We also advise getting a third lactate if the 2nd remains elevated. The reflex order is a good idea. We are working on getting this, but I am going to suggest including a third lactate if needed.
In our recent miss, the 2nd lactate level was 2.0 so did not require repeating. Unfortunately, it was also sent prior to 'Time Zero'. According to the guidelines the repeat lactate must be sent within the 6 hours after time zero. We caught the elevated lactate early and treated the patient correctly, but still get a miss. Very frustrating. Thanks, Molly Molly Duane RN, BSN, CCRN-K Sepsis Program Coordinator Detroit Receiving Hospital Harper-Hutzel Hospital Office: 313-745-4340 Cell: 248-709-6218 Email: [email protected]<mailto:[email protected]> From: Mary ann David [mailto:[email protected]] Sent: Thursday, March 14, 2019 5:56 PM To: Duane, Molly; '[email protected]' Subject: RE: New lactate rule Hi Molly and all, What we've done was to create a reflex lactate order with algorithm that if the 2nd lactate was greater than the first lactate, that a third lactate order is automatically generated, so the third lactate is not always needed. In a way, if the 2nd lactate is greater than the first, we do want a third to make sure that its going down after appropriate interventions. Thanks, Mary Ann David, RN, PhD(c), CNS, ACNS-BC Sharp Chula Vista Medical Center Tel. No. 619-502-5353 Cell No. 619-892-2047 Email. [email protected]<mailto:[email protected]> From: Sepsisgroups <[email protected]<mailto:[email protected]>> On Behalf Of Duane, Molly Sent: Thursday, March 14, 2019 10:12 AM To: '[email protected]' <[email protected]<mailto:[email protected]>> Subject: [Sepsis Groups] New lactate rule [EXTERNAL SENDER] Good Afternoon, We thought the new lactate rule would be helpful, but had our first miss of 2019. Time zero: 0636 First lactate sent 0227 (2.9) Second lactate sent 0445 (2.0) Last year this would have met the metric because the abstractor would use the lactate sent closest to time zero (result was 2.0; no repeat needed). This year the lactate with the higher value is used (result 2.9). But, the lactate sent at 0445 can't be used as 'repeat' because it was sent before time zero. Are any of your systems sending 3 lactates instead of 2, even if the repeat is normal? Any other suggestions? Thanks, Molly Molly Duane RN, BSN, CCRN-K 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. 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.
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