The pt got other antibiotics that weren't at a rate greater than 125/hr that didn't need to be included in the crystalloid fluid calculation.
From: Zhukov, Marina (Tacoma) [mailto:[email protected]] Sent: Tuesday, March 26, 2019 11:31 AM To: Belfi, Karen; [email protected] Subject: [EXTERNAL] RE: Crystalloid fluids This message originated from outside MLHS systems. Any attachments or links should be carefully considered before proceeding. Messages from our business partners still need to be reviewed and should not be opened if suspicious. Please contact the IT Service Desk at 484-596-4357 with any questions or forward a questionable email to [email protected] ________________________________ HI Karen, Looks like your case if failing for antibiotics not timely, nothing to do with the fluids. Since severe sepsis presentation is 10:00, the antibiotics are required to be started within 3hrs from that time, so by 1300 they should've been started. They were started at 1305, according to given information, so they are not timely and outside of the allowable timeframe. I hope this helps. Marina Zhukov, RN, BSN Clinical Data Abstractor Office Hours: M-T-Th-F 8:30-5:00 Ask me about Sepsis! 1149 Market Street, Tacoma, WA 98402 | MS 10-04 P. 253.552.5782 | I. 152-5782 [email protected]<mailto:[email protected]> www.CHIfranciscan.org [CHI_F_1line_midtone_RevBlue_4C_RGB] [facebook] <https://urldefense.proofpoint.com/v2/url?u=https-3A__www.facebook.com_FranciscanHealth&d=DwMFAg&c=qqcbk_QeabW4Z7GBhIMNtn_B7aQjktEuWNmUvrzri9o&r=9XT3K_nIvIIF-7Bh2TiB0g&m=LBgIirBvI7EQ8D3poz2Sxo81Kr3RmeX0SITpiX32OAU&s=zS4v34lwz4lLXgYlbt-RKoACGHcWW13aIo0oj-oEj-8&e=> [twitter1] <https://urldefense.proofpoint.com/v2/url?u=https-3A__twitter.com_fhshealth&d=DwMFAg&c=qqcbk_QeabW4Z7GBhIMNtn_B7aQjktEuWNmUvrzri9o&r=9XT3K_nIvIIF-7Bh2TiB0g&m=LBgIirBvI7EQ8D3poz2Sxo81Kr3RmeX0SITpiX32OAU&s=UDfIgiHsK_dkCsuvxIC5vBUUp9MgvgKJ_Ii3DEkTZkI&e=> [cid:[email protected]] <https://urldefense.proofpoint.com/v2/url?u=https-3A__www.instagram.com_franciscanhealth_&d=DwMFAg&c=qqcbk_QeabW4Z7GBhIMNtn_B7aQjktEuWNmUvrzri9o&r=9XT3K_nIvIIF-7Bh2TiB0g&m=LBgIirBvI7EQ8D3poz2Sxo81Kr3RmeX0SITpiX32OAU&s=tKyUhgUQvQtr11GnoTqBzViWV76LLiYFORHDgYRqjOU&e=> Privileged and Confidential Quality Assurance Related Communication Protected by RCW 70.41.200 and 70.41.230 The information contained in this communication is confidential and private and intended only for the use of the addressee. Unauthorized use, disclosure, distribution or copying is strictly prohibited and may be unlawful. If you received this communication in error, please inform me of the erroneous delivery by return email. From: Sepsisgroups [mailto:[email protected]] On Behalf Of Belfi, Karen Sent: Tuesday, March 19, 2019 7:12 AM To: [email protected] Subject: [Sepsis Groups] Crystalloid fluids CAUTION: This email is not from a CHI source. Only click links or open attachments you know are safe. Please send as an attachment all spam/phishing and unusual emails to [email protected]. ________________________________ I wrote to Qnet regarding crystalloid fluids. This was my question: I have a strange case. Pt needs 2760 mL. The pt had an order for 3 liters of fluid, hung 12:07, 1231, 1306. The first liter ran over almost 2 hours. The others ran faster. At 1305 100 mL of antibiotics was hung at 150/hr. It ran concurrently with the first liter of fluid so was calculated into the crystalloid fluids. Would I take 12:07 for the crystalloid fluid time, or 13:05 since that was the latest one that got us to the 30 mL/kg? Thanks! I was told to take 13:05, because even though the fluids were ordered in one order, multiple bags were used to calculate the crystalloid fluids. The severe sepsis time was 10:00. If I used the time the fluids were hung, it would be 12:07, and we would be compliant. But because antibiotics were appropriately hung in the time frame, we had to use them, and it is now an outlier. Has anyone else experienced this? It's very difficult to explain to physicians that even though they did things appropriately, it is an outlier. Thanks, Karen Belfi MSN, RN Main Line Health (484)476-8092 This email and attachments contain information that may be confidential or privileged. If you are not the intended recipient, notify the sender at once and delete this message completely from your information system. Further use, disclosure, or copying of information contained in this email is not authorized, and any such action should not be construed as a waiver of privilege or other confidentiality protections.
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