This is a common scenario at my facility due to many patients coming from smaller hospitals needing emergent dialysis. Some physician will go ahead and give the antibiotics, but most want to wait until the dialysis is completed. In the later cases, we do fail the measure, but I do not feel that I have the right to tell the provider they made a bad decision in their sequence of care. It would be great if there was an exclusion or extension of time for these patients.
Linda G. Pender RRT-NPS Sepsis Coordinator Navicent Health Patient Care Services Administration phone: 478-633-6806 pager: 4444 KNOW Sepsis: Inside & Out Confidential Quality Improvement: Not for Disclosure Email: [email protected] -----Original Message----- From: Sepsisgroups [mailto:[email protected]] On Behalf Of [email protected] Sent: Friday, August 10, 2018 2:54 PM To: [email protected] Subject: Sepsisgroups Digest, Vol 299, Issue 5 [ W A R N I N G ] This email originated outside of Navicent Health. Do not click on links or attachments unless you recognize the sender and know the content is safe. Sender: [email protected] ========================================================================================================= * ** 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: [External] Antibiotics Admin/ Dialysis (jenny clarke) 2. Re: [External] Question for sepsis groups (Mary Draper) ---------------------------------------------------------------------- Message: 1 Date: Wed, 8 Aug 2018 18:54:17 +0000 From: jenny clarke <[email protected]> To: Mary Draper <[email protected]> Cc: Tara Miller <[email protected]>, "[email protected]" <[email protected]> Subject: Re: [Sepsis Groups] [External] Antibiotics Admin/ Dialysis Message-ID: <cy4pr06mb31443b130c8a9906e4f12625f9...@cy4pr06mb3144.namprd06.prod.outlook.com> Content-Type: text/plain; charset="utf-8" We have to remind ourselves to do what is best for patients first and worry about CMS guidelines second. Which I am sometimes struggling with because I know by watching the stroke volume the patient just can?t handle anymore fluid but guidelines say give it. Good luck. We all feel the same pressure Sent from my iPhone On Aug 8, 2018, at 1:46 PM, Mary Draper <[email protected]<mailto:[email protected]>> wrote: I have not run across this issue. Tough scenario. It was probably best for the patient to receive the dialysis first and then be given the antibiotic. From: Sepsisgroups [mailto:[email protected]] On Behalf Of Tara Miller Sent: Tuesday, August 07, 2018 10:52 AM To: '[email protected]<mailto:[email protected]>' <[email protected]<mailto:[email protected]>> Subject: [External] [Sepsis Groups] Antibiotics Admin/ Dialysis ________________________________ Caution: This email originated outside JMH. Do not open attachments or click on links if you do not recognize the sender. ________________________________ Good afternoon. We had a scenario of a patient who was in ?septic shock? along with severe hyperkalemia with EKG changes. The patient had to go on emergent hemodialysis in the emergency room. The physician, pharmacist, and nursing staff did not want to give the antibiotics due to having it pulled right back out with dialysis. Once the patient was removed from dialysis machine, the antibiotics was given which was on hour 4. Has anyone else had this same situation? What are you doing about it? Are you just taking the fallout for sepsis or are you administering the antibiotic regardless? Thanks. Tara R Miller, RN, BSN Team Leader, Quality Management Mobile Infirmary Medical Center Office: 435-5109 Cell: 605-8270 <image001.jpg> 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. _______________________________________________ Sepsisgroups mailing list [email protected]<mailto:[email protected]> http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org -------------- next part -------------- An HTML attachment was scrubbed... URL: <http://lists.sepsisgroups.org/pipermail/sepsisgroups-sepsisgroups.org/attachments/20180808/ab82c914/attachment-0001.html> -------------- next part -------------- A non-text attachment was scrubbed... Name: image001.jpg Type: image/jpeg Size: 4487 bytes Desc: image001.jpg URL: <http://lists.sepsisgroups.org/pipermail/sepsisgroups-sepsisgroups.org/attachments/20180808/ab82c914/attachment-0001.jpg> ------------------------------ Message: 2 Date: Wed, 8 Aug 2018 19:04:55 +0000 From: Mary Draper <[email protected]> To: "'Belfi, Karen'" <[email protected]>, "Duane, Molly" <[email protected]>, "[email protected]" <[email protected]> Subject: Re: [Sepsis Groups] [External] Question for sepsis groups Message-ID: <bn7pr08mb418097a170e097e61e296f5d90...@bn7pr08mb4180.namprd08.prod.outlook.com> Content-Type: text/plain; charset="us-ascii" Thanks for the information! From: Belfi, Karen [mailto:[email protected]] Sent: Wednesday, August 08, 2018 11:46 AM To: Mary Draper <[email protected]>; Duane, Molly <[email protected]>; [email protected] Subject: RE: [Sepsis Groups] [External] Question for sepsis groups ________________________________ Caution: This email originated outside JMH. Do not open attachments or click on links if you do not recognize the sender. ________________________________ They are. But according to the spec manual oral or rectal vanco is appropriate for c diff: If the patient has C. difficile, and IV antibiotic(s) from Table 5.0 or an appropriate combination of IV antibiotics from Table 5.1 are not started within the 3 hours following presentation of severe sepsis, and the following conditions are met, choose value "1." o There is physician/APN/PA documentation within 24 hours prior to the antibiotic start time identifying the presence of C. difficile. o Any one of the treatments below is initiated within 3 hours following severe sepsis presentation: Oral vancomycin with or without oral or IV metronidazole (Flagyl) Rectal vancomycin with or without IV metronidazole (Flagyl) IV metronidazole (Flagyl) monotherapy Karen Belfi, RN, MSN Quality Outcomes Coordinator Lankenau Medical Center (484)476-8092 From: Sepsisgroups [mailto:[email protected]] On Behalf Of Mary Draper Sent: Friday, August 03, 2018 1:28 PM To: Duane, Molly; [email protected]<mailto:[email protected]> Subject: Re: [Sepsis Groups] [External] Question for sepsis groups 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]> ________________________________ That's a great question. I think though the definition is looking for IV antibiotics. Mary Draper RN BSN Coordinator Quality Improvement Peer Review Support CV/CT JMH Quality Management Office (925) 674-2045 Cell (925) 451-8792 Fax (925) 674-2373 [email protected]<mailto:[email protected]> [cid:[email protected]] "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." Ardath Rodale From: Sepsisgroups [mailto:[email protected]] On Behalf Of Duane, Molly Sent: Thursday, August 02, 2018 12:23 PM To: [email protected]<mailto:[email protected]> Subject: [External] [Sepsis Groups] Question for sepsis groups ________________________________ Caution: This email originated outside JMH. Do not open attachments or click on links if you do not recognize the sender. ________________________________ Good Afternoon, Re: antibiotic choice, if there is a positive C Diff culture, with oral vanco and IV flagyl ordered, do we also have to give broad spectrum IV antibiotics? My understanding was that we could be more specific with the antibiotic if we had a culture result directing the choice. Thank you, Molly Molly Duane RN, BSN, CCRN Sepsis Program Coordinator Detroit Receiving Hospital Harper-Hutzel Hospital Office: 313-745-4340 Cell: 248-709-6218 Email: [email protected]<mailto:[email protected]> This message (including any attachments) is confidential and intended solely for the use of the individual or entity to whom it is addressed, and is protected by law. If you are not the intended recipient, please delete the message (including any attachments) and notify the originator that you received the message in error. Any disclosure, copying, or distribution of this message, or the taking of any action based on it, is strictly prohibited. Any views expressed in this message are those of the individual sender, except where the sender specifies and with authority, states them to be the views of Tenet Healthcare Corporation. -------------- next part -------------- An HTML attachment was scrubbed... URL: <http://lists.sepsisgroups.org/pipermail/sepsisgroups-sepsisgroups.org/attachments/20180808/8e07b8d3/attachment.html> -------------- next part -------------- A non-text attachment was scrubbed... Name: image001.png Type: image/png Size: 21577 bytes Desc: image001.png URL: <http://lists.sepsisgroups.org/pipermail/sepsisgroups-sepsisgroups.org/attachments/20180808/8e07b8d3/attachment.png> ------------------------------ Subject: Digest Footer _______________________________________________ Sepsisgroups mailing list [email protected] http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org ------------------------------ End of Sepsisgroups Digest, Vol 299, Issue 5 ******************************************** CONFIDENTIALITY NOTICE: The information transmitted in this e-mail message, including any attachments, is for the sole use of the intended recipient(s) or entity to which it is addressed and may contain confidential, privileged, and/or proprietary information. Any unauthorized review, retransmission, use, disclosure, dissemination, or other use of, or taking any action in reliance upon this information by persons or entities other than the intended recipient is prohibited. If you are not the intended recipient, you are hereby notified that any reading, dissemination, distribution, copying, or other use of this message or its attachments is strictly prohibited. If you have received this message in error, please notify the sender immediately by reply e-mail, or by calling (478) 633-7272, and destroy the original message, attachments, and all copies thereof on all computers and in any other form. Thank you. Navicent Health. http://www.navicenthealth.org/ _______________________________________________ Sepsisgroups mailing list [email protected] http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org
