Great article Jeanie. I passed this along to our ED physicians who I hope are sharing with our local EMS groups. Theresa
Sent from my iPhone > On Apr 20, 2017, at 2:40 PM, Jeanie Bollinger <[email protected]> > wrote: > > [EXTERNAL] > > The May issue of CCM contains an article by Seymour and colleagues exploring > the delays from first medical contact to administration of antibiotics for > sepsis. Both total medical contact and ED delay in abx administration are > associated with in-hospital mortality in community acquired sepsis. Although > pre-hospital delay was not independently associated with mortality, the > authors do comment that total medical contact delay could be reduced if EMS > administered prehospital antibiotics to high risk septic patients. (rather > than delay upon arrival to the ED). Our local EMS agencies are exploring > including this in their protocols as we are in a rural area of Western NC and > some of our transports can be >1 hr due to mountainous terrain. I am sure > there will be more to come on early recognition and not delaying antibiotics. > > > 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 > > > -----Original Message----- > From: Sepsisgroups [mailto:[email protected]] On > Behalf Of [email protected] > Sent: Monday, April 17, 2017 12:46 PM > To: [email protected] > Subject: Sepsisgroups Digest, Vol 243, Issue 5 > > WARNING: This email originated outside of Mission Health email system DO NOT > CLICK links or attachments unless you recognize the sender and know the > content is safe. > > Send Sepsisgroups mailing list submissions to > [email protected] > > To subscribe or unsubscribe via the World Wide Web, visit > > https://urldefense.proofpoint.com/v2/url?u=http-3A__lists.sepsisgroups.org_listinfo.cgi_sepsisgroups-2Dsepsisgroups.org&d=DwICAg&c=tAAbe3VWSXg4_eMSItYKuRlnp5vCb2OrQZQHnRXk_fc&r=p79YauGgtjdHZ1G27QaI_5GTY0Yn75iOH6Du_TfKiBc&m=qE1B-3vuwKK3eUMJHnNzH8UTYqxla6lZXiy5gRksUDU&s=gB4-E0lDtzgJirSe81TE_HZWJubTVtszWBxFwGBc28k&e= > > > 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: Sepsisgroups Digest, Vol 242, Issue 1 (Umberger, Reba A) > 2. Re: [External] Sepsisgroups Digest, Vol 242, Issue 3 (Sandy Tobar) > > > ---------------------------------------------------------------------- > > Message: 1 > Date: Thu, 13 Apr 2017 23:57:03 +0000 > From: "Umberger, Reba A" <[email protected]> > To: "[email protected]" > <[email protected]> > Subject: Re: [Sepsis Groups] Sepsisgroups Digest, Vol 242, Issue 1 > Message-ID: <[email protected]> > Content-Type: text/plain; charset="utf-8" > > Ann, > > Kumar has shown that every hour of delay in appropriate antibiotics increases > mortality. > https://urldefense.proofpoint.com/v2/url?u=https-3A__www.ncbi.nlm.nih.gov_m_pubmed_19696123_&d=DwICAg&c=tAAbe3VWSXg4_eMSItYKuRlnp5vCb2OrQZQHnRXk_fc&r=p79YauGgtjdHZ1G27QaI_5GTY0Yn75iOH6Du_TfKiBc&m=qE1B-3vuwKK3eUMJHnNzH8UTYqxla6lZXiy5gRksUDU&s=7sz8Q87Cgkl27shEVOtZAgNyhJgmwdcj3ouDnYsaxFE&e= > > > Hope this helps! > > Sent from my iPhone (pardon typos) > > Reba Umberger, PhD, RN, CCRN-K > Assistant Professor of Nursing > The University of Tennessee-Knoxville > 865-974-6416 > > > On Apr 13, 2017, at 6:47 PM, > "[email protected]<mailto:[email protected]>" > > <[email protected]<mailto:[email protected]>> > wrote: > > Send Sepsisgroups mailing list submissions to > > [email protected]<mailto:[email protected]> > > To subscribe or unsubscribe via the World Wide Web, visit > > https://urldefense.proofpoint.com/v2/url?u=http-3A__lists.sepsisgroups.org_listinfo.cgi_sepsisgroups-2Dsepsisgroups.org&d=DwICAg&c=tAAbe3VWSXg4_eMSItYKuRlnp5vCb2OrQZQHnRXk_fc&r=p79YauGgtjdHZ1G27QaI_5GTY0Yn75iOH6Du_TfKiBc&m=qE1B-3vuwKK3eUMJHnNzH8UTYqxla6lZXiy5gRksUDU&s=gB4-E0lDtzgJirSe81TE_HZWJubTVtszWBxFwGBc28k&e= > > > or, via email, send a message with subject or body 'help' to > > [email protected]<mailto:[email protected]> > > You can reach the person managing the list at > > [email protected]<mailto:[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: EMS pre-hospital treatment for sepsis (Sprague, Amy L.) > > > ---------------------------------------------------------------------- > > Message: 1 > Date: Wed, 5 Apr 2017 13:09:43 +0000 > From: "Sprague, Amy L." <[email protected]<mailto:[email protected]>> > To: "Helsley, Anne" <[email protected]<mailto:[email protected]>>, > > "[email protected]<mailto:[email protected]>" > > <[email protected]<mailto:[email protected]>> > Subject: Re: [Sepsis Groups] EMS pre-hospital treatment for sepsis > Message-ID: > > <42f2a2d2f9ec8940bd465762c5e75dee201f5...@vapnsmsgd51s11.vha.med.va.gov<mailto:42f2a2d2f9ec8940bd465762c5e75dee201f5...@vapnsmsgd51s11.vha.med.va.gov>> > > Content-Type: text/plain; charset="us-ascii" > > Anne, > Will you please share with me any information you receive on this? > Thank you, > Amy > > Amy L. Sprague DNP, RN, ACNS-BC, CCRN > Patient Safety Manager > Richard L. Roudebush VA Medical Center > 1481 West 10th Street > Indianapolis, IN 46202 > Office 317-988-3547 > > "Our lives begin to end the day we become silent about things that matter." > Martin Luther King, Jr. > > > > > > > From: Sepsisgroups [mailto:[email protected]] On > Behalf Of Helsley, Anne > Sent: Monday, April 03, 2017 3:29 PM > To: > [email protected]<mailto:[email protected]> > Subject: [EXTERNAL] [Sepsis Groups] EMS pre-hospital treatment for sepsis > > A local EMS is planning a protocol to screen for Severe Sepsis in the field > pre-hospital. Based upon the screening results (which do not include a > lactate), they will be administering crystalloid fluids, drawing blood > cultures and giving a broad spectrum antibiotic. While I can find literature > to support the fluid administration, I have been unable to find any support > for the antibiotic administration. > Are you familiar with this practice, is it happening in your area, or are you > familiar with any literature to support/not-support. > Thank you in advance. > > Anne Helsley MS, RN, CPHQ > Health Informatics Specialist | Quality Management St. Mary's Health > 3700 Washington Avenue > Evansville, IN 47750 > 812.485.7925 TEL | 812.485.7862 FAX > [email protected]<mailto:[email protected]> > <mailto:[email protected]%20> | > www.stmarys.org<https://urldefense.proofpoint.com/v2/url?u=http-3A__www.stmarys.org&d=DwICAg&c=tAAbe3VWSXg4_eMSItYKuRlnp5vCb2OrQZQHnRXk_fc&r=p79YauGgtjdHZ1G27QaI_5GTY0Yn75iOH6Du_TfKiBc&m=qE1B-3vuwKK3eUMJHnNzH8UTYqxla6lZXiy5gRksUDU&s=gKEwO12gt7MRH5cj6l4uT7P4h47JN6Jle-bWmLcT0U8&e= > > ><https://urldefense.proofpoint.com/v2/url?u=http-3A__www.stmarys.org&d=DwICAg&c=tAAbe3VWSXg4_eMSItYKuRlnp5vCb2OrQZQHnRXk_fc&r=p79YauGgtjdHZ1G27QaI_5GTY0Yn75iOH6Du_TfKiBc&m=qE1B-3vuwKK3eUMJHnNzH8UTYqxla6lZXiy5gRksUDU&s=gKEwO12gt7MRH5cj6l4uT7P4h47JN6Jle-bWmLcT0U8&e= > > > > [cid:[email protected]] > The Magnet Recognition Program(r), ANCC Magnet Recognition(r) , Magnet(r) > names and logos are registered trademarks of the American Nurses > Credentialing Center. All rights reserved > > > CONFIDENTIALITY NOTICE: > > This email message and any accompanying data or files is confidential and may > contain privileged information intended only for the named recipient(s). If > you are not the intended recipient(s), you are hereby notified that the > dissemination, distribution, and or copying of this message is strictly > prohibited. If you receive this message in error, or are not the named > recipient(s), please notify the sender at the email address above, delete > this email from your computer, and destroy any copies in any form > immediately. 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We > have done an analysis of our sepsis population and it appears that IPOC's are > one variable that has an impact on severity progression, LOS and patient > outcomes as well as readmissions. Especially if there is a delay in > implementation beyond 4 hours of the identification of sepsis > > Sandy Tobar RN, BSN, MSBA > Director, Clinical Transformation Sepsis, HAI & Patient Safety Trinity Health > [email protected] W 734-343-1496 > > 20555 Victor Parkway > Livonia, MI 48152 > trinity-health.org | Facebook | Twitter | LinkedIn > > > > -----Original Message----- > From: Sepsisgroups [mailto:[email protected]] On > Behalf Of [email protected] > Sent: Thursday, April 13, 2017 6:52 PM > To: [email protected] > Subject: [External] Sepsisgroups Digest, Vol 242, Issue 3 > > Send Sepsisgroups mailing list submissions to > [email protected] > > To subscribe or unsubscribe via the World Wide Web, visit > > https://urldefense.proofpoint.com/v2/url?u=http-3A__lists.sepsisgroups.org_listinfo.cgi_sepsisgroups-2Dsepsisgroups.org&d=DwICAg&c=tAAbe3VWSXg4_eMSItYKuRlnp5vCb2OrQZQHnRXk_fc&r=p79YauGgtjdHZ1G27QaI_5GTY0Yn75iOH6Du_TfKiBc&m=qE1B-3vuwKK3eUMJHnNzH8UTYqxla6lZXiy5gRksUDU&s=gB4-E0lDtzgJirSe81TE_HZWJubTVtszWBxFwGBc28k&e= > > > 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. Sepsis Clinical Pathways and nursing care plans (Engleman, Anne) > 2. Re: Septic shock question (Belfi, Karen) > 3. Re: Initial lactate vs repeat lactate result (Cynthia Wells) > > > ---------------------------------------------------------------------- > > Message: 1 > Date: Thu, 6 Apr 2017 18:55:44 +0000 > From: "Engleman, Anne" <[email protected]> > To: "[email protected]" > <[email protected]> > Subject: [Sepsis Groups] Sepsis Clinical Pathways and nursing care > plans > Message-ID: > <09d1158b26ef3d428ec4b6f30faf73847460a...@tenhdcthmb10-04.tenethealth.net> > > Content-Type: text/plain; charset="us-ascii" > > Hello everyone, > > I am wondering if anyone has developed clinical pathways or nursing care > plans for sepsis patients and would be willing to share what they have. In > addition, to share if they are effective with inpatient sepsis cases and > compliance with the CMS metrics. I appreciate any and all feedback. Our > Sepsis Committee members would like to explore this as an option in our > facility. > > Regards, > Anne > > Anne Engleman RN, MSN > Quality Manager > Quality Management Department > JFK Memorial Hospital > 47-111 Monroe Street > Indio, CA 92201 > Phone: (760) 775-8086 > Email: [email protected]<mailto:[email protected]> > > This email and any attached files 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 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. > > > > -------------- next part -------------- > An HTML attachment was scrubbed... > URL: > <https://urldefense.proofpoint.com/v2/url?u=http-3A__lists.sepsisgroups.org_pipermail_sepsisgroups-2Dsepsisgroups.org_attachments_20170406_6b949107_attachment-2D0001.htm&d=DwICAg&c=tAAbe3VWSXg4_eMSItYKuRlnp5vCb2OrQZQHnRXk_fc&r=p79YauGgtjdHZ1G27QaI_5GTY0Yn75iOH6Du_TfKiBc&m=qE1B-3vuwKK3eUMJHnNzH8UTYqxla6lZXiy5gRksUDU&s=X5nVnBDS1bEZ6rSELl4fD4asRkk3UHQKngFdlvcDkJI&e= > > > > ------------------------------ > > Message: 2 > Date: Wed, 5 Apr 2017 06:37:03 -0400 > From: "Belfi, Karen" <[email protected]> > To: "Gibbs, Katie" <[email protected]>, "'Mills, Mary'" > <[email protected]>, "[email protected]" > <[email protected]> > Subject: Re: [Sepsis Groups] Septic shock question > Message-ID: > <[email protected]> > Content-Type: text/plain; charset="us-ascii" > > In the current specification manual (Version 5.2a), it states: > Crystalloid fluid volumes ordered that are within 10% lower than the actual > volume calculated by weight are acceptable. > > So if a patient needs 2200, they can get as little as 1980. (10% of 2200 is > 220; 2200 -220 is 1980). > > -----Original Message----- > From: Sepsisgroups [mailto:[email protected]] On > Behalf Of Gibbs, Katie > Sent: Thursday, March 30, 2017 3:19 PM > To: 'Mills, Mary'; [email protected] > Subject: [EXTERNAL] Re: [Sepsis Groups] Septic shock question > > Mary, > Can you clarify the 10%. And where to find that in the spec manual? > Thanks! > -----Original Message----- > From: Sepsisgroups [mailto:[email protected]] On > Behalf Of Mills, Mary > Sent: Tuesday, March 21, 2017 5:28 PM > To: [email protected] > Subject: [Sepsis Groups] Septic shock question > > For CMS , you have to have severe sepsis before you have septic shock. > When you say no source identified, are you saying that there is no > documentation of a suspected infection within the 6 hr window criteria? If > that is the case, then you can't meet all the criteria components for severe > sepsis. > > Is there a reason the white count was so low documented in the note (recent > chemo, etc)? If there is and the provider has documented it as such, you > can't use that white count as your 2nd SIRS. > > In terms of just good patient care and reality, yes, this pt clinically is in > septic shock. Per the most recent specs manual, a decrease of 10% of the > 30mL/kg of crystalloids is acceptable, but that would be 1978.56. Not enough > > I hope this help :-) > Sepsis, she is a nasty little bugger :-) > > Mary Mills RN, BSN, CPHQ, CPPS > Centegra Health System > ________________________________________ > From: Sepsisgroups [[email protected]] On Behalf Of > [email protected] > [[email protected]] > Sent: Tuesday, March 21, 2017 2:10 PM > To: [email protected] > Subject: Sepsisgroups Digest, Vol 239, Issue 1 > > Send Sepsisgroups mailing list submissions to > [email protected] > > To subscribe or unsubscribe via the World Wide Web, visit > > https://urldefense.proofpoint.com/v2/url?u=http-3A__lists.sepsisgroups.org_listinfo.cgi_sepsisgroups-2Dsepsisgroups.org&d=DwICAg&c=qqcbk_QeabW4Z7GBhIMNtn_B7aQjktEuWNmUvrzri9o&r=9XT3K_nIvIIF-7Bh2TiB0g&m=FXqwy-DHLddNT3CTdViX75Bd_MMGSCRinSMCq2AUalc&s=9xfcZwmWnIfVa-kgQ98natbkaoxEpp6Rsn5IJpE2iUs&e= > > > 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. Septic shock question (Davis, Diana) > > > ---------------------------------------------------------------------- > > Message: 1 > Date: Mon, 20 Mar 2017 17:58:40 +0000 > From: "Davis, Diana" <[email protected]> > To: "'[email protected]'" > <[email protected]> > Subject: [Sepsis Groups] Septic shock question > Message-ID: > > <bn6pr13mb0947c73172d6a1fa8e0a6bc8a2...@bn6pr13mb0947.namprd13.prod.outlook.com> > > Content-Type: text/plain; charset="utf-8" > > Septic shock > > To everyone: > > Hoping to get some clarification re: potential septic shock pt. > > 1207- B/P- 84/57 P- 135. > > Lactate at 1430- 4.8- lactate at 1810- 4.3 > > WBC- 0.1 at 1621 > > Pt. weight- 73.28 Kg- pt received 1500cc NS - will fallout for this > > No source identified > > Will this patient meet septic shock due to lactate level? > > We cannot come to conclusion 100%- so looking for help from everyone. I > say yes. > > Thank you. > > Diana Davis, Quality Outcomes Coordinator > > CMH Regional Health System > > 937-382-9315 > > > Diana Davis, Quality Outcomes Coordinator CMH Regional Health System > 937-382-9315 > > Disclaimer > > The information transmitted via this e-mail is intended only for the person > or entity to which it is addressed and may contain confidential and/or > proprietary information. Any use, review, retransmission, dissemination or > other use of, or pursuing of any action in reliance upon this information by > persons or entities other than the intended recipient is strictly prohibited. > If you are the recipient of this e-mail transmission in error, please reply > to the sender and delete the material from any computer. Thank you > > This email has been scanned for viruses and malware, and may have been > automatically archived by Mimecast Ltd, an innovator in Software as a Service > (SaaS) for business. Providing a safer and more useful place for your human > generated data. Specializing in; Security, archiving and compliance. To find > out more visit the Mimecast website. > -------------- next part -------------- > An HTML attachment was scrubbed... > URL: > <https://urldefense.proofpoint.com/v2/url?u=http-3A__lists.sepsisgroups.org_pipermail_sepsisgroups-2Dsepsisgroups.org_attachments_20170320_aa5a8f6a_attachment.html&d=DwICAg&c=qqcbk_QeabW4Z7GBhIMNtn_B7aQjktEuWNmUvrzri9o&r=9XT3K_nIvIIF-7Bh2TiB0g&m=FXqwy-DHLddNT3CTdViX75Bd_MMGSCRinSMCq2AUalc&s=cKY8WrhW2Lw1-dEPLizyYWV_yD9JCDXkWWTXPjw1bnI&e=> > > ------------------------------ > > Subject: Digest Footer > > _______________________________________________ > Sepsisgroups mailing list > [email protected] > https://urldefense.proofpoint.com/v2/url?u=http-3A__lists.sepsisgroups.org_listinfo.cgi_sepsisgroups-2Dsepsisgroups.org&d=DwICAg&c=qqcbk_QeabW4Z7GBhIMNtn_B7aQjktEuWNmUvrzri9o&r=9XT3K_nIvIIF-7Bh2TiB0g&m=FXqwy-DHLddNT3CTdViX75Bd_MMGSCRinSMCq2AUalc&s=9xfcZwmWnIfVa-kgQ98natbkaoxEpp6Rsn5IJpE2iUs&e= > > > > ------------------------------ > > End of Sepsisgroups Digest, Vol 239, Issue 1 > ******************************************** > > This transmission may contain information that is privileged, confidential, > or exempt from disclosure under applicable law. If you are not the intended > recipient, consider yourself notified that any disclosure, copying, > distribution, use, or reliance on this transmission is STRICTLY PROHIBITED. > Please destroy this transmission in any format and notify the sender, if you > received this transmission in error. Thank you. > _______________________________________________ > Sepsisgroups mailing list > [email protected] > https://urldefense.proofpoint.com/v2/url?u=http-3A__lists.sepsisgroups.org_listinfo.cgi_sepsisgroups-2Dsepsisgroups.org&d=DwICAg&c=qqcbk_QeabW4Z7GBhIMNtn_B7aQjktEuWNmUvrzri9o&r=9XT3K_nIvIIF-7Bh2TiB0g&m=FXqwy-DHLddNT3CTdViX75Bd_MMGSCRinSMCq2AUalc&s=9xfcZwmWnIfVa-kgQ98natbkaoxEpp6Rsn5IJpE2iUs&e= > _______________________________________________ > Sepsisgroups mailing list > [email protected] > https://urldefense.proofpoint.com/v2/url?u=http-3A__lists.sepsisgroups.org_listinfo.cgi_sepsisgroups-2Dsepsisgroups.org&d=DwICAg&c=qqcbk_QeabW4Z7GBhIMNtn_B7aQjktEuWNmUvrzri9o&r=9XT3K_nIvIIF-7Bh2TiB0g&m=FXqwy-DHLddNT3CTdViX75Bd_MMGSCRinSMCq2AUalc&s=9xfcZwmWnIfVa-kgQ98natbkaoxEpp6Rsn5IJpE2iUs&e= > > > > > ------------------------------ > > Message: 3 > Date: Wed, 5 Apr 2017 12:46:34 +0000 > From: Cynthia Wells <[email protected]> > To: Mary Draper <[email protected]> > Cc: "[email protected]" > <[email protected]> > Subject: Re: [Sepsis Groups] Initial lactate vs repeat lactate result > Message-ID: <[email protected]> > Content-Type: text/plain; charset="utf-8" > > It depends on which lactate is "drawn" closer to time zero. The lactate used > to establish time zero is not always the "initial lactate" data element. > > Cindy > > Sent from my iPhone > > On Apr 4, 2017, at 6:20 PM, Mary Draper > <[email protected]<mailto:[email protected]>> wrote: > > I have a patient that met the SIRS criteria with a possible infection though > etiology unknown and had an initial lactate of 2.2. This ruled the patient in > for severe sepsis. No hypotension. The repeat lactate 4 hours later is > 4. > Patient is still not hypotensive. Does this then qualify the patient for > septic shock? > I thought we used the ?initial? episode?s lactate not the repeat result. > Appreciate your feedback! > Thanks. > > > Mary Draper RN BSN > Coordinator Quality Improvement > Peer Review Support CV/CT > Quality Management JMH > Office (925) 674-2045 > Cell (925) 451-8792 > Fax (925) 674-2373 > [email protected]<mailto:[email protected]> > <image003.png> > ?O, let us always have a mountain within our soul, with a peak so high that > we never quite reach the top? > For then we will always strive for greater things and will not be content > with merely climbing hills.? 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