FYI - we quested how long after initial hypotension you have to abstract to answer Yes-Value 1 for 30ml/kg was received-we were originally looking for a 3-6 hour timeframe in the spirit of the measure. The answer provided was to select value 1- yes as long as 30ml/kg was ordered-administered at a rate >125ml/per hr for any timeframe after initial hypotension and is sufficient based on weight. This is quite burdensome on abstraction and again if the patient does not receive adequate fluids until >6 hours after severe sepsis time in the absence of an elevated lactate (4.0) or documented septic shock the patient will pass that measure because you would have to answer no to septic shock...
Please see below Quest response. I wish the Sepsis measure was more in alignment to the way SCIP and PN measures were developed. There are too many questions that the abstractor has to make decisions on, the measure should require to just enter the names of antibiotics and times, and the date/times of lactate, and weight of patient-amount of fluid administered etc and determine if it passes or not within the algorithm. By asking the abstractor if it meets the antibiotic selection guidelines, or collected within 6 hours-3 hours it adds extra steps and opportunities for error. Subject Timeframe for Crystalloid Administration for Initial Hypotension Discussion Thread Response Via Email (Noel Albritton) 08/19/2016 01:41 PM That is correct. If a patient requires 4000 mL and they are given at 126 mL/hr, they will be infusing 30 hours later. If all 4000 mL were infused, "Yes" would be selected for crystalloid fluid administration. While this is a rare scenario, the measure is not intended to force high volume rapid infusions. The specifications allow for this liberal approach as each case must be treated individually. Customer By Web Form 08/19/2016 01:27 PM Thank you for providing some clarification, but I am still unclear as to when we stop looking for Crystalloid Fluids. If there is no specified timeframe, for which the 30 ml/kg needs to be given, then I could say yes if they were to receive the appropriate amount of fluid within 16 hrs or 48 hrs or even days after Initial Hypotension as long as it is ordered and infused at a rate greater than 125 ml/ hr? Response Via Email (Noel Albritton) 08/19/2016 11:28 AM Thanks for the question. Is there a specific timeframe for Crystalloid fluids to be completed for Initial Hypotension? The initial hypotension data element simply provides a trigger point or reference point in which to begin looking for crystalloid fluid administration. No time frame is specified for crystalloid fluid administration. In your example, with initial hypotension documented at 0800, 0800 would be a reference point to begin looking for crystalloid fluid administration. Fluids may be infusing at greater than 125 mL/hr at the time of the initial hypotension, and those fluids would suffice. Fluids may not have been started until until after severe sepsis presentation, and those fluid would suffice, etc. Hope this helps! Customer By Web Form 08/18/2016 03:02 PM Is there a specific timeframe for Crystalloid fluids to be completed for Initial Hypotension? For example, if a patient has a Severe Sepsis time of 1200, but they had a low Blood pressure at 0800, at what time would the Crystalloid Fluids need to be given by in order to answer value 1 for Crystalloids administered ? (in the absence of Septic Shock) Question Reference #160818-000143 Cynthia Wells Steward Health Care Director of Clinical Performance Analytics (508) 404-8647
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