Anyone out there going for the TJC Sepsis Certification? I am wondering what Databases everyone is using to enter their sepsis patients.
Michelle Foss RN Critical Care Data Coordinator Shawnee Mission Medical Center 913.632.2429 office -----Original Message----- From: Sepsisgroups [mailto:[email protected]] On Behalf Of [email protected] Sent: Monday, August 08, 2016 11:23 AM To: [email protected] Subject: Sepsisgroups Digest, Vol 216, Issue 4 Authentication-Results: symauth.service.identifier; spf=neutral; senderid=neutral 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. Re: Repeat Lactate ([email protected]) 2. Re: EGDT (Seckel, Maureen M) ---------------------------------------------------------------------- Message: 1 Date: Thu, 4 Aug 2016 13:00:38 +0000 From: <[email protected]> To: <[email protected]> Subject: Re: [Sepsis Groups] Repeat Lactate Message-ID: <595c1ea7ab3d9f479d0c6956995cfa9b21fa4...@fwdcwpmsghcmd4c.hca.corpad.net> Content-Type: text/plain; charset="us-ascii" Hi, At our facility most of the patients have infection or suspected infection documented in the nursing screening. Nursing documentation of infection or suspected infection may be used according the guidelines. Another possible documentation area by the physician is found in the indications for imaging. I often find that our providers are using sepsis or possible infection (abscess for example) as the indication for a chest x-ray or CT scan. Thanks Meghan Lux, BSN, CPHQ Sepsis Coordinator Clinical Outcomes Department Metropolitan Methodist Hospital, a campus of Methodist Hospital 1310 Mc Cullough Avenue San Antonio, TX 78212 (210) 757-2341 (Office) (210) 857-5751 (Cell) -----Original Message----- From: Sepsisgroups [mailto:[email protected]] On Behalf Of [email protected] Sent: Thursday, August 04, 2016 7:44 AM To: [email protected] Subject: [EXTERNAL] Sepsisgroups Digest, Vol 215, Issue 2 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. Repeat Lactate (Claire Sirois-Melvin) 2. Re: Time Zero (Gibbs, Katie) 3. 30 cc's/kg (Pender.Linda) ---------------------------------------------------------------------- Message: 1 Date: Tue, 2 Aug 2016 14:24:25 +0000 From: Claire Sirois-Melvin <[email protected]> To: "[email protected]" <[email protected]> Subject: [Sepsis Groups] Repeat Lactate Message-ID: <by1pr0601mb15290477a6ae390e28abf291d7...@by1pr0601mb1529.namprd06.prod.outlook.com> Content-Type: text/plain; charset="us-ascii" 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] -------------- next part -------------- An HTML attachment was scrubbed... URL: <http://lists.sepsisgroups.org/pipermail/sepsisgroups-sepsisgroups.org/attachments/20160802/d975edce/attachment-0001.htm> ------------------------------ Message: 2 Date: Mon, 1 Aug 2016 13:44:05 -0400 From: "Gibbs, Katie" <[email protected]> To: "'[email protected]'" <[email protected]>, "Zhukov, Marina (Tacoma)" <[email protected]> Cc: "Murray, Sandra" <[email protected]>, "'[email protected]'" <[email protected]> Subject: Re: [Sepsis Groups] Time Zero Message-ID: <[email protected]> Content-Type: text/plain; charset="utf-8" Our Indiana Hospital Association gave this for examples, I found it helpful. The 3rd bullet point gives good clarification. Example: Patient was noted to have purulent drainage from the surgical wound on 01-10-20xx at 22:00, when the physician documented ?suspect surgical wound infection. A culture of the surgical site was obtained. At 01:30 on 01-11-20xx, blood pressure was noted to be 74/40. At 02:00, 30 minutes later, temperature was 38.4 and pulse was 118. Severe Sepsis Presentation Time is 02:00. ?Physician/APN/PA documentation of severe sepsis or suspected severe sepsis is acceptable. ?If a suspected infection, severe sepsis or septic shock is in an ED physician note without a specific time documented within the note use the time the note was started or opened. ?If severe sepsis is present on arrival to the Emergency Department or severe sepsis is identified in triage, the Severe Sepsis Presentation Time is the time the patient was triaged in the Emergency Department. If more than one triage time is documented (e.g., ?Triage started? and ?Triage completed?) use the later time reflecting triage is completed. ?For patients with multiple episodes of severe sepsis, abstract only the first episode. ?If there are multiple times documented when the last criterion to meet the definition of severe sepsis or physician/APN/PA documentation of severe sepsis occurred, and they are at variance with each other, use the earliest time. ?If criteria for severe sepsis are met after physician/APN/PA documentation of septic shock, enter the time the physician/APN/PA documented septic shock. ?If criteria for severe sepsis are not documented and there is not physician/APN/PA documentation of severe sepsis, but there is physician/APN/PA documentation of septic shock, enter the earliest time septic shock was documented Hope this helps! Katie Gibbs, RN, BSN Quality Improvement Specialist Witham Health Services PH 765-485-8459 CONFIDENTIALITY NOTICE: The information in this e-mail, including any attachments, is for the sole use of the intended recipient(s) and may contain confidential and legally privileged information. If you are not the intended recipient, any disclosure, copying, distribution or use of the contents of this information in any manner is strictly prohibited and may be unlawful. -----Original Message----- From: Sepsisgroups [mailto:[email protected]] On Behalf Of [email protected] Sent: Saturday, July 23, 2016 5:51 PM To: Zhukov, Marina (Tacoma) Cc: Murray, Sandra; '[email protected]' Subject: Re: [Sepsis Groups] Time Zero Hello everyone, Just an fyi- At the UWMC we have a similar situation to what Marina has describe: We rarely hit all three criteria for severe sepsis when the patient walks in the ED door. The patient usually meets criteria later during the ED visit. Thanks, Mary L. Ransom, RN, BSN, MA, CPHQ Core Measures Project Manager Center for Clinical Excellence Box 359425 University of Washington Medical Center Seattle WA 98195 Office Days: Mon, Tues and Thurs *************************************** This message and any attachments to it is protected by coordinated quality improvement/risk management/peer review confidentiality under RCW 70.41.200/4.24.250/43.70.510. Privileged confidential patient identifiable information also may be contained in this message. This information is meant only for the use of the intended recipients. If you are not the intended recipient or if the message has been addressed to you in error, do not read, disclose, reproduce, distribute, disseminate or otherwise use this transmission. Instead, please notify the sender by reply email and then destroy all copies of the message and any attachments. On Thu, 21 Jul 2016, Zhukov, Marina (Tacoma) wrote: > > This does not happen for the majority of our sepsis cases. Keep in > mind that patient needs to meet ALL criteria (infx, two SIRS and organ > dysfunction) during/before triage in order to use triage time. There is > always little something that shifts the clock so that triage time could not > be used. > > ? > > Also, with just added SEP-1 Additional Notes for Abstraction, Version > 5.1 there is new clarification: ?if the note (physician?s note) states severe > sepsis was present on admission, use the earliest documented admission > date/time? > > ? > > Marina Zhukov, RN, BSN > > Clinical Data Abstractor > > CHI Franciscan Health > > ? > > ? > > ? > > From: Sepsisgroups > [mailto:[email protected]] On Behalf Of > Madrid, Pamela A > Sent: Thursday, July 07, 2016 9:45 AM > To: Belfi, Karen; Dena Videtic; Murray, Sandra; > '[email protected]' > Subject: [Sepsis Groups] Time Zero > > ? > > CAUTION: This email is not from a CHI source. Only click links or open > attachments you know are safe. > > > ______________________________________________________________________ > ______________________________________________________________________ > ________________________________________________ > > > Hi Everyone!? Just a follow-up question/comment on the time zero discussion. > > ? > > For determination of time zero for patients who present to the > Emergency Department, how are you applying this portion of the Notes for > Abstraction on page 1-232. By this it seems that we should we be using triage > time for the majority of the severe sepsis and septic shock patients?? > > ? > > Severe Sepsis Time > > If severe sepsis is present on arrival to the Emergency Department or > severe sepsis is identified in triage, the Severe Sepsis Presentation Time is > the time the patient was triaged in the Emergency Department. If more than > one triage time is documented (e.g., ?Triage started? and ?Triage completed?) > use the later time reflecting triage is completed. > > ? > > ? > > Pam Madrid, RN, MS, CCRN, CCNS > > Clinical Nurse Specialist ? Critical Care ? Mercy Hospital, part of > Allina Health > > Phone: 763-236-8331 ? Pager: 612-654-0624 ? Fax: 612-236-8304 ? > [email protected] > > Mail Route 51415 ? 4050 Coon Rapids Blvd ? Coon Rapids, MN 55434 > > ? > > ?Information is random and miscellaneous, but knowledge is orderly and > cumulative.?? Daniel Boorstin > > ? > > ? > > Image removed by sender. > This message contains information that is confidential and may be > privileged. Unless you are the addressee (or authorized to receive for the > addressee), you may not use, copy or disclose to anyone the message or any > information contained in the message. If you have received the message in > error, please advise the sender by reply e-mail and delete the message. > > > ------------------------------ Message: 3 Date: Tue, 2 Aug 2016 17:52:54 +0000 From: Pender.Linda <[email protected]> To: "'[email protected]'" <[email protected]> Subject: [Sepsis Groups] 30 cc's/kg Message-ID: <[email protected]> Content-Type: text/plain; charset="us-ascii" How are you all working with your physicians to encourage the use of 30cc's/kg? Especially in CHF and Renal patients? Linda G. Pender RRT-NPS Sepsis Coordinator Patient Care Services Administration phone: 478-633-6806 pager: 4444 KNOW Sepsis: Inside & Out [MCCG...World Class Care! See our website...]<http://www.navicenthealth.org/> Email: [email protected] CONFIDENTIALITY NOTICE: The information transmitted in this e-mail message, including any attachments, is for the sole use of the intended recipient(s) or entity to which it is addressed and may contain confidential, privileged, and/or proprietary information. Any unauthorized review, retransmission, use, disclosure, dissemination, or other use of, or taking any action in reliance upon this information by persons or entities other than the intended recipient is prohibited. If you are not the intended recipient, you are hereby notified that any reading, dissemination, distribution, copying, or other use of this message or its attachments is strictly prohibited. If you have received this message in error, please notify the sender immediately by reply e-mail, or by calling (478) 633-7272, and destroy the original message, attachments, and all copies thereof on all computers and in any other form. Thank you. Navicent Health. http://www.navicenthealth.org/ -------------- next part -------------- An HTML attachment was scrubbed... URL: <http://lists.sepsisgroups.org/pipermail/sepsisgroups-sepsisgroups.org/attachments/20160802/063ee838/attachment.htm> -------------- next part -------------- A non-text attachment was scrubbed... Name: image001.png Type: image/png Size: 9451 bytes Desc: image001.png URL: <http://lists.sepsisgroups.org/pipermail/sepsisgroups-sepsisgroups.org/attachments/20160802/063ee838/attachment.png> ------------------------------ Subject: Digest Footer _______________________________________________ Sepsisgroups mailing list [email protected] http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org ------------------------------ End of Sepsisgroups Digest, Vol 215, Issue 2 ******************************************** ------------------------------ Message: 2 Date: Thu, 4 Aug 2016 12:57:30 +0000 From: "Seckel, Maureen M" <[email protected]> To: Pender.Linda <[email protected]>, "'[email protected]'" <[email protected]> Subject: Re: [Sepsis Groups] EGDT Message-ID: <[email protected]> Content-Type: text/plain; charset="us-ascii" We have not been monitoring CVPs since Process. In general, central lines are placed when there are pressor requirements. Arterial lines are used as needed for "higher" pressor requirements or in patients who have difficulty in obtaining reliable manual BPs on pressors. We are using the Edwards monitors - EV1000 for minimally invasive Flotrac or non-invasive Clearsight in patients who are not quickly responsive or are felt to be more complex to monitor volume responsiveness via stroke volume. CVP alone is really not considered a reliable measure of fluid responsiveness in septic patients. Marik PE, Monnet X, Teboul J. Hemodynamic parameters to guide fluid therapy. Annals of Intensive Care 2011;1:1. Marik PE, Baram M, Bahid B. Does central venous pressure predict fluid responsiveness? A systematic review of the literature and the tale of seven mares. Chest 2008;134:172-178. Marik P, Bellomo R. A rationale approach to giving fluid in sepsis. British Journal of Anesthesia 2016;116:339-49. Maureen A. Seckel, APRN, ACNS-BC, CCNS, CCRN, FCCM Lead CNS Medical Pulmonary Critical Care Sepsis Coordinator Christiana Care Health System 4755 Ogletown-Stanton Road 3E29 Newark, DE 19718 Office 302 733-6023 [email protected] [cid:[email protected]] From: Sepsisgroups [mailto:[email protected]] On Behalf Of Pender.Linda Sent: Tuesday, August 02, 2016 1:54 PM To: '[email protected]' Subject: [Sepsis Groups] EGDT Is anyone still using EGDT with placing CVP lines and arterial line to monitor fluid status? If so, do you feel this is beneficial? Linda G. Pender RRT-NPS Sepsis Coordinator Patient Care Services Administration phone: 478-633-6806 pager: 4444 KNOW Sepsis: Inside & Out [MCCG...World Class Care! See our website...]<http://www.navicenthealth.org/> Email: [email protected]<mailto:[email protected]> CONFIDENTIALITY NOTICE: The information transmitted in this e-mail message, including any attachments, is for the sole use of the intended recipient(s) or entity to which it is addressed and may contain confidential, privileged, and/or proprietary information. Any unauthorized review, retransmission, use, disclosure, dissemination, or other use of, or taking any action in reliance upon this information by persons or entities other than the intended recipient is prohibited. If you are not the intended recipient, you are hereby notified that any reading, dissemination, distribution, copying, or other use of this message or its attachments is strictly prohibited. If you have received this message in error, please notify the sender immediately by reply e-mail, or by calling (478) 633-7272, and destroy the original message, attachments, and all copies thereof on all computers and in any other form. Thank you. Navicent Health. http://www.navicenthealth.org/ -------------- next part -------------- An HTML attachment was scrubbed... URL: <http://lists.sepsisgroups.org/pipermail/sepsisgroups-sepsisgroups.org/attachments/20160804/d27fc915/attachment.htm> -------------- next part -------------- A non-text attachment was scrubbed... Name: image002.png Type: image/png Size: 9014 bytes Desc: image002.png URL: <http://lists.sepsisgroups.org/pipermail/sepsisgroups-sepsisgroups.org/attachments/20160804/d27fc915/attachment.png> -------------- next part -------------- A non-text attachment was scrubbed... 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