Hi Debbie, It is my understanding that a patient with severe sepsis only has to have a repeat lactate within 6 hours if initial lactate is elevated. Only in septic shock patients does the patient need the focused exam or two of the other items.
Maybe I am misunderstanding the measure? My perception is if after the initial 3 hour requirement (lactate, blood culture, abx, and fluid), if the "repeat exam" shows hypotension and the patient is placed on a vasopressor, then at that time (which is the re-assessment) they need the focused exam or two of the other items. If they are not hypotensive/on vasopressors, then they are only severe sepsis and not septic shock which does not require the additional testing?! If you find out differently, please let me know! I have attached a sepsis guideline sheet that a hospital shared on the listserv that has been helpful to me. Brandy Brandy Cuevas, BSN, RN Quality Improvement Coordinator William Newton Hospital 1300 E. 5th Ave. Winfield, KS 67156 620-222-6225 [email protected]<mailto:[email protected]> CONFIDENTIALITY NOTICE: This email communication may contain private, confidential, or legally privileged information intended for the sole use of the designated and/or duly authorized recipient(s). If you are not the intended recipient or have received this email in error, please notify the sender immediately by email and permanently delete all copies of this email including all attachments without reading them. If you are the intended recipient, secure the contents in a manner that conforms to all applicable state and/or federal requirements related to privacy and confidentiality of such information. From: Sepsisgroups [mailto:[email protected]] On Behalf Of [email protected] Sent: Wednesday, May 27, 2015 2:25 PM To: [email protected] Subject: [Sepsis Groups] CMS Guidelines So, I've read through the new CMS Guidelines and it states that a repeat assessment must be completed within 6 hrs with either a focused exam (including VS, cardiopulmonary exam, cap refill, peripheral pulse eval and skin exam) or any two of the four: CVP, SV02, bedside cardiovascular ultrasound, passive leg raise or fluid challenge. At our hospital, we have the "shift evaluation" and "shift re-evaluation." If the nurse documents the "shift re-evaluation" they are basically saying nothing has changed since the last evaluation. I'm wondering if that will suffice, or if they actually have to do another complete head-to-toe assessment. Any thoughts?? Thanks, Debbie Debbie Chambless, MSN, RN, ARNP-C Sepsis Coordinator Osceola Regional Medical Center Kissimmee, Fl 34741 Office: 407-518-3949 Cell: 772-807-0525 ~~Recognizing sepsis as a global enemy. Hoping for global unity in finding a solution~~ [cid:[email protected]] ________________________________ The materials in this email are private and may contain Protected Health Information. If you are not the intended recipient, be advised that any unauthorized use, disclosure, copying, distribution or the taking of any action in reliance on the contents of this information is strictly prohibited. If you have received this email in error, please immediately notify the sender.
Sepsis Core Measure Requirements.docx
Description: Sepsis Core Measure Requirements.docx
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