Re: [Sepsis Groups] Fluid management

[Pamela Green]

Maintenance 150 ml/hr Unless Fluid responsive continues then 500 ml bolus over 
15 to 30 min. And reassess. Vasopressor if continues to be hypotensive after 
fluid resuscitation of course and continue with boluses as indicated. Pam

From: Sepsisgroups  On Behalf Of 
Jenny Clarke
Sent: Tuesday, November 12, 2019 3:43 PM
To: sepsisgroups@lists.sepsisgroups.org
Subject: [Sepsis Groups] Fluid management

What is everyone using for fluid management after the 30 ml/kg? Thanks for help
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Re: [Sepsis Groups] Procalcitonin in Sepsis Order Set?

[Pamela Green]

We are CAH 20 Bed Inpatient and * Bed ER. PCT is included in both order sets. 
WE use this  to Differentiate if Infection is suspected but unconfirmed. Also 
as part of our AB Stewardship.

[cid:image002.png@01D58372.E1327B30]
http://www.sepsis.org/sepsis-heroes/
Pam Green BSN RN CCRN
Clinical Informatics / Sepsis Team Leader /Coordinator

[cid:image001.png@01D0FCE5.2E7479C0]

130 Medical Circle
Nashville, Ark. 71852
Work-870-845-4400 (ext. 8918)
Cell-870-703-1360
Email: pa...@howardmemorial.com
 www.howardmemorial.com
 Improving the Health of the Communities We Serve
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please immediately notify the sender via telephone or return email and delete 
the email immediately.





From: Sepsisgroups  On Behalf Of 
Rosemary Grant
Sent: Thursday, October 10, 2019 1:28 PM
To: sepsisgroups@lists.sepsisgroups.org
Subject: [Sepsis Groups] Procalcitonin in Sepsis Order Set?

Hello!  I'm curious how many hospitals include procalcitonin in their sepsis 
order set (both for ED and inpatient if you have different order sets?)

How many beds does your hospital have and do you include procalcitonin in 
sepsis order sets?

Thank you!
Rosemary

Rosemary Mitchell Grant, BSN, RN, CPHQ
Director, Safety and Quality- Sepsis and Readmissions

Washington State Hospital Association
999 Third Avenue, Suite 1400
Seattle, WA   98104
Phone:  206-216-2516
Email:  rosema...@wsha.org

[WSHA_logo_blue_SignatureFriendlySize--2_PhotoGalleryReSize]

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Re: [Sepsis Groups] lactic acid reflex time

[Pamela Green]

I am wondering if anyone is currently using a POC testing  device for Lactic 
acid using Finger stick blood levels how accurate is it? Pam

From: Sepsisgroups  On Behalf Of 
Pamela Green
Sent: Thursday, June 13, 2019 1:25 PM
To: Laura Soares ; 
'sepsisgroups@lists.sepsisgroups.org' 
Subject: Re: [Sepsis Groups] lactic acid reflex time


We reflex if LA >2 also. Usually 3 hours from initial draw regardless what 
result is.  This helps to not miss in repeats  most of the time.

[cid:image002.png@01D525E6.9E4D0090]
http://www.sepsis.org/sepsis-heroes/

Pam Green BSN RN CCRN
Clinical Informatics / Sepsis Team Leader /Coordinator

[cid:image001.png@01D0FCE5.2E7479C0]

130 Medical Circle
Nashville, Ark. 71852
Work-870-845-4400 (ext. 8918)
Cell-870-703-1360
Email: pa...@howardmemorial.com<mailto:pa...@howardmemorial.com>
 www.howardmemorial.com<http://www.howardmemorial.com/>
 Improving the Health of the Communities We Serve
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From: Sepsisgroups 
mailto:sepsisgroups-boun...@lists.sepsisgroups.org>>
 On Behalf Of Laura Soares
Sent: Thursday, June 06, 2019 3:50 PM
To: 'sepsisgroups@lists.sepsisgroups.org' 
mailto:sepsisgroups@lists.sepsisgroups.org>>
Subject: [Sepsis Groups] lactic acid reflex time

Good afternoon,

Currently we reflex any lactic acid that is > 2 to be re-drawn in 2 hrs.

I'm wondering what others' practices are when reflexing the lactic acid - do 
you use a 2 hr timeframe, or 3 hr, or?

Thanks so much!

Laura Soares MSN RN SCRN
Sepsis & Stroke Program Coordinator
559.788.6067 Office
559.280.2036 Cell

"Teamwork is the ability to work together toward a common vision--the ability 
to direct individual accomplishments toward organizational objectives. It is 
the fuel that allows common people to attain uncommon results"- Andrew Carnegie

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Re: [Sepsis Groups] lactic acid reflex time

[Pamela Green]

We reflex if LA >2 also. Usually 3 hours from initial draw regardless what 
result is.  This helps to not miss in repeats  most of the time.

[cid:image003.png@01D521EB.76A76250]
http://www.sepsis.org/sepsis-heroes/

Pam Green BSN RN CCRN
Clinical Informatics / Sepsis Team Leader /Coordinator

[cid:image001.png@01D0FCE5.2E7479C0]

130 Medical Circle
Nashville, Ark. 71852
Work-870-845-4400 (ext. 8918)
Cell-870-703-1360
Email: pa...@howardmemorial.com
 www.howardmemorial.com
 Improving the Health of the Communities We Serve
HIPAA PRIVACY NOTICE: The information contained in or attached to this email 
may be private, may contain Protected Health Information covered under the 
Health Insurance Portability and Accountability Act of 1996 (PL 104-191) and 
must be protected in accordance with its provisions. The information contained 
in or attached to this email may be personal and sensitive and you are 
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From: Sepsisgroups  On Behalf Of 
Laura Soares
Sent: Thursday, June 06, 2019 3:50 PM
To: 'sepsisgroups@lists.sepsisgroups.org' 
Subject: [Sepsis Groups] lactic acid reflex time

Good afternoon,

Currently we reflex any lactic acid that is > 2 to be re-drawn in 2 hrs.

I'm wondering what others' practices are when reflexing the lactic acid - do 
you use a 2 hr timeframe, or 3 hr, or?

Thanks so much!

Laura Soares MSN RN SCRN
Sepsis & Stroke Program Coordinator
559.788.6067 Office
559.280.2036 Cell

"Teamwork is the ability to work together toward a common vision--the ability 
to direct individual accomplishments toward organizational objectives. It is 
the fuel that allows common people to attain uncommon results"- Andrew Carnegie

[SVMC Logo]
465 W. Putnam Ave
Porterville, CA  93257
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California Evidence Code Section 1157, the information contained in this email 
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of sending the information via this email.

If you receive this email in error, please call the Information Technology 
Security Coordinator at (559) 788-6090 (collect if necessary) immediately upon 
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Re: [Sepsis Groups] [External Email] Re: Sepsis Screening

[Pamela Green]

1.   Are you screening every patient? Not always

2.   Are they screened in Triage or not until they are in a room? both

3.   If not screening every patient, what are the triggers for screening? 
Based on Suspect infection and q SOFA

4.   Is the screen on paper or electronic? Paper at the moment but 
implementing electronic


From: Sepsisgroups  On Behalf Of 
Joyce Luster
Sent: Monday, March 04, 2019 1:14 PM
To: 'Maupin, Christina' ; 
Maykel, Julie ; Krall, Eva 
; Orth, Claudia ; 
sepsisgroups@lists.sepsisgroups.org
Subject: Re: [Sepsis Groups] [External Email] Re: Sepsis Screening


1.   Are you screening every patient? 18 & older

2.   Are they screened in Triage or not until they are in a room? In triage

3.   If not screening every patient, what are the triggers for screening?
4.   Is the screen on paper or electronic?  electronic

Joyce C. Luster, RN, CPHQ
System Sepsis Program Coordinator
Quality Management
Baptist Health
MOB 2, Suite 2600
350 Taylor Road
Montgomery, AL  36117
(334) 747-8727





From: Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On 
Behalf Of Maupin, Christina
Sent: Friday, January 18, 2019 12:42 PM
To: Maykel, Julie; Krall, Eva; Orth, Claudia; 
sepsisgroups@lists.sepsisgroups.org
Subject: Re: [Sepsis Groups] [External Email] Re: Sepsis Screening

We screen all patients in ED triage using a paper form at this point. The 
nurses follow a protocol to initiate the labs/BCs if positive.

Chris

Christina Maupin MN, RN, CNS
Clinical Outcomes Specialist
Bakersfield Heart Hospital
3001 Sillect Ave.
Bakersfield Heart Hospital 93308
661-316-6016

Strive not to be a success, but rather to be of value.
Albert Einstein




From: Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On 
Behalf Of Maykel, Julie
Sent: Thursday, January 17, 2019 2:35 PM
To: Krall, Eva 
mailto:eva.kr...@palomarhealth.org>>; Orth, 
Claudia mailto:cor...@mhc.net>>; 
sepsisgroups@lists.sepsisgroups.org
Subject: Re: [Sepsis Groups] [External Email] Re: Sepsis Screening

We screen all patients 18 years and older in triage; the tool is in our 
electronic record.

Thank you,
Julie

Julie Maykel, RN, BSN
Quality Coordinator

juliemay...@verity.org
Seton Medical Center | Part of Verity Health System
1900 Sullivan Avenue, Daly City CA 94015
Office  650-991-6366
Fax  650-991-6390

seton.verity.org | Verity.org

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From: Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On 
Behalf Of Krall, Eva
Sent: Wednesday, January 16, 2019 5:09 PM
To: Orth, Claudia; 
sepsisgroups@lists.sepsisgroups.org
Subject: [External Email] Re: [Sepsis Groups] Sepsis Screening

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I would appreciate this information as well

Eva Bunny Krall MSN APRN ACNS-BC CDE CPHQ
Clinical Nurse Specialist
Quality and Patient Safety


[cid:image001.jpg@01D4AF1A.3B9B48F0]

 2185 Citracado Parkway | Escondido, CA 92029

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[Sepsis Groups] Total Bundle compliance

[Pamela Green]

We are having trouble getting consistent 3 and 6 hr documentation of tissue 
perfusion status. So I fail the bundle compliance if there is no documentation 
found at 3 hr and 6 hr. Even though all other components are present. Most 
times the patient is leaving the ER before or at 3 hours and by the time the 
Attending if admitted sees it is outside of 3 hr parameter. I was wondering if 
anyone else counts the entire bundle compliance as fail if the documentation is 
not there at the accurate parameter for Focused re-exam. It's frustrating 
because we don't get credit for what is being done for Bundle compliance for 
these patients. Would appreciate other observations. Thanks Pam

[cid:image001.png@01D47770.34A0C160][cid:image002.png@01D47770.34A0C160]

Pam Green BSN RN CCRN
Clinical Informatics / Sepsis Team Leader /Coordinator

[cid:image001.png@01D0FCE5.2E7479C0]

130 Medical Circle
Nashville, Ark. 71852
Work-870-845-4400 (ext. 8918)
Cell-870-703-1360
Email: pa...@howardmemorial.com
 www.howardmemorial.com
 Improving the Health of the Communities We Serve
HIPAA PRIVACY NOTICE: The information contained in or attached to this email 
may be private, may contain Protected Health Information covered under the 
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must be protected in accordance with its provisions. The information contained 
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please immediately notify the sender via telephone or return email and delete 
the email immediately.



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Re: [Sepsis Groups] ideas for September Sepsis Awareness Month

[Pamela Green]

We have a hospital wide hunt for the Sepsis bug (stuffed toy bug) for a prize! 
We use clues that lead to sepsis! Also we are ordering a sepsis awareness 
banner and set up a table with questions for test your knowledge about sepsis 
and put in a drawing for prize. We are planning to make bug and critter shaped 
snacks for the table. That's all we have discussed so far. 
[cid:image004.jpg@01D43A2E.D3529BA0]

Pam Green BSN RN CCRN
Clinical Informatics

[cid:image001.png@01D0FCE5.2E7479C0]

130 Medical Circle
Nashville, Ark. 71852
Work-870-845-4400 (ext. 8918)
Cell-870-703-1360
Email: pa...@howardmemorial.com
 www.howardmemorial.com
 Improving the Health of the Communities We Serve
HIPAA PRIVACY NOTICE: The information contained in or attached to this email 
may be private, may contain Protected Health Information covered under the 
Health Insurance Portability and Accountability Act of 1996 (PL 104-191) and 
must be protected in accordance with its provisions. The information contained 
in or attached to this email may be personal and sensitive and you are 
obligated to maintain it in a safe, secure and confidential manner. Further 
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information is strictly prohibited. If you have received this email in error, 
please immediately notify the sender via telephone or return email and delete 
the email immediately.





From: Sepsisgroups  On Behalf Of 
Posani, Theresa
Sent: Tuesday, August 21, 2018 11:15 AM
To: sepsisgroups@lists.sepsisgroups.org
Subject: [Sepsis Groups] ideas for September Sepsis Awareness Month

Please share any and all ideas for celebrating Sepsis Awareness Month in 
September.
Our facility is looking for ideas to bring awareness to our staff and patients.
Thank you
Theresa

Theresa Posani, MS, RN, ACNS-BC | Med/Surg CNS/Sepsis Coordinator
T 817.250-3907 | M 972.838-7954
theresapos...@texashealth.org


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Re: [Sepsis Groups] severe sepsis presentation [External]

[Pamela Green]

My understanding is we use the earliest time stamp  that confirms the presence 
of severe sepsis, that can be physician documentation (which is usually late), 
time of Lactic Acid >2.0, Triage that indicates qSOFA criteria, at least 1 
indication of organ dysfunction.

From: Sepsisgroups  On Behalf Of 
Schrecengost, Lisa M.
Sent: Tuesday, June 26, 2018 1:49 PM
To: Cox, Debra M. (RN) ; sepsisgroups@lists.sepsisgroups.org
Subject: Re: [Sepsis Groups] severe sepsis presentation [External]

In the body of the physician's note, he says pneumonia (no time).  We have a 
time of sepsis dx as 19:50 in the body.  At the D/C impression, he has primary 
impression as Pneumonia & Additional Impression as severe sepsis... (no times)
  Our struggle is to find out if we can use the times within the body of the 
note to meet our severe sepsis criteria, or do we have to take the time the 
note was opened since he has  a dc impression of severe sepsis.  I have asked 
quality net and it goes in circles.  I thought we used the time the note was 
opened  only  if we did not have any times within the body of the note.  For 
example, I have times for SIRS, the sepsis dx time, and lactate level of 2.9.  
I thought the time would be 19:50 when all criteria meets, since we have times 
in the documentation.   My coworker says since the dr has severe sepsis as an 
impression, we have to use time note was opened for severe sepsis presentation 
time.

From: Cox, Debra M. (RN) [mailto:dm...@srhs.com]
Sent: Tuesday, June 26, 2018 2:19 PM
To: Schrecengost, Lisa M.; 
sepsisgroups@lists.sepsisgroups.org
Subject: Re: [Sepsis Groups] severe sepsis presentation [External]

Be aware: [This message came from outside of Spartanburg Regional Network]

Is there anything in the ED record or nursing documentation showing a source? 
This can even be "Sepsis ED order" or the triage impression of a code Sepsis. 
If so, what time is this documentation?

Get Outlook for iOS

From: Sepsisgroups 
mailto:sepsisgroups-boun...@lists.sepsisgroups.org>>
 on behalf of Schrecengost, Lisa M. 
mailto:schrecengo...@acmh.org>>
Sent: Tuesday, June 26, 2018 10:00:26 AM
To: 
sepsisgroups@lists.sepsisgroups.org
Subject: [Sepsis Groups] severe sepsis presentation [External]

Be aware: [This message came from outside of Spartanburg Regional Network]

Hello all.


Need help!!   We are having issues with figuring out severe sepsis presentation 
times.   We are having discrepancies at our facility understanding what times 
to use, especially when the physician has severe sepsis as the impression and 
there are other times within the note.


We have a patient that comes into the ED.  The note was opened at 16:37 by the 
physician. In the body of the report, it says "Time of sepsis diagnosis is 
19:50". Pulse of 104 at 16:19. Respirations of 24 at 16:19. Lactate 2.9 at 
17:50. He documents in the body of the note "the patient has severe sepsis but 
not septic shock".
Primary impression documented on the ED Physician Report is Pneumonia, 
additional impression is Severe Sepsis. What time should we collect as Time of 
Severe Sepsis?   Do we take the time the note was opened since he has an 
impression of severe sepsis or use the times within the body of the note?


Thanks for your time,
Lisa




Lisa Schrecengost RN BSN
Quality Management
ACMH Hospital
One Nolte Drive
Kittanning, PA 16201
Phone:  724-543-8871
email:  schrecengo...@acmh.org
Confidentiality Notice: This e-mail message, including any attachments, is for 
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message.


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Re: [Sepsis Groups] severe sepsis presentation

[Pamela Green]

We use the initial Triage Vital Signs, Elevated Lactate etc... as Time zero if 
they meet criteria for Severe Sepsis or Septic Shock.  The Criteria for 
Screening is any of those Vitals that screen Sepsis is present or Labs etc.. 
that have a time stamp. If you are waiting until the doctor decides that it is 
final Diagnosis for admit you are already in a late presentation. Our policy is 
nurse driven protocol to initiate Code Sepsis if the patient Screens as at Risk 
of/or having Severe Sepsis/Septic Shock. That is time Zero and starts the 
clock.  The scenario that was used indicates that time from initial triage 
vital signs is outside of 3 hour window.  Are you waiting until the Physician 
final diagnosis of Sepsis documented to initiate EGDT when indicated?

From: Sepsisgroups  On Behalf Of 
Schrecengost, Lisa M.
Sent: Tuesday, June 26, 2018 9:00 AM
To: sepsisgroups@lists.sepsisgroups.org
Subject: [Sepsis Groups] severe sepsis presentation

Hello all.


Need help!!   We are having issues with figuring out severe sepsis presentation 
times.   We are having discrepancies at our facility understanding what times 
to use, especially when the physician has severe sepsis as the impression and 
there are other times within the note.


We have a patient that comes into the ED.  The note was opened at 16:37 by the 
physician. In the body of the report, it says "Time of sepsis diagnosis is 
19:50". Pulse of 104 at 16:19. Respirations of 24 at 16:19. Lactate 2.9 at 
17:50. He documents in the body of the note "the patient has severe sepsis but 
not septic shock".
Primary impression documented on the ED Physician Report is Pneumonia, 
additional impression is Severe Sepsis. What time should we collect as Time of 
Severe Sepsis?   Do we take the time the note was opened since he has an 
impression of severe sepsis or use the times within the body of the note?


Thanks for your time,
Lisa




Lisa Schrecengost RN BSN
Quality Management
ACMH Hospital
One Nolte Drive
Kittanning, PA 16201
Phone:  724-543-8871
email:  schrecengo...@acmh.org
Confidentiality Notice: This e-mail message, including any attachments, is for 
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[Sepsis Groups] Sepsis Readmissions

[Pamela Green]

What is the threshold for sepsis readmissions percentage?

Pam Green BSN RN CCRN
Clinical Informatics

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130 Medical Circle
Nashville, Ark. 71852
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Re: [Sepsis Groups] Vasopressor administration

[Pamela Green]

Our Sepsis protocol at HMH uses "Initiate Vasopressors for persistent 
Hypotension <90 syst or MAP<65 after initial Fluid Resuscitation of 30 ml/kg".  
Either measure meets the Bundle compliance Goals of therapy. Pam
From: Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On 
Behalf Of Tara Miller
Sent: Thursday, April 19, 2018 9:39 AM
To: 'sepsisgroups@lists.sepsisgroups.org' 
Subject: [Sepsis Groups] Vasopressor administration

Pam Green BSN RN CCRN
Clinical Informatics

[cid:image001.png@01D0FCE5.2E7479C0]

130 Medical Circle
Nashville, Ark. 71852
Work-870-845-4400 (ext. 8918)
Cell-870-703-1360
Email: pa...@howardmemorial.com
 www.howardmemorial.com
 Improving the Health of the Communities We Serve
HIPAA PRIVACY NOTICE: The information contained in or attached to this email 
may be private, may contain Protected Health Information covered under the 
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the email immediately.




Is anyone having issues with patients who have persistent hypotension after 
fluids defined as SBP < 90, but they still have a MAP of > or equal to 65 and 
no vasopressors being ordered? My facility's vasopressor orders read to 
initiate when the MAP is < 65. We have had two patients who did not meet that 
criteria until after the 6 hour window was up for vasopressors.

Are other facility's changing their practice to start pressors for SBP < 90?

Thanks.

Tara R Miller, RN
Team Leader, Quality Management
Mobile Infirmary Medical Center
Office: 435-5109
Cell: 605-8270

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Re: [Sepsis Groups] Question re: documentation of attestation that focused exam was completed

[Pamela Green]

Good  afternoon everyone,
We are having a difficult time getting the appropriate documentation to meet 
the bundle compliance even though everything is done correctly! Use of our 
Sepsis  Screening and Evaluation Documentation tool is hit and missed although 
I can see by the labs and treatment protocol that they are doing it.  On the IP 
side it  is the issue with getting them to document to the Sepsis Shift Screen 
and Focus reassessment. With the physicians if they are here when patient is 
admitted to the floor they usually do an admit note that includes a focused 
reassessment so we will catch those.  If it is after hours we are hoping to 
hold the ER physicians accountable to documenting a focused reassessment prior 
to moving patient to PCU or ICU.  I would be open to suggestions for better 
documentation compliance also. Pam
Pam

From: Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On 
Behalf Of Duane, Molly
Sent: Thursday, April 05, 2018 11:18 AM
To: Sepsisgroups@lists.sepsisgroups.org
Subject: [Sepsis Groups] Question re: documentation of attestation that focused 
exam was completed

Hello All,
I was wondering if your physicians were using the attestation statement instead 
of documenting the specific focused exam components. If so, how is that going? 
How did you implement this?

We had a miss this month: even though the physician documented in his note the 
specific amount of fluid that was given, followed with "after these 
interventions the patient was reassessed", we missed because the attestation 
did not have a specific time included. The time the note was opened/started was 
used. This was an ED note, started at the beginning of the pt's visit, so that 
was prior to fluids being given.

It is frustrating to see that the correct care is being given, yet we are 
missing on documentation technicalities.
Does anyone have suggestions?
Thanks,
Molly



Molly Duane RN, BSN, CCRN
Sepsis Program Coordinator
Detroit Receiving Hospital
Harper-Hutzel Hospital
Mobile: 248-709-6218
DRH: 313-966-8087
HUH: 313-745-4340
Email: mdu...@dmc.org


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Re: [Sepsis Groups] Procalcitonin and Lactate Questions

[Pamela Green]

Sorry I was referring to initial Lactate on the second statement

From: Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On 
Behalf Of Pamela Green
Sent: Tuesday, January 09, 2018 8:43 AM
To: Robert Hattabaugh ; 
'sepsisgroups@lists.sepsisgroups.org' 
Subject: Re: [Sepsis Groups] Procalcitonin and Lactate Questions

We use it for ABX stewardship on all patients for Antibiotic effectiveness.  We 
count as meeting the compliance if it was attempted within the 3 and 6 hour 
time frame, however our expectation is  that we document a result if at all 
possible in presence of Sever or Septic Shock.

From: Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On 
Behalf Of Robert Hattabaugh
Sent: Wednesday, January 03, 2018 12:03 PMmeasured
To: 'sepsisgroups@lists.sepsisgroups.org' 
mailto:sepsisgroups@lists.sepsisgroups.org>>
Subject: [Sepsis Groups] Procalcitonin and Lactate Questions


1.  Procalcitonin: is anyone using this in their sepsis protocol, as a 
routine lab with Sepsis patients or how is it being used in your facility 
overall; ABX stewardship...

2.  If the provider or nurse is unable to obtain blood for initial or 
repeat lab work, lactate, etc..., secondary to shock, etc... are you 
abstracting the cases as meeting the measure or falling out of the measure.  
CMS SEP-1 notes for Abstraction- "if a lactate level is ordered and there is an 
attempt to collect it, but the attempt results in failure to collect the 
specimen (too dehydrated to get a vein) or the specimen was contaminated during 
or after the draw."

Thanks in advance for your response
Robert Hattabaugh MSN, RN, ACNS-BC, CMSRN
Adult Health Clinical Nurse Specialist
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Re: [Sepsis Groups] Automated Lactate Orders

[Pamela Green]

We obtain an initial lactate on all patients who are suspected and screen for 
risk of severe sepsis. We felt that if initial blood draws are being done with 
placement of saline lock access we go ahead and draw blood cultures and lactate 
at that time since we will drawing for CBC and CMP most likely. Our practice is 
to not miss these tests and to try to save patient as many additional sticks as 
possible. We have been drawing blood cultures this way for quite a while. We 
just added the initial lactate as part of any and all sepsis workup with 
screening. I heard a lot about costly  tests but doing a lactate in our 
facility is reasonably cheap according to the lab director.
From: Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On 
Behalf Of Rutherford, Richard
Sent: Monday, January 08, 2018 4:54 PM
To: sepsisgroups@lists.sepsisgroups.org
Subject: [Sepsis Groups] Automated Lactate Orders


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


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Re: [Sepsis Groups] Procalcitonin and Lactate Questions

[Pamela Green]

We use it for ABX stewardship on all patients for Antibiotic effectiveness.  We 
count as meeting the compliance if it was attempted within the 3 and 6 hour 
time frame, however our expectation is  that we document a result if at all 
possible in presence of Sever or Septic Shock.

From: Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On 
Behalf Of Robert Hattabaugh
Sent: Wednesday, January 03, 2018 12:03 PMmeasured
To: 'sepsisgroups@lists.sepsisgroups.org' 
Subject: [Sepsis Groups] Procalcitonin and Lactate Questions


1.  Procalcitonin: is anyone using this in their sepsis protocol, as a 
routine lab with Sepsis patients or how is it being used in your facility 
overall; ABX stewardship...

2.  If the provider or nurse is unable to obtain blood for initial or 
repeat lab work, lactate, etc..., secondary to shock, etc... are you 
abstracting the cases as meeting the measure or falling out of the measure.  
CMS SEP-1 notes for Abstraction- "if a lactate level is ordered and there is an 
attempt to collect it, but the attempt results in failure to collect the 
specimen (too dehydrated to get a vein) or the specimen was contaminated during 
or after the draw."

Thanks in advance for your response
Robert Hattabaugh MSN, RN, ACNS-BC, CMSRN
Adult Health Clinical Nurse Specialist
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Re: [Sepsis Groups] [External] Sepsis Validation

[Pamela Green]

I was wondering if anyone has a  "Sepsis ruled out"  checkbox and time or 
indicator included in their screening forms or systems. We use
Screening form in the system that screens for patients who are at risk for 
Severe Sepsis and/or Septic Shock. The Staff are asking if we can add a 
checkbox to the bottom of the form that indicates a time that sepsis was ruled 
out. I am just not sure that that is appropriate or if it is something that we 
should be doing. I would appreciate any input or guidance in this area. Pam
From: Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On 
Behalf Of Mary Draper
Sent: Wednesday, December 20, 2017 3:16 PM
To: DHILLON, ROOPINDER ; 
sepsisgroups@lists.sepsisgroups.org
Subject: Re: [Sepsis Groups] [External] Sepsis Validation

No one to date that I know of has been validated by CMS. I don't think it 
matters if you use branch logic or not. Once a metric isn't met the abstraction 
stops there.

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
mary.dra...@johnmuirhealth.com
[cid:image004.png@01D3807D.0452F810][cid:image005.png@01D3807D.0452F810]
"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:sepsisgroups-boun...@lists.sepsisgroups.org] On 
Behalf Of DHILLON, ROOPINDER
Sent: Friday, December 15, 2017 7:34 AM
To: 
sepsisgroups@lists.sepsisgroups.org
Subject: [External] [Sepsis Groups] Sepsis Validation


Caution: This email originated outside JMH. Do not open attachments or click on 
links if you do not recognize the sender.

Hi,
I wanted to know if any hospital has been validated by CMS for Core Measure 
SEP-1. My question is, are we supposed to use branching logic for abstraction? 
For example, if we answer 'Yes' to Severe sepsis, but we don't have an Initial 
Lactate collected and we say 'No' to Initial Lactate question; do we stop at 
that point or do we have to still go ahead and answer the rest of the questions?

If anyone has been validated, what did you do? If you used branching logic (did 
not answer rest of the questions) was it taken against the hospital and 
considered as 'wrong' abstraction?


Thank you,
Roopa Dhillon MBBS, MBA
Clinical Quality Analyst I
Quality Improvement/Clinical Outcomes
University Hospitals Elyria Medical Centre
630 East River
Elyria, Ohio  44035
T 440-329-4959 F 440-329-5971
Roopinder.Dhillon@UHhospitals .org
Quality Assurance/Peer Review Privileged Pursuant to Ohio Rev. Code secs. 
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Re: [Sepsis Groups] Sepsis-3 Definition

[Pamela Green]

We are using the qSOFA in our screening also.

From: Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On 
Behalf Of Vovan, Andre
Sent: Thursday, September 14, 2017 2:22 PM
To: Emily C. McKinney ; Sims, Chadrick L 
; 'sepsisgroups@lists.sepsisgroups.org' 

Subject: Re: [Sepsis Groups] Sepsis-3 Definition

Incorporated the qsofa in screening but not for defining until cms change.  Cms 
put out a  advisory that they are not yet ready to adopt.



Sent from my Verizon, Samsung Galaxy smartphone


 Original message 
From: "Emily C. McKinney" 
mailto:emily.sw...@stjoeshealth.org>>
Date: 9/14/17 12:11 PM (GMT-05:00)
To: "Sims, Chadrick L" mailto:cs...@utmck.edu>>, 
"'sepsisgroups@lists.sepsisgroups.org'" 
mailto:sepsisgroups@lists.sepsisgroups.org>>
Subject: Re: [Sepsis Groups] Sepsis-3 Definition


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DO NOT click links or open attachments if the email cannot be verified. If in 
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We did not make the change. As CMS has not yet made the change.

Thank you,

Emily

From: Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On 
Behalf Of Sims, Chadrick L
Sent: Tuesday, September 12, 2017 9:14 AM
To: 'sepsisgroups@lists.sepsisgroups.org'
Subject: [External] [Sepsis Groups] Sepsis-3 Definition

Warning:  This email originated from the Internet!
DO NOT CLICK links if the sender is unknown, and NEVER provide your Password.

Hello All:

Would love to get a sense of who has adopted the sepsis-3 definition and who 
has stayed with sepsis-2? I know this has been asked before, just trying to 
prepare for the future.

Chadrick Sims, BSN, RN, CFRN, SCRN
Sepsis and Rescue Coordinator
UT Medical Center

PerfectServe: Sepsis Care Coordinator

cs...@mc.utmck.edu

Office: (865)305-6497
Cell: (865)705-9996
Fax: (865) 305-6544

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Re: [Sepsis Groups] posting on the ssc list serv

[Pamela Green]

Also, I would be interested I some examples of how your staff is addressing the 
performance measure for documenting a shift screening. I have created a 
question that allows them to check that the screening was addressed as a 
reminder to do it but it does not have specifics. Thanks Pam Green

From: Pamela Green
Sent: Friday, August 25, 2017 2:39 PM
To: 'Surviving Sepsis' ; sepsisgroups@lists.sepsisgroups.org
Subject: RE: posting on the ssc list serv

I would like to know how other facilities are defining that Code Sepsis  alert 
is initiated and how do you have staff document that  a Sepsis alert has been 
communicated.

From: Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On 
Behalf Of Surviving Sepsis
Sent: Tuesday, August 22, 2017 8:09 AM
To: 
sepsisgroups@lists.sepsisgroups.org<mailto:sepsisgroups@lists.sepsisgroups.org>
Subject: [Sepsis Groups] posting on the ssc list serv

Colleagues,

There was a technical problem with the SSC list serv on Monday. If you posted 
over the weekend or on Monday of this week (8/22/17) you posting was 
automatically discarded. Please resend to the list serv for approved 
dissemination. We apologize for any inconvenience.

With best regards,
Lori


Lori A. Harmon, RRT, MBA | Director of Quality | Society of Critical Care 
Medicine
500 Midway Drive, Mount Prospect, IL 60056-5811 USA
t: +1 847.493.6403 | m: +1 847.693.0359 | www.sccm.org<http://www.sccm.org>
www.facebook.com/SCCM1<http://www.facebook.com/SCCM1> | 
www.twitter.com/SCCM<http://www.twitter.com/SCCM> | 
www.youtube.com/SCCM500<http://www.youtube.com/SCCM500>

Visit www.survivingsepsis.org<http://www.survivingsepsis.org> and 
www.iculiberation.org<http://www.iculiberation.org>


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Re: [Sepsis Groups] posting on the ssc list serv

[Pamela Green]

I would like to know how other facilities are defining that Code Sepsis  alert 
is initiated and how do you have staff document that  a Sepsis alert has been 
communicated.

From: Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On 
Behalf Of Surviving Sepsis
Sent: Tuesday, August 22, 2017 8:09 AM
To: sepsisgroups@lists.sepsisgroups.org
Subject: [Sepsis Groups] posting on the ssc list serv

Colleagues,

There was a technical problem with the SSC list serv on Monday. If you posted 
over the weekend or on Monday of this week (8/22/17) you posting was 
automatically discarded. Please resend to the list serv for approved 
dissemination. We apologize for any inconvenience.

With best regards,
Lori


Lori A. Harmon, RRT, MBA | Director of Quality | Society of Critical Care 
Medicine
500 Midway Drive, Mount Prospect, IL 60056-5811 USA
t: +1 847.493.6403 | m: +1 847.693.0359 | www.sccm.org
www.facebook.com/SCCM1 | 
www.twitter.com/SCCM | 
www.youtube.com/SCCM500

Visit www.survivingsepsis.org and 
www.iculiberation.org


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[Sepsis Groups] Evaluation for Severe Sepsis Screening Tool HMH revised

[Pamela Green]

After meeting with HIM and coding yesterday it was brought to my attention that 
the Lab normal range high is 2. Our screening form had only the > 4 mmol/L 
under #3. Criteria for Severe Sepsis. So I went back to the original form the 
actual value is supposed to be >2 . The edited form had the wrong  value of >4. 
So I have made that change on the screening form as indicated. I also, have a 
question out to the Sepsis Groups to understand how other facilities are using 
this measurement. Please make copies for your dept. and make changes to your 
existing forms thanks. Pam


Evaluation for Severe Sepsis Screening Tool HMH revised.docx
Description: Evaluation for Severe Sepsis Screening Tool HMH revised.docx
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Re: [Sepsis Groups] Lab times

[Pamela Green]

We have been utilizing our Sepsis Protocol for the last Month and have been 
screening and intervening on several patients. There is one Level that we need 
clarification for. Our Protocol says any Lactate Level ≥2 is considered to 
indicate sepsis, but our lab range is Normal for 0.4- 2.0. Would like to know 
how everyone is using this? Thanks Pam

From: Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On 
Behalf Of Belfi, Karen
Sent: Thursday, August 03, 2017 12:27 PM
To: sepsisgroups@lists.sepsisgroups.org
Subject: [Sepsis Groups] Lab times

Hi, we are confused about something here.
On our lab report in our EMR, it lists a time. It's the draw time, not report 
time, though it doesn't say draw time. We just know it is.
Can we use that for severe sepsis criteria since it doesn't specify draw time?
Thank you.

Karen Belfi, RN, MSN
Quality Outcomes Coordinator
Lankenau Medical Center
(484)476-8092

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Re: [Sepsis Groups] fluids given prior to arrival

[Pamela Green]

Does anyone have any information on Sepsis related to heat exhaustion or heat 
stroke? This time of year seems to bring these patients in that in presentation 
have all the criteria to screen and intervene as you would for Sepsis. Some os 
the same intervention applies, however, my ER Docs and staff do not feel it is 
beneficial to screen for Sepsis on these patients. I disagree. Anyone have any 
other information that supports this? Any help appreciated.

From: Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On 
Behalf Of Nanette Kent
Sent: Monday, July 17, 2017 11:04 AM
To: 'Jessica Slater' ; sepsisgroups@lists.sepsisgroups.org
Subject: Re: [Sepsis Groups] fluids given prior to arrival

Our prehospital records are scanned into the record and once that occurs, it 
can be utilized as part of the record

From: Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On 
Behalf Of Jessica Slater
Sent: Tuesday, July 11, 2017 08:15 AM
To: 
sepsisgroups@lists.sepsisgroups.org
Subject: Re: [Sepsis Groups] fluids given prior to arrival

How does your ER document IV fluids given prior to arrival (by EMS Sepsis 
protocol) so it can be abstracted from the chart to count towards the 30ml/kg 
requirement?

Our dilemma is the clinical abstractors need a physician order for the fluids 
given via EMS. The EMS sepsis protocol is based on physician orders, but is not 
a part of the patient record. I was wondering if anyone else had tackled this 
and how you were successful?

Any feedback is appreciated.

Thanks,
Jessica Slater, RN, BSN, CCRN
Sepsis Coordinator
Miami Valley Hospital
Dayton, OH

On Jul 9, 2017 2:00 PM, "Mary Draper" 
mailto:mary.dra...@johnmuirhealth.com>> wrote:
The last I saw was there wouldn’t be any updates until January of 2018.

Mary Draper RN BSN
Coordinator Quality Improvement
Peer Review Support CV/CT
Quality Management JMH
Office (925) 674-2045
Cell (925) 451-8792
Fax (925) 674-2373
mary.dra...@johnmuirhealth.com
[cid:image001.png@01D3006B.5DB5C2D0]
“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:sepsisgroups-boun...@lists.sepsisgroups.org]
 On Behalf Of Jamie Natkowski
Sent: Saturday, July 01, 2017 1:24 PM
To: 
sepsisgroups@lists.sepsisgroups.org
Subject: [Sepsis Groups] CMS Updates

Forgive me if this has already been addressed:
Does anyone know when the next set of CMS updates will come out for sep-1?  
Curious if they will reflect the 2016 SCCM/SSC guidelines.
Thanks!

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Re: [Sepsis Groups] Sepsis Badge Tool

[Pamela Green]

This is one that I found on line and tweaked for our facility. Pam

From: Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On 
Behalf Of Amy Holland
Sent: Friday, June 30, 2017 3:48 PM
To: sepsisgroups@lists.sepsisgroups.org
Subject: [Sepsis Groups] Sepsis Badge Tool

Good Afternoon,

Does anyone have an example of a tool that they use that is given to nursing 
staff to put on their employee badge that has easy access information on Sepsis 
dx and bundle orders?

Thanks,
Amy Holland

Amy Holland APRN, AGACNP-BC
Sepsis Coordinator
Baptist Health North Little Rock
 Springhill Drive
North Little Rock, AR 72117
Office # 501.202.4830
Spectralink # 501.202.6973
Fax# 501.202.4838
Cell # 501.416.1404
amy.holl...@baptist-health.org


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Sepsis Pocket Card HMH revised.docx
Description: Sepsis Pocket Card HMH revised.docx
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Re: [Sepsis Groups] initial hypotension

[Pamela Green]

My understanding, based on the Best Practice is that the initial bolus is to 
resuscitate within the first 3 hours. The initial infusion at 30ml/kg may 
correct hypoperfusion within this time frame. After that if the Hypotension 
persists following Fluid resuscitation then you should follow with 
Vasopressors. Although  fluids have been given the patient may still be found 
to be fluid responsive with additional reassessment And may require additional 
fluids . Dr. Jaffer who is Director of Surgical intensive Care at UAMS 
explained it really well, in that it is to provide more tissue perfusion at the 
cellular level. Also, it should be administered as long as hypotension persists 
and patient assessment still indicates signs of hypoperfusion (BP<90, MAP<65, 
Cool Mottling skin, or Lactate Level remains >4.) Then once the 30 ml/kg is 
reached or adequate perfusion is reached then  you would put the maintenance  
rate to 150 ml/hr. I suppose the question that many physicians have is do they 
give the entire amount of 30ml/kg initially or just until stable perfusion has 
been reached. We have interpreted this to be an initial  end amount. Hope this 
helps a little.

From: Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On 
Behalf Of DHILLON, ROOPINDER
Sent: Friday, June 30, 2017 12:35 PM
To: 'Schrecengost, Lisa M.' ; 
sepsisgroups@lists.sepsisgroups.org
Subject: Re: [Sepsis Groups] initial hypotension

Yes having lot of fallouts because of the initial hypotension and less fluids 
issue. Physicians don't want to give this amount initially especially with LA<2 
and only one systolic <90.
CMS needs to look into this.

From: Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On 
Behalf Of Schrecengost, Lisa M.
Sent: Wednesday, June 28, 2017 8:51 AM
To: 
sepsisgroups@lists.sepsisgroups.org
Subject: [Sepsis Groups] initial hypotension

Hello,
I am in search of assistance.   Can somebody explain why 30ml/kg of crystalloid 
fluids are to be given for an initial hypotension.even if in severe sepsis 
and not in septic shock.   I have many doctors questioning thisThey say 
these fluids of 30ml/kg are only to be given if in septic shock.  When we do 
our chart abstractions and answer the question "yes" for initial hypotension, 
it asks if fluids of 30ml/kg were given.  If we say these fluids were not given 
at 30ml/kg, then it falls out.   I have even seen it happen with the lactate <2.

Anybody else having same problems?

Thanks,

Lisa  :)




Lisa Schrecengost RN BSN
Clinical Resource Management
ACMH Hospital
One Nolte Drive
Kittanning, PA 16201
Phone:  724-543-8871
email:  schrecengo...@acmh.org
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