I am also teaching nurses to administer two antibiotics at a time if the patient has the access. I also stress that if two antibiotics are ordered and there is only one line, to give the broad spectrum first (unless the MD instructs otherwise). Very often Zosyn and Vanc are ordered together in the ED as first line ABX.. Zosyn also has a faster infusion time. Changing the culture to recognize sepsis as "an emergency" is one that will take some time.
Jeanie Bollinger MSN,RN,ACCNS-AG, CCRN Clinical Nurse Specialist Acute Medicine Mission Health Asheville, NC. Phone 828-213-7171 Pager 207-2363 -----Original Message----- From: Sepsisgroups [mailto:[email protected]] On Behalf Of [email protected] Sent: Thursday, October 22, 2015 3:12 AM To: [email protected] Subject: Sepsisgroups Digest, Vol 176, Issue 8 Send Sepsisgroups mailing list submissions to [email protected] To subscribe or unsubscribe via the World Wide Web, visit http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org or, via email, send a message with subject or body 'help' to [email protected] You can reach the person managing the list at [email protected] When replying, please edit your Subject line so it is more specific than "Re: Contents of Sepsisgroups digest..." Today's Topics: 1. Re: Administering IV Antibiotics (Baker, Patricia) 2. Re: severe sepsis determination (Brown, Sheree) ---------------------------------------------------------------------- Message: 1 Date: Wed, 21 Oct 2015 11:19:13 +0000 From: "Baker, Patricia" <[email protected]> To: 'Clifford Peebles' <[email protected]>, Mary McAdams <[email protected]> Cc: "[email protected]" <[email protected]> Subject: Re: [Sepsis Groups] Administering IV Antibiotics Message-ID: <dafd2ecea3bdb044b08e7dee47fca552effb2...@exchmail-dr03.ds.valleyhealthlink.com> Content-Type: text/plain; charset="us-ascii" We do recommend administration of two antibiotics, provided there are two separate lines. Tough culture to change as still taught in nursing school. We have successfully converted the ED to first antibiotic administrations, then the subsequent dosing is scheduled by pharmacy, thankfully with different frequencies for most abx's. The floor nursing population is a little different, will take us longer to convert. Pat Patricia A. Baker MS RN CNS CCRN CCNS Critical Care Clinical Nurse Specialist Heart & Vascular Center Winchester Medical Center Winchester VA 22601 Office: 540-536-6679 BB: 540-533-0754 A Clinical Nurse Specialist (CNS) is a Master's prepared Advanced Practice RN, with additional licensure, whose function is to improve outcomes in patient care. The CNS function in five sub-roles: clinical practice, leader, educator, researcher and consultant with the goal of improving patient outcomes in three areas: patient, practice, & organization. From: Sepsisgroups [mailto:[email protected]] On Behalf Of Clifford Peebles Sent: Sunday, October 18, 2015 6:41 PM To: Mary McAdams Cc: [email protected] Subject: Re: [Sepsis Groups] Administering IV Antibiotics I understand there are those who are hesitant in administering two new antibiotics to a patient because it would be difficult to determine the offending drug during a drug reaction. As I see it, and as I practice, the concurrent administration of the antibiotics is more important than the risk of a reaction. Especially when using nepho/hepato-insulting vein irritating vesicant antibiotics that must be infused over a longer period of time. Not too sure how others feel about the question. Cliff. [Description: sig1] Cliff Peebles, RN<outbind://23-000000004315E22FCF058346A5246C72F39E671307000CBF5C420BD8AD4AAEDED774BD4A240F000003C2DFC000000CBF5C420BD8AD4AAEDED774BD4A240F000007DE01060000/[email protected]> Northwestern Medical Center<http://www.northwesternmedicalcenter.org/> Intensive Care Unit 133 Fairfield Street<http://www.mapquest.com/maps?address=133+Fairfield+St&city=Saint+Albans&state=VT&zipcode=05478-1726&country=US> Saint Albans, Vermont 05478<http://www.mapquest.com/maps?address=133+Fairfield+St&city=Saint+Albans&state=VT&zipcode=05478-1726&country=US> Phone 802-524-1039 / FAX 802-524-1204 Statement of Confidentiality This message and any attachments are from NMC and intended only for the addressee(s). The information contained may include privileged information. Unauthorized review, forwarding, printing, copying or distribution is strictly prohibited. If you have received this message in error, please delete it and notify the sender. Thank you. From: Sepsisgroups [mailto:[email protected]] On Behalf Of Mary McAdams Sent: Friday, October 16, 2015 10:33 AM To: [email protected]<mailto:[email protected]> Subject: [Sepsis Groups] Administering IV Antibiotics Can you please tell me thoughts on administering two IV antibiotics simultaneously to patients with severe sepsis or septic shock? Mary K. McAdams, BSN, RN, CEN, CPEN, TNS Manager of Education Honor Society of Nursing, Sigma Theta Tau International 550 W. North Street, Indianapolis, IN 46202, USA 888.634.7575 (U.S./Canada toll free) Phone: +1.317.634.8171 Fax: +1.317.634.8188 E-mail: [email protected]<mailto:[email protected]> Web: www.nursingsociety.org<http://www.nursingsociety.org/> IMPROVING WORLD HEALTH THROUGH KNOWLEDGE(tm) CONFIDENTIALITY NOTICE: This e-mail message, including any attachments, is for the sole use of the intended recipient(s) and may contain confidential and privileged information or information otherwise protected by law. Any unauthorized review, use, disclosure or distribution of this e-mail message and its content is prohibited. If you receive this message in error or are not the named recipient, please contact the sender by reply e-mail, delete this e-mail from your computer and destroy any copies of the original message. -------------- next part -------------- An HTML attachment was scrubbed... URL: <http://lists.sepsisgroups.org/pipermail/sepsisgroups-sepsisgroups.org/attachments/20151021/43e8f14b/attachment-0001.htm> -------------- next part -------------- A non-text attachment was scrubbed... Name: image001.jpg Type: image/jpeg Size: 1535 bytes Desc: image001.jpg URL: <http://lists.sepsisgroups.org/pipermail/sepsisgroups-sepsisgroups.org/attachments/20151021/43e8f14b/attachment-0001.jpg> ------------------------------ Message: 2 Date: Wed, 21 Oct 2015 14:10:32 +0000 From: "Brown, Sheree" <[email protected]> To: "'Townsend, Sean, M.D.'" <[email protected]>, Rona Capps <[email protected]> Cc: "[email protected]" <[email protected]> Subject: Re: [Sepsis Groups] severe sepsis determination Message-ID: <[email protected]> Content-Type: text/plain; charset="us-ascii" The specification manual infers that only physician, APN, or PA documentation can be used in abstracting the criterion of Documentation of Suspected Source of Infection. The way I interpret this is not to use nurse documentation or diagnostic test results (i.e., CXR positive for pneumonia). The data dictionary for severe sepsis presentation also reads as if this documentation note must be timed within 6 hours of SIRS and organ dysfunction. This doesn't seem right either, as you could initiate treatment for suspected or known pneumonia and if the patient developed severe sepsis >6 hours later without again documenting the suspicion of pneumonia, the case would be thrown out for inclusion in the measure? Sheree Brown MSN, RN, CNL Manager, Performance Excellence Phone: 517 205-4209 ext. 4209 Pager: 517 534-0127 Fax: 517 788-4715 [email protected] -----Original Message----- From: Sepsisgroups [mailto:[email protected]] On Behalf Of Townsend, Sean, M.D. Sent: Sunday, October 18, 2015 10:36 AM To: Rona Capps Cc: [email protected] Subject: Re: [Sepsis Groups] severe sepsis determination Probably you say no, but if you expand the pneumonia search to things like nursing notes for suspicion of infection, not a formal diagnosis, I bet you can get an earlier time. However, if they don't overlap, no big deal -- you are only excluding a chart, not failing the measure. On Oct 18, 2015, at 7:08 AM, Rona Capps <[email protected]> wrote: 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] http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org _______________________________________________ Sepsisgroups mailing list [email protected] http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org ------------------------------ Subject: Digest Footer _______________________________________________ Sepsisgroups mailing list [email protected] http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org ------------------------------ End of Sepsisgroups Digest, Vol 176, Issue 8 ******************************************** ---------------------------------------------------------------------------------------------------- This message and its attachments may contain confidential and/or legally-sensitive information that is intended for the sole use of the addressee(s). 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