However, without the central line vasopressors can't be administered. Dale DeLude P.I. Specialist Advocate Condell Medical Center 801 S. Milwaukee Ave. Libertyville, IL 60048 Telephone: 847-990-5863 Fax: 847-573-4251 [email protected]
This e-mail, and any attachments thereto, is intended only for use by the addressee(s) named herein and may contain legally privileged and/or confidential information. If you are not the intended recipient of this e-mail (or the person responsible for delivering this document to the intended recipient), you are hereby notified that any dissemination, distribution, printing or copying of this e-mail, and any attachments thereto, is strictly prohibited. If you have received this e-mail in error, please respond to the individual sending the message and permanently delete the original and any copy of any e-mail and any printout thereof. -----Original Message----- From: Townsend, Sean, M.D. [mailto:[email protected]] Sent: Thursday, October 22, 2015 9:25 AM To: Delude, Dale Cc: Prabhakar, Brenda; [email protected] Subject: Re: [Sepsis Groups] DNR, DNI, and comfort care with regards to the septic shock requirements The reason for no exclusion for central line placement is that the physical exam option means the line is not mandatory. The vasopressor issue wasn't envisioned as something a patient would refuse, but I suppose it is conceivable. In any case as others have said here there is no refusal option for vasopressors. Sean On Oct 22, 2015, at 5:15 AM, Delude, Dale <[email protected]<mailto:[email protected]>> wrote: Good Morning Dr. Townsend, I respectfully disagree that the patient refusing vasopressors will be excluded from the measure. The abstraction guideline and algorithm only excludes patients who are refusing blood draw, fluid administration, or antibiotic administration, or those patients who have a directive for comfort care documented within 6 hours of septic shock presentation. There is also no out for those patients who refuse to have a central line inserted for administration of vasopressors. Dale DeLude P.I. Specialist Advocate Condell Medical Center 801 S. Milwaukee Ave. Libertyville, IL 60048 Telephone: 847-990-5863 Fax: 847-573-4251 [email protected]<mailto:[email protected]> This e-mail, and any attachments thereto, is intended only for use by the addressee(s) named herein and may contain legally privileged and/or confidential information. If you are not the intended recipient of this e-mail (or the person responsible for delivering this document to the intended recipient), you are hereby notified that any dissemination, distribution, printing or copying of this e-mail, and any attachments thereto, is strictly prohibited. If you have received this e-mail in error, please respond to the individual sending the message and permanently delete the original and any copy of any e-mail and any printout thereof. From: Sepsisgroups [mailto:[email protected]] On Behalf Of Townsend, Sean, M.D. Sent: Wednesday, October 21, 2015 5:16 PM To: 'Prabhakar, Brenda'; [email protected]<mailto:[email protected]> Subject: Re: [Sepsis Groups] DNR, DNI, and comfort care with regards to the septic shock requirements As regards your questions, yes if they are refusing a required intervention then they may be excluded (vasopressors). With respect to the later question on DNI patients, I think to get to use the comfort measures exclusion I would document that rather than being intubated the patient prefers comfort strategies and thus trigger the exclusion. 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]<mailto:[email protected]> office (415) 600-5770 fax (415) 600-1541 From: Sepsisgroups [mailto:[email protected]] On Behalf Of Prabhakar, Brenda Sent: Wednesday, October 21, 2015 4:50 AM To: [email protected]<mailto:[email protected]> Subject: [Sepsis Groups] DNR, DNI, and comfort care with regards to the septic shock requirements Hello everyone. Thank you all for you questions and answers online. They've been very helpful. My physicians are wondering how to handle those patients who have advanced directives but are not yet comfort care. * If they are refusing vasopressors, is it correct that they would NOT be included in the measure for septic shock with persistent hypotension? They are refusing one the measure components to give vasopressors. * If they are a DNI (Do Not Intubate), often times the physicians are concerned they could put their patients into CHF if they order the full 30ml/kg fluid bolus without the ability to intubate if required. I've read the prior lively discussions about fluid resuscitation and the lack of data reporting any harm from administering the boluses, but Dr. Townsend also brought up the good point that intubation isn't always an adverse outcome. Any insight with how to manage these patients would be greatly appreciated. Thank you, Brenda Prabhakar RN BSN Sepsis Steering Committee Co-Chair Doylestown Hospital Doylestown, PA This e-mail, and any attachments thereto, is intended only for use by the addressee(s) named herein and may contain legally privileged and/or confidential information. If you are not the intended recipient of this e-mail (or the person responsible for delivering this document to the intended recipient), you are hereby notified that any dissemination, distribution, printing or copying of this e-mail, and any attachments thereto, is strictly prohibited. If you have received this e-mail in error, please respond to the individual sending the message and permanently delete the original and any copy of any e-mail and any printout thereof. This e-mail, and any attachments thereto, is intended only for use by the addressee(s) named herein and may contain legally privileged and/or confidential information. If you are not the intended recipient of this e-mail (or the person responsible for delivering this document to the intended recipient), you are hereby notified that any dissemination, distribution, printing or copying of this e-mail, and any attachments thereto, is strictly prohibited. If you have received this e-mail in error, please respond to the individual sending the message and permanently delete the original and any copy of any e-mail and any printout thereof. _______________________________________________ Sepsisgroups mailing list [email protected] http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org
