Patricia,
It appears that the question you asked is in relation to v5.1 (cases discharged
7/1/16 - 12/31/16). I think this may be more confusion than anything else given
that the concept you question is not unique to this data element.
Conceptually the concern you ask about is the same in v5.0b and v5.1 with
differences in specific documentation requirements noted below for each version.
What qualifies as a Vital Sign Review does change significantly in v5.2, also
noted below.
General background
* The name of the data element is Vital Signs Review Performed. Because of
this the Definition, Suggested Data Collection Question, Allowable Values, and
Notes for Abstraction refer to a Vital Signs Review being Performed. This is a
consistent reference used in many other data elements.
* The Notes for Abstraction provide the details of what constitutes a Vital
Signs Review for purposes of the Vital Signs Review Performed data element.
Again this is not a new concept and is consistent with ALL other data elements.
Common factors between v5.0b and v5.1
* Both versions require the physician document the actual vitals they
reviewed and it must include that they reviewed the following:
* temperature
* pulse
* respiratory rate
* systolic and diastolic blood pressure
* The Exclusion Guidelines for Abstraction identify documentation or wording
that is not acceptable. Documentation of vital signs reviewed is not considered
acceptable for either v5.0b or v5.1 because it lacks the detail required in the
Notes for Abstraction. This is consistent with other data elements.
Differences between v5.0b and v5.1
* v5.0b requires the actual values for the temperature, pulse, resp rate and
BP be included in the physician documentation.
* v5.1 does NOT require physician documentation of the actual values for the
temperature, pulse, resp rate and BP. The physician must still document the
names of the vitals they reviewed but they do not need to document the values
as this was deemed redundant.
v5.2 (cases discharged 1/1/2017 - 12/31/2017)
* There are more flexible options to meet the data element.
* Vital signs review has been removed from The Exclusion Guidelines for
Abstraction because this is now acceptabel
* The physician can document that they:
reviewed the temperature, pulse, resp rate and BP.
OR
reviewed, performed or attested to reviewing or performing a vital signs review
(if documented this way do not need to include names of the vital signs)
OR
performed or attested to performing a physician exam, perfusion assessment of
sepsis (severe sepsis of septic shock) focused exam (if documented this way do
not need to include names of the vital signs)
I hope this helps you.
Sean Townsend
-----Original Message-----
From: Humiston, Patricia [mailto:[email protected]]
Sent: Saturday, August 27, 2016 7:33 AM
To: Townsend, Sean, M.D.; Marlett Amy; Clement, Joseph (DPH)
Cc: [email protected]
Subject: RE: [Sepsis Groups] [External] RE: Re: SEP-1 Specification Manual for
January 2017 Discharges
Interesting regarding the vital signs review as I recently sent the question to
QNET around vital signs review, see the discussion thread response below
Subject
Vital signs review performed /septic shock
Customer By Web Form (Patricia Humiston) 08/16/2016 08:05 AM
When abstracting the element of vital signs for the focused exam, the specs
identify choose value #1 (Yes) Vital signs review was documented by a
physician/APN/PA in the time window beginning at the crystalloid fluid
administration date and time and ending six hours after the presentation of
septic shock date and time.
But under Exclusion Guidelines for Abstraction:
• Vitals signs reviewed
The terminology vital signs reviewed is exclusion terminology, I find this a
bit confusing if MD documents vital signs reviewed one part of spec's
identifies it is acceptable and an additional part it is not. Is there any
additional clarity around this element?
Discussion Thread
Response Via Email (Char Teed) 08/16/2016 01:56 PM
Second bullet: Vital signs review is done to assess overall status. The review
must include temperature, pulse (also referred to as heart rate), respirations,
and systolic and diastolic blood pressure reading. They cannot just say
"vitals signs reviewed" need readings.
Patricia Humiston, MBA RN-C
Division of Healthcare Quality
Baystate Health Systems
(413) 794-0194
[email protected]<mailto:[email protected]>
-----Original Message-----
From: Sepsisgroups [mailto:[email protected]] On
Behalf Of Townsend, Sean, M.D.
Sent: Friday, August 26, 2016 10:54 AM
To: Marlett Amy; Clement, Joseph (DPH)
Cc:
[email protected]<mailto:[email protected]>
Subject: Re: [Sepsis Groups] [External] RE: Re: SEP-1 Specification Manual for
January 2017 Discharges
One more thing --
I was also unclear below as regards the cardiopulmonary exam. From today until
Jan 1 an LIP still has to perform the cardiopulmonary exam. However after that
time to satisfy the concept of a reperfusion assessment for a shock patient,
an MD/NP/PA may then document simply that they “attest to having reviewed or
performed a sepsis focused exam and findings were ____.” The findings can
include “within normal limits.” The provider DOES NOT need to state, nor
include, nor specifically reference the terms vital signs, cardiopulmonary
exam, capillary refill, peripheral pulses, or skin exam. This simple statement
of reassessment satisfies the intent that the patient was closely observed.
Note as well the LIP can attest to a nurse’s review of the same.
Hope that's more clear.
Sean
On Aug 25, 2016, at 5:06 PM, Townsend, Sean, M.D.
<[email protected]<mailto:[email protected]<mailto:[email protected]%3cmailto:[email protected]>>>
wrote:
Amy, you were correct. I mean to say “blood culture” acceptable delay and too
quickly typed “antibiotic” acceptable delay.
To summarize:
To further ensure that blood culture collection does not delay appropriate
care, the next specification update, Version 5.2, has a new data element
entitled Blood Culture Collection Acceptable Delay which allows for a case to
pass the measure if a clinician indicates that “the IV antibiotic was started
before the blood culture was drawn because waiting for the blood culture to be
drawn would have resulted in a delay of 45 minutes or more in starting the IV
antibiotic.” SEP-1 Version 5.2 was published July 1st, 2016, and will cover
discharges from January 1st, 2017 through December 31st, 2017.
Sean R. Townsend, M.D.
Vice President of Quality & Safety
California Pacific Medical Center
2330 Clay Street, #301
San Francisco, CA 94115
email
[email protected]<mailto:[email protected]<mailto:[email protected]%3cmailto:[email protected]>>
office (415) 600-5770
fax (415) 600-1541
-----Original Message-----
From: Marlett Amy [mailto:[email protected]]
Sent: Thursday, August 25, 2016 1:21 PM
To: Townsend, Sean, M.D.; Clement, Joseph (DPH)
Cc:
[email protected]<mailto:[email protected]<mailto:[email protected]%3cmailto:[email protected]>>
Subject: [External] RE: Re: [Sepsis Groups] SEP-1 Specification Manual for
January 2017 Discharges
I am looking at the following below from Dr. Townsend " As regards antibiotic
acceptable delay the provider has to state a delay of 45 minutes or longer
would have transpired."
My question is- was this this answer to J. Clement comment below " I see that a
new element was added "Blood Culture Collection Acceptable Delay" - but I'm not
clear from the manual what constitutes an acceptable delay. Am I missing
something? Can anybody clarify?"
If so, I do not understand the reply. I only see a change to the BC part of the
measure, not Abx. So why I do not understand. If there is another question in
these emails regarding Abx, then I missed it. Thank you for clarifying and for
this workgroup. I have never sent in a question before, but I find most of the
posts very useful and know that eventually someone will ask my questions.
Amy Gossett Marlett
BSN, RN, CCRN
Sepsis Coordinator
Denton Regional Medical Center
Office: 940.384.3254
Cell: 214.801.2950
[email protected]<mailto:[email protected]<mailto:[email protected]%3cmailto:[email protected]>>
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-----Original Message-----
From: Sepsisgroups [mailto:[email protected]] On
Behalf Of Townsend, Sean, M.D.
Sent: Wednesday, August 24, 2016 5:53 PM
To: Clement, Joseph (DPH)
<[email protected]<mailto:[email protected]<mailto:[email protected]%3cmailto:[email protected]>>>
Cc:
[email protected]<mailto:[email protected]<mailto:[email protected]%3cmailto:[email protected]>>
Subject: [EXTERNAL] Re: [Sepsis Groups] SEP-1 Specification Manual for January
2017 Discharges
You are correct in your reading. The LIP can now attest to the reperfusion
assessment without giving greater detail. What is more, nursing documentation
and a nursing exam can be the basis of that attestation. The only requirement
is that the one exam item LIP has to do as part of that attestation is a
cardiopulmonary exam.
This is huge. I hope you appreciate the change. Our goal wasn't to make people
document but rather to conduct an exam and satisfy themselves that the patient
was perfusing adequately.
As regards antibiotic acceptable delay the provider has to state a delay of 45
minutes or longer would have transpired.
There are other goodies in version 5.2.
On Aug 24, 2016, at 1:49 PM, Clement, Joseph (DPH)
<[email protected]<mailto:[email protected]<mailto:[email protected]%3cmailto:[email protected]<mailto:[email protected]%3cmailto:[email protected]%3cmailto:[email protected]%3cmailto:[email protected]>>>>
wrote:
Hello,
I'm reviewing the updated specification manual 5.2 for SEP-1, that will go into
effect 1/1/17, and I have a few questions - I wonder if others are further
along than me.
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[] The manual says that MD attestation of reassessment, VS review, skin
assessment, cardiopulmonary exam, and peripheral pulse exams are acceptable. It
also says that "performing, or attesting to performing a physical examination,
perfusion (re-perfusion) assessment, or sepsis (severe sepsis or septic shock)
focused exam is acceptable."
At the risk of asking an obvious question, I just want to make sure I am
getting this right. If the MD signs something that says "I attest to having
performed a severe sepsis re-perfusion exam at XX:XX", then this would meet the
measure requirement?
[] I see that a new element was added "Blood Culture Collection Acceptable
Delay" - but I'm not clear from the manual what constitutes an acceptable
delay. Am I missing something? Can anybody clarify?
Thanks in advance!
Joe
Joseph Clement, MS, RN, CCNS
Clinical Nurse Specialist
San Francisco General Hospital
ph: 628 206-6174
pg: 415 327-0220
office: H5841
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