this group! Don't know what we'd do without each other! 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: Belfi, Karen [mailto:[email protected]] Sent: Tuesday, March 22, 2016 12:27 PM To: PAMELA J. ANDERSON; Clement, Joseph (DPH); [email protected]<mailto:[email protected]> Subject: RE: [EXTERNAL] Re: [Sepsis Groups] Severe Sepsis with Initial Lactate <4, repeat 3hrs later >4-?Shock or not This was addressed in the CMS Q&A, from the Oct 26 webinar. We are to abstract the Initial Lactate for shock criteria, not any repeat levels. Question 182: How would an abstractor proceed if a patient's initial lactate level was <2.0 but the repeat lactate level was >4.0? At the time of the repeat lactate level returning within 6 hours at a level greater than 4.0 (in the absence of hypotension <90), is the 30 cc/kg fluid bolus required or is the 30 cc/kg fluid bolus only required on the initial lactate level if it is greater than 4.0? Answer 182: For purposes of the SEP-1 measure, the initial lactate level result value is what is used. Assuming the patient does not have hypotension, if the initial lactate level result is < 4 the patient does not have septic shock. If it is ≥4 the patient does have septic shock. The measure does not require abstraction of the repeat lactate result level, only the time the repeat lactate was drawn. Clinically this would still represent septic shock and the patient should be treated accordingly. Question 209: Shouldn't repeat lactate >4 be the definition of shock, not the initial, similar to how shock is not diagnosed until after fluid bolus administration? Answer 209: While clinically a repeated or subsequent lactate ≥4 could signify the presence of septic shock, initial lactate is used for purposes of the measure to reduce the complexity in determining the presence of severe sepsis and septic shock. Please note, for purposes of the measure the initial lactate is not necessarily always going to be the first lactate drawn. The first bullet point in the Initial Lactate Level Collection data element's Notes for Abstraction states, "If there are multiple lactate levels, only abstract the level drawn closest to the time of presentation of severe sepsis. That lactate level is the initial lactate level for purposes of this data element." Question 211: Septic Shock Present: On slide 26 it was added that the lactate level greater than 4 is related to the initial lactate. So if the repeat lactate to be done for the 6 hour window for severe sepsis is greater than 4 but the initial was only 2.1, does this qualify as septic shock of no hypotension is present? Answer 211: For purposes of the measure, the repeat lactate level is not collected and not taken into consideration. The measure only looks at whether or not a repeat lactate was drawn and the time it was drawn. If the initial lactate is < 4 and the patient does not have persistent hypotension, the patient does not have septic shock for purposes of the measure. Karen Belfi, RN, MSN Quality Outcomes Coordinator Lankenau Medical Center 484-476-8092 Pager: 5240 [cid:25FFED76-F7F0-4047-910F-0D7077ED1E1E] From: Sepsisgroups [mailto:[email protected]] On Behalf Of PAMELA J. ANDERSON Sent: Friday, March 18, 2016 7:56 AM To: Clement, Joseph (DPH); [email protected]<mailto:[email protected]> Subject: [EXTERNAL] Re: [Sepsis Groups] Severe Sepsis with Initial Lactate <4, repeat 3hrs later >4-?Shock or not That's what I would do, too - but because the v5.0b updated the spec to include mention of "initial lactate >=4", I'm confused - I've got a QNet pending that addresses this issue & I'll post it when I get a response. Thanks! 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: Clement, Joseph (DPH) [mailto:[email protected]] Sent: Thursday, March 17, 2016 4:09 PM To: PAMELA J. ANDERSON; [email protected]<mailto:[email protected]> Subject: Re: [Sepsis Groups] Severe Sepsis with Initial Lactate <4, repeat 3hrs later >4-?Shock or not I would answer Yes to the septic shock question - as long as the shock date/time is within 6 hours of the severe sepsis time, it would count. If anybody believes otherwise I'd love to hear as that's how we've done it. Joseph Clement, MS, RN, CCNS Clinical Nurse Specialist San Francisco General Hospital ph: 415206-6174 pg: 415 327-0220 ________________________________ From: Sepsisgroups <[email protected]<mailto:[email protected]>> on behalf of PAMELA J. ANDERSON <[email protected]<mailto:[email protected]>> Sent: Thursday, March 10, 2016 6:19 AM To: [email protected]<mailto:[email protected]>; [email protected]<mailto:[email protected]> Subject: [Sepsis Groups] Severe Sepsis with Initial Lactate <4, repeat 3hrs later >4-?Shock or not v5.0b Specs indicate septic shock presentation date and time is determined by persistent hypotension... OR tissue perfusion present as evidenced by INITIAL lactate >=4. Severe sepsis was present @ 09:12, with the initial lactate of 3.6. The repeat done @ 12:01 was 6.7 (30cc/kg was given). Because there was no documentation of "septic shock", and the patient was not hypotensive at the end of the bolus, based on the verbiage from the specs, I would answer, "NO" to the question of whether Septic Shock was present. Any thoughts? Thanks- Pam Pamela Anderson, BSN, RN Clinical Data Abstractor Sepsis Coordinator Loyola University Health System Center for Clinical Excellence 2160 S. 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