Ron; While I respect and appreciate the point you are making, the tenor of your email presumes a level of naiveté that is incorrect and unwarranted For better or worse CMS core measures need to have strict and achievable data definitions. I took no part in creating this measure, and for sure there are many things contained in it with which I disagree. As always, the best interest of the patient and the clinical judgment of the provider are the first priorities. Unfortunately, many providers ignore or actively resist evidence and always believe that their judgment is best - all too often to the detriment of the patient.
30ml/kg is almost always a safe starting point for fluid resuscitation in patients who have compromised perfusion from septic shock. And those who argue against it, particularly in the case of HF and ESRD patients, are misinformed luddites who don't open those fancy journals they pay for. Thanks, MARY ANN BARNES-DALY MS-L RN CCRN DC | Clinical Performance Improvement Consultant Quality & Clinical Effectiveness Team | Office of Patient Experience Sutter Health -2200 River Plaza Drive, Sacramento, CA 95833 Mobile 916.200.5604| Office 916.286.6717 | [email protected] "You never change things by fighting the existing reality. To change something, build a new model that makes the existing model obsolete." ~R. Buckminster Fuller From: Ron Daniels [mailto:[email protected]] Sent: Thursday, April 28, 2016 8:40 PM To: Barnes-Daly, Mary Ann Cc: Mary Draper; [email protected] Subject: Re: [Sepsis Groups] [External] 30ml/kg Ah I see and apologise: the question was one of hitting a target rather than a clinical/ best interests of patents one. I shall therefore duck out. Dr Ron Daniels BEM CEO: UK Sepsis Trust and Global Sepsis Alliance Clinical Adviser to NHS England Sent on the move from my iPhone, excuse brevity! On 28 Apr 2016, at 23:02, Barnes-Daly, Mary Ann <[email protected]<mailto:[email protected]>> wrote: My understanding of the measure is that you should likely round up to 3500 to be sure to meet the mark; the challenge with almost but not quite is that it leaves the interpretation open - then who gets to decided that it is close enough? Thanks, MARY ANN BARNES-DALY MS-L RN CCRN DC | Clinical Performance Improvement Consultant Quality & Clinical Effectiveness Team | Office of Patient Experience Sutter Health -2200 River Plaza Drive, Sacramento, CA 95833 Mobile 916.200.5604| Office 916.286.6717 | [email protected]<mailto:[email protected]> "You never change things by fighting the existing reality. To change something, build a new model that makes the existing model obsolete." ~R. Buckminster Fuller From: Sepsisgroups [mailto:[email protected]] On Behalf Of Mary Draper Sent: Tuesday, April 26, 2016 12:54 PM To: [email protected]<mailto:[email protected]> Subject: [External] [Sepsis Groups] 30ml/kg Importance: High Does anyone know if there is any leeway with the calculated volume? For example pt weighs 107 kg which requires 3210ml. Pt only receives 3000. Does this become an opportunity for improvement? Clinically I doubt an extra 210 ml would have made an impact on the patients hemodynamics. Thanks for your feedback. Mary Draper RN BSN Coordinator Quality Improvement Peer Review Support CV/CT Quality Management JMH Office (925) 674-2045 Cell (925) 451-8792 Fax (925) 674-2373 [email protected]<mailto:[email protected]> <image001.png> "O, let us always have a mountain within our soul, with a peak so high that we never quite reach the top... For then we will always strive for greater things and will not be content with merely climbing hills." Ardath Rodale _______________________________________________ Sepsisgroups mailing list [email protected]<mailto:[email protected]> http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org<https://na01.safelinks.protection.outlook.com/?url=http%3a%2f%2flists.sepsisgroups.org%2flistinfo.cgi%2fsepsisgroups-sepsisgroups.org&data=01%7c01%7cBarnesM4%40sutterhealth.org%7c9306cf5871bf437c85d408d36fdfe514%7caef453eadaa243e0be62818066e9ff63%7c1&sdata=%2b7butSXThTFZFL70BQATGIxyQinH2228m2GSR20OTpA%3d>
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