We have a reflex lactate policy that any result 2 or > would auto reflex a serum lactate order in 3 hours. We initially had it set for 4 hours but had delays in lab draws because our initial lactates were POC istat and although were generating the reflex order, were not generating labels in the ED. So once we figured out what was happening and we changed the time to 3 hours, educated and worked around the no label generation issue, we now rarely have fallouts related to repeat lactates.
The only thing I would have done differently is to have the initial lab draw be serum instead of POC because there are a lot of technical issues with the POC's in our ED...results not crossing over into lab results because of operator error and such and as I said the auto reflex order doesn't trigger a label to print. It's not at all perfect but it has helped. Starlynn Burnett, RN Concurrent Review West Hills Hospital and Medical Center 7300 Medical Center Drive West Hills, CA 91307 818-676-4513 818-529-3651 pgr -----Original Message----- From: Sepsisgroups [mailto:[email protected]] On Behalf Of [email protected] Sent: Friday, February 03, 2017 12:22 PM To: [email protected] Subject: [EXTERNAL] Sepsisgroups Digest, Vol 232, Issue 19 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: RENAL FAILURE ([email protected]) 2. Re: repeat lactate levels (Gibbs, Katie) ---------------------------------------------------------------------- Message: 1 Date: Thu, 2 Feb 2017 17:55:11 +0000 From: <[email protected]> To: <[email protected]>, <[email protected]>, <[email protected]> Subject: Re: [Sepsis Groups] RENAL FAILURE Message-ID: <a632510231a514428b8761ce10d7e20f116eb...@xrdcwpmsghcmd1a.hca.corpad.net> Content-Type: text/plain; charset="us-ascii" I asked the same question to determine severe sepsis per CMS criteria (no severe sepsis documented by providers). In my case scenario, the patient's creatinine was greater than the baseline range documented by the provider with documentation of acute on chronic renal failure. From what I understood from QNet response, if the physician documents acute on chronic with a creatinine lab value higher than baseline and greater than 2 MG/DL, it can be used as organ failure. For example: If the baseline creatinine is documented as a range between 1.9 and 2.4 then a creatinine level up to 2.4 cannot be used as organ failure. Anything greater than baseline of 2.4 can be used. Jocelyne [sepsis_logo_update_copy_300x265[1]][Brain_In_Blue_by_SilverGryphon8[1]] "Teamwork is the ability to work together toward a common vision--the ability to direct individual accomplishments toward organizational objectives. It is the fuel that allows common people to attain uncommon results"- Andrew Carnegie Jocelyne F. Davis, MSN, RN, CNRN Stroke and Sepsis Programs Coordinator Doctors Hospital of Sarasota 5731 Bee Ridge Road Sarasota, FL 34233 doctorsofsarasota.com From: Sepsisgroups [mailto:[email protected]] On Behalf Of Belfi, Karen Sent: Thursday, February 02, 2017 10:42 AM To: Gibbs, Katie <[email protected]>; [email protected] Subject: [EXTERNAL] Re: [Sepsis Groups] RENAL FAILURE I had asked qnet if acute on chronic was acceptable with a creat over baseline, and they said yes. I would abstract this as sepsis. From: Sepsisgroups [mailto:[email protected]] On Behalf Of Gibbs, Katie Sent: Thursday, January 26, 2017 9:20 AM To: [email protected]<mailto:[email protected]> Subject: [EXTERNAL] [Sepsis Groups] RENAL FAILURE Good morning, While reviewing a chart today, I have a patient that has acute on chronic renal failure. MD noted this a due to sepsis. She elevated her creatinine from baseline over 1 point. She does not have an elevated lactate. She does meet SIRS criteria. Would you abstract this as sepsis? Thanks for the help! Katie Gibbs, RN, BSN Quality Improvement Specialist Witham Health Services PH 765-485-8459 [cid:[email protected]] 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. -------------- next part -------------- An HTML attachment was scrubbed... URL: <http://lists.sepsisgroups.org/pipermail/sepsisgroups-sepsisgroups.org/attachments/20170202/1a68bb07/attachment-0001.htm> -------------- next part -------------- A non-text attachment was scrubbed... Name: image001.png Type: image/png Size: 1885 bytes Desc: image001.png URL: <http://lists.sepsisgroups.org/pipermail/sepsisgroups-sepsisgroups.org/attachments/20170202/1a68bb07/attachment-0001.png> -------------- next part -------------- A non-text attachment was scrubbed... Name: image006.jpg Type: image/jpeg Size: 2100 bytes Desc: image006.jpg URL: <http://lists.sepsisgroups.org/pipermail/sepsisgroups-sepsisgroups.org/attachments/20170202/1a68bb07/attachment-0002.jpg> -------------- next part -------------- A non-text attachment was scrubbed... Name: image007.jpg Type: image/jpeg Size: 1878 bytes Desc: image007.jpg URL: <http://lists.sepsisgroups.org/pipermail/sepsisgroups-sepsisgroups.org/attachments/20170202/1a68bb07/attachment-0003.jpg> ------------------------------ Message: 2 Date: Thu, 2 Feb 2017 11:15:50 -0500 From: "Gibbs, Katie" <[email protected]> To: "'[email protected]'" <[email protected]>, "[email protected]" <[email protected]>, "[email protected]" <[email protected]> Cc: "[email protected]" <[email protected]> Subject: Re: [Sepsis Groups] repeat lactate levels Message-ID: <[email protected]> Content-Type: text/plain; charset="us-ascii" We also have an auto-reflux. We use meditech as our software. The 2nd order comes past on the result timing of the 1st at 3 hours. We have had zero fall outs related to 2nd lactic draws since initiating this in August! I would be interested in knowing if anyone in the group uses bedside lactic draws (i.e. Istat) ? Looking at our initial results it takes us over an hour to get a results from lab, then delaying our antibiotic and fluid administration (Disclaimer: preference of our ED docs don't want to start these treatments until after lab results) Thanks! Katie Maggie-Do you not have Istats??? CCMC Northwest (HCA Facility ) Has them and prior to my departure our initials and repeats we did not have any issues...may check in with Pam Danser there and see how things are going From: Sepsisgroups [mailto:[email protected]] On Behalf Of [email protected] Sent: Thursday, February 02, 2017 10:46 AM To: [email protected]; [email protected] Cc: [email protected] Subject: Re: [Sepsis Groups] repeat lactate levels Lori, we have the reflex order here set for 2 hours post the initial lactate level. It has been working well for us. I know originally some wanted to push the reflex back to 4 hours, but I am worried that if we do that we might experience a delay that leads to a fallout. Maggie Macias, RN Sepsis Program Coordinator Valley Regional Medical Center Brownsville, TX (956) 350-7179 (O) [email protected]<mailto:[email protected]> From: Sepsisgroups [mailto:[email protected]] On Behalf Of Bly, Lori Sent: Friday, January 27, 2017 10:51 AM To: [email protected]<mailto:[email protected]> Cc: Verdi, Rachel C. <[email protected]<mailto:[email protected]>> Subject: [EXTERNAL] [Sepsis Groups] repeat lactate levels At our facility we are considering placing a reflex order on initial lactate levels >2.0. Has anyone else initiated this and how is it working? Thank you Lori Bly, RN Quality Management Department ACMH Hospital One Nolte Drive Kittanning, PA 16201 Extension: 8459 email: [email protected]<mailto:[email protected]> Confidentiality Notice: This e-mail message, including any attachments, is for the sole use of the intended recipient(s) and may contain confidential and privileged information. Any unauthorized review, use, disclosure or distribution is prohibited. If you are not the intended recipient, please contact the sender by reply e-mail and destroy all copies of the original message. -------------- next part -------------- An HTML attachment was scrubbed... URL: <http://lists.sepsisgroups.org/pipermail/sepsisgroups-sepsisgroups.org/attachments/20170202/30063a8d/attachment.htm> ------------------------------ Subject: Digest Footer _______________________________________________ Sepsisgroups mailing list [email protected] http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org ------------------------------ End of Sepsisgroups Digest, Vol 232, Issue 19 ********************************************* _______________________________________________ Sepsisgroups mailing list [email protected] http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org
