I would simply provide the clinical advice that for a provider it's best thought of as the time that you first suspected severe sepsis or shock. Give yourself 6 hours from that point. You likely have much more time than that given that the shock click starts later than the severe sepsis clock, do they should be fine.
It simply requires then getting comfortable with saying, "I first suspected sepsis at 11:30. I'll start the block then." If they want a "real" time, that's probably not possible to ascertain in the clinical domain, it needs to be abstacted. On Dec 14, 2015, at 11:27 AM, CARIANN M DAHLQUIST <[email protected]<mailto:[email protected]>> wrote: Hello, I am inquiring if other facilities are still facing the barriers of physicians and nurses actually knowing when presentation time starts? I am looking for any ideas that you may be utilizing to help aide in the understanding or identification of time zero. Thank you greatly! CariAnn CariAnn Dahlquist RN Quality Management Altru Health System | Grand Forks, ND 701.780.5339 phone | 701.780.1942 fax | [email protected]<mailto:[email protected]> >>> "Downs, Brenda - PHX" >>> <[email protected]<mailto:[email protected]>> >>> 11/18/2015 11:53 AM >>> Per the spec manual - all elements need to meet within the 6 hours - so I would say yes, it needs to be mentioned again unfortunately - whether it makes sense or not... Brenda ☺ Brenda Downs MSN, APRN, ACNS-BC Cell: 480-720-6102 Program Director Clinical Performance Improvement – ICU Care -----Original Message----- From: Sepsisgroups [mailto:[email protected]] On Behalf Of Prabhakar, Brenda Sent: Wednesday, November 18, 2015 9:08 AM To: Cynthia Wells; [email protected]<mailto:[email protected]> Subject: Re: [Sepsis Groups] Severe Sepsis Time Zero and documentation of infection Hello- I am looking for an answer to the question below posed some time ago. If an infectious source is documented on admission and a patient develops signs of severe sepsis more than 6hrs later, must infection be documented again to determine start time and to be included in the measure? It makes sense that the infectious source is known, but for data abstraction, must it be documented again within 6 hrs? Any help would be appreciated. Thank you, Brenda Prabhakar RN BSN Sepsis Steering Committee Co-Chair Doylestown Hospital Doylestown, PA ________________________________________ From: Sepsisgroups [[email protected]<mailto:[email protected]>] on behalf of Cynthia Wells [[email protected]<mailto:[email protected]>] Sent: Wednesday, September 30, 2015 1:48 AM To: [email protected]<mailto:[email protected]> Subject: [Sepsis Groups] Severe Sepsis Time Zero Hello, If infection/suspect infection is already established however the patient does not meet criteria until 8 hours after documentation of infection (SIRS + Organ Dysfunction) do we have to tie in the infection documentation again within 6 hours or is it already assumed since infection has been documented/confirmed before the vital signs/abnormal lab values. For Example: Patient presents to ED with Fever 09:00 and Chest X-Ray shows Pneumonia subsequently documented by ED at 9:30 no other abnormal labs or vitals. 16:00 Fever Persists, HR elevated, Lab work shows 16:20 lactate = 2.1 and progress note 21:00 with documented interventions for PN. Do we have to tie the infection documentation timing back into the evaluation or because Patient already noted to have PN by ED at 9:30 that counts as 1 of the three criterion and 16:20 = Time Zero. Or do we account for all three criterion and 21:00 is new time zero as all three criterion within 6 hours of each other. Cindy Cynthia Wells Steward Health Care Director of Clinical Performance Analytics (508) 404-8647 _______________________________________________ Sepsisgroups mailing list [email protected]<mailto:[email protected]> http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org _______________________________________________ Sepsisgroups mailing list [email protected]<mailto:[email protected]> http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org _______________________________________________ Sepsisgroups mailing list [email protected]<mailto:[email protected]> http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org ------------------------------------------------------------------------------------------------------------------- CONFIDENTIAL & PRIVILEGED COMMUNICATION This email and any files transmitted with it are confidential, may contain privileged or copyright information, and are intended solely for the use of the intended recipient. 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