Good point, though probably increasingly unlikely, as with the new Sepsis-3 definitions the lactate >4 would not necessarily mean that the patient was in septic shock.
So, interestingly, this would seem to be an example of convergence between the new definitions and the metric - this patient will not qualify for the shock bundle, and does not qualify for the shock diagnosis. Joseph Clement, MS, RN, CCNS Clinical Nurse Specialist San Francisco General Hospital ph: 415206-6174 pg: 415 327-0220 ________________________________ From: Downs, Brenda - PHX <[email protected]> Sent: Friday, March 25, 2016 9:40 AM To: Breanna Burningham; PAMELA J. ANDERSON; Clement, Joseph (DPH); [email protected] Subject: RE: [Sepsis Groups] Severe Sepsis with Initial Lactate <4, repeat 3hrs later >4-?Shock or not This is where the physicians need to make sure to document that the patient is in septic shock – so then you would say yes to the septic shock question- as they are clearly in septic shock. Brenda :) Brenda Downs MSN, APRN, ACNS-BC Cell: 480-622-8103 Program Director Clinical Performance Improvement – ICU Care [cid:[email protected]] From: Sepsisgroups [mailto:[email protected]] On Behalf Of Breanna Burningham Sent: Tuesday, March 22, 2016 11:57 AM To: PAMELA J. ANDERSON; Clement, Joseph (DPH); [email protected] Subject: Re: [Sepsis Groups] Severe Sepsis with Initial Lactate <4, repeat 3hrs later >4-?Shock or not I would say NO. I had the same question and this is what I received from QNET. [cid:[email protected]] From: Sepsisgroups [mailto:[email protected]] On Behalf Of PAMELA J. ANDERSON Sent: Friday, March 18, 2016 5:56 AM To: Clement, Joseph (DPH); [email protected]<mailto:[email protected]> Subject: 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. First Avenue | Bldg 105-3915 | Maywood, IL 60153 (O) 708-216-5544 | (F) 708-216-7867 | (E) [email protected]<mailto:[email protected]> CONFIDENTIALITY NOTICE** This email communication and any attachments may contain confidential and privileged PHI for the use of the designated recipients named above. Distribution, reproduction or any other use of this transmission by any party other than the intended recipient is prohibited. If you have received this communication in error, please notify the sender immediately. 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