Hi Claire, We have the exact same issue. Our ED physicians have 24 hours to complete their note which makes it extremely difficult to get the documentation of suspected or actual infection. Many times it throws off the timing of the appropriate treatment that occurred prior to that. I hope that later versions of this measure will develop a more accurate way to determine the presentation time because this does not give a clear picture of compliance.
Dena Dena Videtic RN BSN Quality Indicators Doctors Hospital Coral Gables, FL 786-308-3315 From: Sepsisgroups [mailto:[email protected]] On Behalf Of Claire Sirois-Melvin Sent: Tuesday, August 02, 2016 10:24 AM To: [email protected] Subject: [Sepsis Groups] Repeat Lactate Hello, We are having challenges at some of our facilities with meeting bundle compliance due to timing of repeat lactates. The issue is often that even though we are drawing more than 1 Lactate, the second lactate is actually becoming our "Initial Lactate" due to timing of Severe Sepsis. According to Technical Specifications, the "initial Lactate" is the one drawn closest to time 0. For example, Patient comes in with a cough, fever, and an elevated HR at 1420, MD orders lactate and Blood Culture which are drawn at 1430. Lactate results come back at 3.0 at 1515. MD orders fluids and antibiotics at 1530, but does not document infection until 1700 (? pneumonia in admission order.) Repeat Lactate ordered and drawn at 1830 with result of 2.2 ... In this scenario, the Severe Sepsis time zero is 1700. Based on abstraction guidelines, this makes the second Lactate at 1830 the "initial Lactate" since it is the one drawn closest to time 0. Providers do not order another lactate to be drawn until the next morning since the value is trending downward. This case fails due to no repeat Lactate within 6 hrs of SST zero. This is frustrating for providers since the care is appropriate, and just the timing of documentation throws off the timing of initial lactate. Is anyone having similar challenges or does anyone have a process/recommendation in place for such scenerios. Any information you can share would be greatly appreciated. Thank you in advance! Claire Claire Sirois-Melvin RN, BSN Quality Measure Resource Specialist - Steward Healthcare 824 Oak Street, Brockton, MA 02301 Email: [email protected]<mailto:[email protected]>
_______________________________________________ Sepsisgroups mailing list [email protected] http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org
