There may be cases that fall out of the measure as you are all describing. Falling out of the measure is not the end of the world (and treating clinicians for the most part do not understand the fallout, so treat accordingly). Improperly failing the measure is bad, improperly passing the measure is bad.
All that said, I do think if you expand your search for suspicion of infection to nursing notes which happen at greater frequency you can make a time of presentation. This is a permissible strategy. Sean R. Townsend, M.D. Vice President of Quality & Safety California Pacific Medical Center 2330 Clay Street, #301 San Francisco, CA 94115 email [email protected] office (415) 600-5770 fax (415) 600-1541 -----Original Message----- From: Sepsisgroups [mailto:[email protected]] On Behalf Of Wightman, Mary Sent: Wednesday, October 21, 2015 6:19 AM To: 'Clement, Joseph (DPH)'; Rona Capps; [email protected] Subject: Re: [Sepsis Groups] severe sepsis determination Good Day- We have a similar concern & would greatly appreciate a definitive answer from CMS. Since we have not received a clear cut answer from Qnet after multiple inquiries, we continue to look into the chart for all 3 criterion met within a 6 hour period. Case abstraction is extremely time consuming; but, is leading to opportunities for improvement & education to staff. In addition, we are finding many cases excluded due to IV abx for more than 24 hrs prior to severe sepsis met. Take care- Mary Mary Wightman, MAOM Manager, Quality & Operations Improvement Wexner Medical Center Hospital East Hawthorne House, Room 113, 1492 East Broad Street, Columbus, OH, 43205 614-257-2821 Office / 614-257-2234 Fax [email protected] We are committed to improving people’s lives through personalized health care. P Please consider the environment before printing this e-mail This information is confidential per Ohio Revised Code Sec 2305.25 and may not be shared discussed, or distributed outside of the quality process. If the reader of this communication is not an intended recipient, you are hereby notified that any dissemination, distribution or copying of this communication is strictly prohibited. -----Original Message----- From: Sepsisgroups [mailto:[email protected]] On Behalf Of Clement, Joseph (DPH) Sent: Monday, October 19, 2015 3:35 PM To: Rona Capps; [email protected] Subject: Re: [Sepsis Groups] severe sepsis determination Thanks for asking this questions - I have a similar one. My read of the specification manual suggests to me that when using the 3-criteria method (meaning there was no documentation of severe sepsis by an MD/NP/PA), you need to have all 3 within a six hour period. In the instance you gave below, if this is truly the only relevant data points that exist, then I would say that this patient does not have a Severe Sepsis Time and would fall out of the measure. A related question is for our presentations on a medsurg unit after admission. MD progress notes are for the most part daily. If we already have infection documented on a daily progress note, do we also need to find it documented again within that six hour window? My read says yes, but I want to make sure I'm correct. Thanks Joe Joseph Clement, MS, RN, CCNS Clinical Nurse Specialist San Francisco General Hospital ph: 415206-6174 pg: 415 327-0220 ________________________________________ From: Sepsisgroups <[email protected]> on behalf of Rona Capps <[email protected]> Sent: Friday, October 16, 2015 11:20 AM To: [email protected] Subject: [Sepsis Groups] severe sepsis determination Please help. The Spec manual states that criteria must be found within 6 hours of each other to qualify for the severe sepsis diagnosis but many charts that I review are delayed in one thing or another. Current chart example that meets specific criteria: 9-22 @ 2121 lactate =2.1 organ dys 9-22 @ 2255 HR = 111 SIR 9-23 @ 1600 documentation of pneumonia Infection 9-24 @ 0550 WBC = 14.3 SIR 9-24 @ 0832 RR = 24 SIR As you can see the time span is great. 2 SIRs, Infection and organ dysfunction all met at 9-24 @ 0550 but did not take place within 6 hours of each other but rather days. Severe sepsis is NOT documented by physician. Do I say NO to severe sepsis question? Thank you Rona Capps, RN Sepsis/VTE/Meaningful Use Quality Coordinator Jackson Hospital Montgomery, AL 36116 [email protected] ************* _______________________________________________ Sepsisgroups mailing list [email protected] https://urldefense.proofpoint.com/v2/url?u=http-3A__lists.sepsisgroups.org_listinfo.cgi_sepsisgroups-2Dsepsisgroups.org&d=BQICAg&c=k9MF1d71ITtkuJx-PdWme51dKbmfPEvxwt8SFEkBfs4&r=vLPDxFMohgilJov5wBC82ePiVLbyzzu1Cw3Ybi5EXhw&m=Zf_Omv_sqTF5q6nUVS36-l0_z2v_utKkEoghJOwL8aw&s=W8ooLEm3zyAoSuleSmhzjVvzJKNfByL_D-Mwfx2dt9s&e= _______________________________________________ Sepsisgroups mailing list [email protected] https://urldefense.proofpoint.com/v2/url?u=http-3A__lists.sepsisgroups.org_listinfo.cgi_sepsisgroups-2Dsepsisgroups.org&d=BQICAg&c=k9MF1d71ITtkuJx-PdWme51dKbmfPEvxwt8SFEkBfs4&r=vLPDxFMohgilJov5wBC82ePiVLbyzzu1Cw3Ybi5EXhw&m=Zf_Omv_sqTF5q6nUVS36-l0_z2v_utKkEoghJOwL8aw&s=W8ooLEm3zyAoSuleSmhzjVvzJKNfByL_D-Mwfx2dt9s&e= _______________________________________________ Sepsisgroups mailing list [email protected] http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org _______________________________________________ Sepsisgroups mailing list [email protected] http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org
