Amy,
I have had similar questions about the patient presenting to the ED in
cardiopulmonary arrest. I don’t know if it would be an excluded population for
CMS but I looked at it this way: This patient is in cardiogenic shock. If you
look at a post arrest patient they will be the “picture” of septic shock
(elevated lactate/WBC/New Organ Dysfunction…) but the shock is cardiogenic. I
have ran into this situation. Patient is S/P cardiac arrest, ROCS but no
started on hypothermia protocol as patient was Dx w/Sepsis (had PNA) and that
is a contraindication to hypothermia. The physician documents this information
as well as Dx PNA. In this case the clinical pathway was put in place as the
patient met the criteria for Severe Sepsis/Septic Shock. I am interested in
hearing what others think!
Rebecca Garner R.N.
Sepsis Coordinator
Conroe Regional Medical Center
Sent from Windows Mail
From: Cobb, Amy L.
Sent: Wednesday, October 14, 2015 12:26 PM
To: [email protected]
Question:
When abstracting for severe sepsis/septic shock, would a patient who presents
to the ED in cardiopulmonary arrest be considered part of the “excluded
population” for CMS? Or if the patient codes in the unit/on the floor just
prior to the presentation of septic shock be considered part of the “excluded
population” as well?
Thank you!
Amy Cobb RN, BSN
Sepsis Coordinator/ICU Tracker
Research Outcomes
Morton Plant Hospital
MS #73
300 Pinellas St.
Clearwater, FL 33756
727-298-6953 (Desk)
727-462-3638 (Fax)
[email protected]
From: Sepsisgroups [mailto:[email protected]] On
Behalf Of [email protected]
Sent: Friday, October 09, 2015 1:44 PM
To: [email protected]
Subject: [Sepsis Groups] Severe Sepsis Presentation
What if patient’s final code at discharge is severe sepsis and they came
through the ED but did not meet all three criteria until the next day or much
later that day but the bundle was completed? Do we continue to abstract the
chart until the patient meets all 3 criteria and use that as Severe Sepsis
Presentation Date and Time?
Example: Day 1 pt meets SIRS @ 0850, Lactate level of 3 @ 0850 but the
physician documentation stating infection or severe sepsis isn’t until 1800.
Based on the next physician documentation and the other 2 criteria, the pt
meets severe sepsis the following day. I haven’t found any direction within
the guidelines regarding this type of scenario.
Thanks,
Gena Henriques, MSN, RN
Sepsis Coordinator
Tulane Medical Center
1415 Tulane Ave.
New Orleans, LA 70112
Phone: 504-988-3195
Think Sepsis: Save A Life
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