As a Clinical Nurse Specialist and part of our multidisciplinary sepsis team, I review all of the opportunities for improvement from our CMS data abstractors. I am finding a repeating theme and wanted to know if others have seen this also. Once a patient receives fluid for hypotension, we are not meeting the CMS bundle due to no vasopressors for shock. What I am observing is the abstractors are looking at the first 2 MAPs after fluids have been infused and requiring a vasopressor to be given if MAP is not >65. For example, fluids complete at 1300 in less than 45 minutes from hypotension and the first 2 MAPS recorded at 1315 and 1320 are <65 even though subsequent MAPs are consistently >65. On-going assessments of perfusion are being made by our providers and bedside clinicians during this time. Since CMS gives a 6 hour window for vasopressors for initial septic shock, is there any consideration for examining this time window for vasopressor support? We give our initial fluid resuscitation for most patients in less than one hour. I am interested to know other viewpoints on this issue.
Jeanie Bollinger MSN,RN, ACCNS-AG, CCRN Clinical Nurse Specialist Acute Medicine Mission Health 509 Biltmore Avenue Asheville, NC 28801 Office: 828-213-7171 Cell: 828-400-1194 ------------------------------------------------------------------------------ This message and its attachments may contain confidential and/or legally-sensitive information that is intended for the sole use of the addressee(s). Any unauthorized review, use, disclosure, or distribution of the information contained in this message and its attachments is prohibited. If you have received this message or any of its attachments in error, please destroy all originals and copies of the same and notify the sender immediately.
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