Thanks Pamela, this is helpful. Good to know that starting with Jan 1, 2018 discharges, 2 hypotensive BP's will need to be present in the 6hr window for us to consider hypotension as criteria for organ dysfunction for severe sepsis.
From: Sepsisgroups [mailto:[email protected]] On Behalf Of PAMELA J. ANDERSON Sent: Friday, June 30, 2017 1:05 PM To: Schrecengost, Lisa M.; [email protected] Subject: Re: [Sepsis Groups] initial hypotension Hi, Lisa- You can refer to the v5.2a SEP-1 Manual (attached to this email) that has the rationale for why we abstract what we do, along with a long list of references that were used to come up with the bundles. I like to explain the rationale in this way: We are attempting to decrease the morbidity, mortality, and length of stay for our sepsis patients by early recognition and intervention - if the patient has severe sepsis and is hypotensive related to the infection/sepsis, administration of the 30cc/kg crystalloids will help to determine whether or not septic shock is present. If the patient is given the fluids and is not hypotensive as evidenced by the presence of 2 CONSECUTIVE hypotensive BP's (as defined in the specs ) in the hour following the end of the 30cc/kg bolus, then septic shock is not considered to be present. If he has persistent hypotension in that one hour, then vasopressors need to be started as he is likely in septic shock. A patient with septic shock is vasodilated, thus decreasing the perfusion to his organs, causing organ failure. We need to keep enough circulating volume to help prevent this and by quickly giving the bolus, it helps to do this. This is also why we give the bolus for a lactate >= 4.0 for severe sepsis patients because this value can be an indication of organ failure already occurring and we want to prevent this from worsening. The good news is that starting with Jan 1, 2018 discharges, 2 hypotensive BP's will need to be present in the 6hr window as per the specs. In the meantime, remember that if the MD documents within 6hrs of TOP that the patient does not have Severe Sepsis or Septic Shock, then you would not abstract this. In addition, if prior to TOP Severe Sepsis/Septic Shock or within 24hrs after TOP, the MD documents the hypotension is related to something else NOT an infection/sepsis OR is normal for the patient, then you would not use the hypotensive BP for the element of initial hypotension. I hope this helps! Pam Pamela Anderson, BSN, RN Clinical Data Abstractor Loyola University Health System Center for Clinical Excellence 2160 S. First Avenue | Bldg 105-3908 | Maywood, IL 60153 (O) 708-216-5228 | (F) 708-216-7867 | (E) [email protected]<mailto:[email protected]> CONFIDENTIALITY NOTICE** This email communication and any attachments may contain confidential and privileged PHI for the use of the designated recipients named above. Distribution, reproduction or any other use of this transmission by any party other than the intended recipient is prohibited. If you have received this communication in error, please notify the sender immediately. From: Sepsisgroups [mailto:[email protected]] On Behalf Of Schrecengost, Lisa M. Sent: Wednesday, June 28, 2017 7:51 AM To: [email protected]<mailto:[email protected]> Subject: [External] [Sepsis Groups] initial hypotension Hello, I am in search of assistance. Can somebody explain why 30ml/kg of crystalloid fluids are to be given for an initial hypotension.....even if in severe sepsis and not in septic shock. I have many doctors questioning this....They say these fluids of 30ml/kg are only to be given if in septic shock. When we do our chart abstractions and answer the question "yes" for initial hypotension, it asks if fluids of 30ml/kg were given. If we say these fluids were not given at 30ml/kg, then it falls out. I have even seen it happen with the lactate <2. Anybody else having same problems? Thanks, Lisa :) Lisa Schrecengost RN BSN Clinical Resource Management ACMH Hospital One Nolte Drive Kittanning, PA 16201 Phone: 724-543-8871 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. Confidentiality Notice: This e-mail, including any attachments is the property of Trinity Health and is intended for the sole use of the intended recipient(s). It may contain information that is privileged and confidential. Any unauthorized review, use, disclosure, or distribution is prohibited. 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