We had a similar discussion so we have the provider order the initial lactate and a repeat x 1 in 180 minutes after the initial. The subsequent lactate is cancelled if the lactate is <2.0. This eliminates the auto repeat order without a validation by providers because 2 are ordered initially. We have had success with this.
Sandy Tobar MSBA, BSN, RN, CPPS 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: Tuesday, January 09, 2018 9:43 AM To: [email protected] Subject: [External] Sepsisgroups Digest, Vol 275, Issue 3 Warning: This email originated from the Internet! DO NOT CLICK links if the sender is unknown, and NEVER provide your password. 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. Automated Lactate Orders (Rutherford, Richard) 2. Re: Antibiotics/ normal saline shortage (Hodge - Garrett, Sara Mical) ---------------------------------------------------------------------- Message: 1 Date: Mon, 8 Jan 2018 22:53:36 +0000 From: "Rutherford, Richard" <[email protected]> To: "[email protected]" <[email protected]> Subject: [Sepsis Groups] Automated Lactate Orders Message-ID: <by2pr09mb0723511ec299b385b3c847249b...@by2pr09mb0723.namprd09.prod.outlook.com> Content-Type: text/plain; charset="iso-8859-1" Hello All, We are having a debate in our organization about whether automatic lactate orders violate nursing standard of practice. Currently if a patient in ED or on floor screens in for sepsis, the nurse follows hospital protocol and orders a lactate which is then routed to the attending physician for cosignature (after drawn). We also have an automated order to repeat lactate at 4 hours for admitted patients with an initial lactate>2. I believe our initial lactate order in ER is covered by Standardized Nursing Procedures. We are having more debate around the initial lactate ordered on inpatients and the automated second lactate on all patients with lactate>2 without a prior physician order. I am interested in knowing if other hospitals use our approach, and if so is nursing leadership feeling comfortable that nursing standards of practice are not being violated. Thanks, Rick Rutherford -------------- next part -------------- An HTML attachment was scrubbed... URL: <http://lists.sepsisgroups.org/pipermail/sepsisgroups-sepsisgroups.org/attachments/20180108/38db5cac/attachment-0001.html> ------------------------------ Message: 2 Date: Wed, 3 Jan 2018 17:41:33 +0000 From: "Hodge - Garrett, Sara Mical" <[email protected]> To: 'Angela Craig' <[email protected]>, 'Tara Miller' <[email protected]>, "[email protected]" <[email protected]> Subject: Re: [Sepsis Groups] Antibiotics/ normal saline shortage Message-ID: <[email protected]> Content-Type: text/plain; charset="utf-8" In Houston, many of the hospitals are being affected by the saline shortage. In order to be proactive, we are doing IVP medications as well. Sara M. Hodge-Garrett, MSN, RN, MSCRN, CPHQ Quality Manager Ben Taub Hospital Quality Programs HARRIS HEALTH SYSTEM 1504 Taub Loop | Houston, TX 77030 | phone 713.873.4452 [email protected]<mailto:[email protected]> CONFIDENTIALITY NOTICE: If you have received this e-mail in error, please immediately notify the sender by return e-mail and delete this e-mail and any attachments from your computer system. To the extent the information in this e-mail and any attachments contain protected health information as defined by the Health Insurance Portability and Accountability Act of 1996 ("HIPAA"), PL 104-191; 45 CFR Parts 160 and 164; or Chapter 181, Texas Health and Safety Code, it is confidential and/or privileged. This e-mail may also be confidential and/or privileged under Texas law. The e-mail is for the use of only the individual or entity named above. If you are not the intended recipient, or any authorized representative of the intended recipient, you are hereby notified that any review, dissemination or copying of this e-mail and its attachments is strictly prohibited. From: Sepsisgroups [mailto:[email protected]] On Behalf Of Angela Craig Sent: Tuesday, January 02, 2018 11:34 AM To: 'Tara Miller'; [email protected] Subject: Re: [Sepsis Groups] Antibiotics/ normal saline shortage We are starting to give IVP antibiotics for these instances. Yes we are feeling this in TN as well. 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 Tara Miller Sent: Tuesday, January 02, 2018 9:16 AM To: [email protected]<mailto:[email protected]> Subject: [Sepsis Groups] Antibiotics/ normal saline shortage Is anyone else having issues with no spike bags or normal saline bags available for mixing antibiotics? Our hospital and pharmacy are completely out of most saline bags. We are mixing all antibiotics manually. Have you heard of CMS allowing IM/IO antibiotics due to this shortage? Thanks. Tara R Miller, RN Team Leader, Quality Management Mobile Infirmary Medical Center Office: 435-5109 Cell: 605-8270 [IH_Logo_20170609] Confidentiality Notice: This electronic 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, you are hereby notified that any disclosure, copying, distribution, or action taken in reliance on the contents of this electronic message and/or any attachments is strictly prohibited. This quality assurance document is for the use of Infirmary Health and is prepared and maintained pursuant to Section 22-21-8 of the 1975 Code of Alabama. Prepared in an anticipation of litigation. 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