Certain patients may not need or be able to tolerate the fluids needed to meet the 30ml/kg requirement if it is calculated by their actual weight. A practitioner has several tools available to them to help decide whether the fluids should be given by actual body weight or by ideal body weight. A simple bedside ultrasound can be performed or they can utilize invasive or noninvasive hemodynamic monitoring to determine the fluid responsiveness of the patient and whether more is needed. This change could be beneficial for some of our patients. I would encourage the physicians at your facility to use their assessment of the patient to dictate who would benefit from less and who needs more. If they are not trained to use the bedside ultrasound or hemodynamic monitoring or lack the resources to do so, I would suggest trying to get them the training and equipment they need so they can make this choice based on objective data. I can say with absolution that what is good for one patient is not always good for all, I agree that these decisions should be made based on the patient's presentation. Fortunately, I understand this change in the measure to be a choice for the doctors and not a rule that they must use IBW on all obese patients.
Leslie Harris, RN, BSN Stroke and Sepsis Coordinator Southern Hills Medical Center 391 Wallace Road, Nashville, TN 37211 Office: 615-781-4158 Cell: 615-768-0169 Email: [email protected] 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. -----Original Message----- From: Sepsisgroups [mailto:[email protected]] On Behalf Of [email protected] Sent: Thursday, August 03, 2017 11:39 AM To: [email protected] Subject: [EXTERNAL] Sepsisgroups Digest, Vol 256, Issue 9 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: FLUID REQUIREMENTS (Angela Craig) ---------------------------------------------------------------------- Message: 1 Date: Tue, 1 Aug 2017 17:33:59 -0500 From: Angela Craig <[email protected]> To: "'Izard, Kimberly'" <[email protected]>, "Belfi, Karen" <[email protected]>, Nicole Dyess <[email protected]>, "[email protected]" <[email protected]> Subject: Re: [Sepsis Groups] FLUID REQUIREMENTS Message-ID: <343E31412FC9094487B54371286ADDA06D54D6D12A@D109EXCHMB.crmchealth.hospital> Content-Type: text/plain; charset="utf-8" I guess I am one who doesn't just like to go with a "rule" but ask the question what is best for our patients. If you live in a place like I do many patients are larger and may not get the fluids they may need if they go with this new decision. I know we CAN but should we?? I would love to hear the evidence toward this decision. Angela Craig APN,MS,CCNS Clinical Nurse Specialist Intensive Care Unit Cookeville Regional Medical Center 931-783-5035 From: Sepsisgroups [mailto:[email protected]] On Behalf Of Izard, Kimberly Sent: Monday, July 31, 2017 1:09 PM To: Belfi, Karen; Nicole Dyess; [email protected] Subject: Re: [Sepsis Groups] FLUID REQUIREMENTS Data Element Name: Crystalloid Fluid Administration If there is physician/APN/PA documentation identifying the patient has obesity (defined as a Body Mass Index >30), the clinician may choose to use Ideal Body Weight (IBW) to determine the target ordered crystalloid fluid volume. If the clinician prefers to use IBW, it must be documented clearly and the clinician must indicate that IBW will be the weight used to determine the target ordered volume. This is from the new updates starting with 2018 discharges. Thank you, Kim Kim Izard | Team Leader - Clinical Outcomes SSMHealth - St. Louis/Mid-MO/Southern Illinois Regions 1015 Corporate Square Drive Suite 240 Creve Coeur, MO 63132 Office - 314-989-2137 Cell - 618-670-3616 [email protected]<mailto:[email protected]> [cid:[email protected]] This e-mail message is confidential, intended only for the named recipient(s) above and may contain information that is privileged or exempt from disclosure under applicable law. If you are not the intended recipient(s), you are notified that the dissemination, distribution or copying of this message is strictly prohibited. If you received this message in error, or are not the named recipient(s) please notify the sender at the e-mail address or telephone number above and delete this e-mail from your computer. Thank you! From: Sepsisgroups [mailto:[email protected]] On Behalf Of Belfi, Karen Sent: Monday, July 31, 2017 1:01 PM To: Nicole Dyess <[email protected]<mailto:[email protected]>>; [email protected]<mailto:[email protected]> Subject: Re: [Sepsis Groups] FLUID REQUIREMENTS CAUTION: This email originated from outside of the SSMHealth organization. Do not click links or open attachments unless you recognize the sender and know the content is safe. Questions? Contact the TSC at 314-644-7345 or your local Help Desk. The guidelines state not to use ideal body weight. Use the patient's actual weight. Use estimated weight only if actual weight is not available to determine the volume of crystalloid fluids the patient should receive. Do not use ideal weight. Karen Belfi, RN, MSN Quality Outcomes Coordinator Lankenau Medical Center (484)476-8092 From: Sepsisgroups [mailto:[email protected]] On Behalf Of Nicole Dyess Sent: Saturday, July 29, 2017 12:02 PM To: [email protected]<mailto:[email protected]> Subject: [EXTERNAL] [Sepsis Groups] FLUID REQUIREMENTS This message originated from outside MLHS systems. Any attachments or links should be carefully considered before proceeding. Please contact the Help Desk at 484-596-4357 with any questions or forward a questionable email to [email protected]<mailto:[email protected]> ________________________________ For the 30ml/kg fluid requirement, is anyone using IBW for your obese patients? I have found conflicting statements on if this will satisfy the requirement. If you do use IBW, can you send me your reference that supports using it. Thanks! Nicole Dyess, PharmD Antimicrobial Stewardship Team Leader Conway Regional Health System 2302 College Ave, Conway, AR 72034 (501) 513-5152 (501) 450-2368 Fax [cid:[email protected]] ________________________________ Confidentiality Notice: This email 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 email and destroy all copies of the original message. This email message has been delivered safely and archived online by Mimecast. For more information please visit http://www.mimecast.com -------------- next part -------------- An HTML attachment was scrubbed... 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