Hi Linda, I am not really clear on what you are asking.... 1. Are you asking about failing the measure because of the timing of abx administration (24 hours prior to or 3 hours after) around the presentation of severe sepsis OR 2. are you saying that you fail the measure because a LA is not obtained before abx administration?
If it's the first, then they would fail the measure, not be excluded from it. A new abx should be started when the pt presents with severe sepsis, regardless if they were already on one that got dc'd 24 hours prior to that presentation. They either get a new one or should have already been on one 24 hours prior. If it's the second, CMS does not require a LA before abx, so you should not fall out for this. Mention of such is not anywhere in the rules for initial LA collection, only what is in green below, but nothing to do with antibiotics, to my knowledge. If I interpreted what you said incorrectly, then I apologize and disregard- If not, then I hope this helps!! Or if I am not understanding the questions or the measure correctly, then please someone tell me!! Initial Lactate Level Collection Documentation of collection of an initial lactate level between 6 hours prior to and 3 hours following the presentation of severe sepsis. Was an initial lactate level drawn between 6 hours prior to and 3 hours following the presentation of severe sepsis? Allowable Values 1 (Yes) An initial lactate level was drawn in the time window between 6 hours prior to and 3 hours following the presentation of severe sepsis 2 (No) An initial lactate level was not drawn in the time window between 6 hours prior to and 3 hours following the presentation of severe sepsis, or unable to determine. Notes for Abstraction * If there are multiple lactate levels, only abstract the level drawn closest to the time of presentation of severe sepsis. If there is a lactate level both before and after presentation of severe sepsis that are the same time apart, use the level prior to presentation. That lactate level is the initial lactate level for purposes of this data element. * If there is physician/APN/PA or nursing documentation that a lactate value is invalid, erroneous or questionable, disregard that value. * Use documentation specifying a lactate was actually drawn or collected. Do not use documentation such as "Labs Drawn" as it is not specific for lactate level. * Do not use a physician order for lactate levels as it does not specify that lactate level was drawn; however, you may use a physician order that has a notation "drawn" or "collected" next to it. * If a lactate level is ordered and there is an attempt to collect it, but the attempt results in failure to collect the specimen (too dehydrated to get a vein) or the specimen was contaminated during or after the draw, select Value "1." * If a lactate level is drawn but there are no results in the record, choose Value "1." * If there is no documentation indicating a lactate was drawn or collected, but there is supportive documentation that a lactate was drawn, use the earliest supportive documentation (e.g., lactate sent to lab, lactate received, lactate result). Suggested Data Source(s) * Laboratory Reports * Nursing Notes * Physician/APN/PA notes or orders Inclusion Guidelines for Abstraction * Lactate level collected * Lactate drawn * Lactic acid drawn Exclusion Guidelines for Abstraction * Labs drawn Amy Crowley Sepsis Coordinator Medical City Denton 3535 South I-35E Denton, Texas 76210 P: 940-384-3254 C: 214-801-2950 DentonRegional.com This email and any files transmitted with it may contain PRIVILEGED or CONFIDENTIAL information and may be read or used only by the intended recipient. If you are not the intended recipient of the email or any of its attachments, please be advised that you have received this email in error and that any use, dissemination, distribution, forwarding, printing, or copying of this email or any attached files is strictly prohibited. If you have received this email in error, please immediately purge it and all attachments and notify the sender by reply email or contact the sender at the number listed. From: Sepsisgroups [mailto:[email protected]] On Behalf Of Pender.Linda Sent: Friday, March 03, 2017 11:12 AM To: [email protected] Subject: [EXTERNAL] [Sepsis Groups] Antibiotics >24 prior to presentation of Sepsis If a patient is on IV antibiotics for >24 hours prior severe sepsis presentation shouldn't they be excluded from the Sep-1 Core Measure? We use Comparion to abstract our data. The abstracting tool requires entry of the initial collection of the lactic acid before the antibiotics, if the patient did not have a lactic acid collected 6 hrs before of 3 hrs after the severe sepsis presentation, the pt fails the measure instead of being excluded. Please let me know what you all think of this. It is truly affecting our numbers. 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! 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