According to CMS, the entire 30 ml/kg need be infused within 3 hours of "recognition of severe sepsis with hypotension or lactic acid > 4, not within 3 hours of start of fluids. No wiggle room re Chf or renal failure. We view this as a big problem as many of our patients have very poor EFs and severe renal disease. Makes doing the right thing very difficult at times. SFH is a cardiac specialty hospital.
Evan SORETT, MD, FCCP, FACP Director of Critical Care & Medical Informatics St. Francis Hospital Roslyn, NY Sent from my iPhone > On Jan 25, 2016, at 4:01 PM, [email protected] > wrote: > > 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: Repeat volume assessment and tissue perfusion CMS > requirements (Belfi, Karen) > 2. Crystalloid fluids (Belfi, Karen) > 3. Re: Septic Shock Presentation Time (Belfi, Karen) > > > ---------------------------------------------------------------------- > > Message: 1 > Date: Thu, 21 Jan 2016 15:16:29 -0500 > From: "Belfi, Karen" <[email protected]> > To: "Wilson, Van" <[email protected]> > Cc: "Sullivan-Wright, Dawn M." <[email protected]>, > "Gieselman, Morris" <[email protected]>, > "[email protected]" > <[email protected]> > Subject: Re: [Sepsis Groups] Repeat volume assessment and tissue > perfusion CMS requirements > Message-ID: <[email protected]> > Content-Type: text/plain; charset="us-ascii" > > There is no time frame stated for the fluids. > There are currently no reasons in the guidelines for not infusing the full 30 > mL/kg. CMS has said they may review this for the next guideline update but > for now they don't allow for a reason not to infuse. However, they said of > course to use clinical judgment and not to order fluids for someone for whom > it is clinically contraindicated. > > Karen Belfi, RN, MSN > Quality Outcomes Coordinator > Lankenau Medical Center > > >> On Jan 21, 2016, at 3:11 PM, Wilson, Van <[email protected]> wrote: >> >> at what time does the IVF have to be started? it looks like within 3 hrs of >> presentation of septic shock, however part of the definition of septic shock >> is severe sepsis with persistant hypotension measured one hr after bolus... >> >> ________________________________________ >> From: Sepsisgroups [[email protected]] on behalf >> of Patricia Posa [[email protected]] >> Sent: Thursday, January 14, 2016 7:49 PM >> To: Murray, Theresa >> Cc: [email protected]; Sullivan-Wright, Dawn M.; >> Gieselman, Morris >> Subject: Re: [Sepsis Groups] Repeat volume assessment and tissue perfusion >> CMS requirements >> >> Hi Theresa >> >> The full 30ml/kg needs to be given. There are no exceptions per CMS >> guidelines >> >> The reassessment can be done anytime after the fluid bolus is completed and >> 6 hours from time met criteria for septic shock >> >> Pat >> >> Sent from my iPhone >> >>> On Jan 13, 2016, at 1:09 PM, "Murray, Theresa" <[email protected]> >>> wrote: >>> >>> At our shop we are talking about the volume resuscitation. Does it have to >>> be the entire 30ml/kg, or can the clinician treat the hypotension with >>> volume to the point of normotension especially in a renal or CHF patent and >>> still get credit for the metric? I have heard different responses. >>> Thanks in advance for the info >>> >>> >>> >>> Theresa Murray RN, MSN, CCRN, CCNS >>> Critical Care Clinical Nurse Specialist >>> Community Health Network >>> 1500 N. Ritter Ave >>> Indianapolis Indiana 46219 >>> 1-317-355-4258 office >>> 1-317-351-7860 fax >>> 1-317-904-7212 pager >>> 1-317-627-9350 Mobile >>> [email protected] >>> >>> Cookeville Regional Medical Center >>> 931-783-5035 >>> >>> >>> >>> This email message has been delivered safely and archived online by >>> Mimecast. For more information please visit http://www.mimecast.com >>> >>> _______________________________________________ >>> 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 >>> >>> >>> CONFIDENTIALITY NOTE: This e-mail contains information that may be >>> privileged, confidential and subject to legal restrictions and penalties >>> regarding its unauthorized disclosure or other use. You are prohibited from >>> copying, distributing or otherwise using this information if you are not >>> the intended recipient or the employee or agent to deliver to the intended >>> recipient. If you have received this e-mail in error, please notify us >>> immediately by return e-mail and delete this e-mail and all attachments >>> from your system. Thank you. >>> _______________________________________________ >>> 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 >> >> ----------------------------------------- Confidentiality Notice: The >> information contained in this email message is privileged and confidential >> information and intended only for the use of the individual or entity named >> in the address. If you are not the intended recipient, you are hereby >> notified that any dissemination, distribution, or copying of this >> information is strictly prohibited. If you received this information in >> error, please notify the sender and delete this information from your >> computer and retain no copies of any of this information. >> _______________________________________________ >> Sepsisgroups mailing list >> [email protected] >> http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org > > > > ------------------------------ > > Message: 2 > Date: Fri, 22 Jan 2016 05:50:14 -0500 > From: "Belfi, Karen" <[email protected]> > To: "Penoyer, Daleen" <[email protected]>, > "[email protected]" > <[email protected]> > Subject: [Sepsis Groups] Crystalloid fluids > Message-ID: > <[email protected]> > Content-Type: text/plain; charset="us-ascii" > > What I believe they meant is that the physician must order what he or she > thinks is best. However, there is no way in the measure currently to allow > for this-there is no question asking for "reason for no crystalloid fluids" > or "reason for <30 mL/kg fluids". However, they may address this later. > > Karen Belfi, RN, MSN > Quality Outcomes Coordinator > Lankenau Medical Center > 484-476-8092 > Pager: 5240 > > > -----Original Message----- > From: Sepsisgroups [mailto:[email protected]] On > Behalf Of Penoyer, Daleen > Sent: Wednesday, January 20, 2016 3:16 PM > To: [email protected] > Subject: Re: [Sepsis Groups] Sepsisgroups Digest, Vol 188, Issue 3 > > While we've been telling our team this re: volume replacement, I recently saw > a question answered on CMS re: this and while it supports that this volume is > always required, but the last sentence indicates that the physician's > judgment may come into their decision (Question #8) This may allow loopholes > in the measure. > > > Daleen Aragon Penoyer, PhD, RN, CCRP, FCCM Director, Center for Nursing > Research Orlando Health myorlandohealth.com facebook.com/orlandohealth > youtube.com/orlandohealth [email protected] > 1404 Kuhl Ave., MP 161 > Orlando, FL 32806 > tel: 321.841.5589 > fax: 321.841.3530 > > > -----Original Message----- > From: Sepsisgroups [mailto:[email protected]] On > Behalf Of [email protected] > Sent: Wednesday, January 20, 2016 3:11 PM > To: [email protected] > Subject: Sepsisgroups Digest, Vol 188, Issue 3 > > 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..." > > > > > > ------------------------------ > > Message: 3 > Date: Fri, 22 Jan 2016 05:51:23 -0500 > From: "Belfi, Karen" <[email protected]> > To: "[email protected]" <[email protected]>, > "[email protected]" > <[email protected]> > Subject: Re: [Sepsis Groups] Septic Shock Presentation Time > Message-ID: > <[email protected]> > Content-Type: text/plain; charset="us-ascii" > > 10:47 would be septic shock time. It's the earliest time criteria is met. > > Karen Belfi, RN, MSN > Quality Outcomes Coordinator > Lankenau Medical Center > 484-476-8092 > Pager: 5240 > [cid:[email protected]] > > From: Sepsisgroups [mailto:[email protected]] On > Behalf Of [email protected] > Sent: Wednesday, January 20, 2016 9:15 PM > To: [email protected] > Subject: [Sepsis Groups] Septic Shock Presentation Time > > Clinical criteria for severe sepsis is met at 1002. Crystalloid bolus > completed at 1247. SBP=79 @ 1300. SBP=87 @1330. > Initial lactic acid =4.0 resulted at 1126. > ED physician note started at 1047 containing documentation of possible septic > shock. > Would septic shock presentation time be 1047, 1126 or 1300? > > Karen King, RN MSN > Quality Management Core Measures Specialist, Lead > Lakeview Regional Medical Center > 95 Judge Tanner Boulevard > Covington, LA 70433 > Office: (985) 867-4467 > Cell: (985) 788-0585 > Fax: (985) 867-4263 > Email: [email protected]<mailto:[email protected]> > > This email and any files transmitted with it may contain privileged or > confidential information and may be read or used only by the intended > recipient. If you are not the intended recipient of the email or any of its > attachments, please be advised that you have received this email in error and > that any use, dissemination, distribution, forwarding, printing, or copying > of this email or any attached files is strictly prohibited. If you have > received this email in error, please immediately purge it and all attachments > and notify the sender by reply email or contact the sender at the number > listed. > > > > -------------- next part -------------- > An HTML attachment was scrubbed... > URL: > <http://lists.sepsisgroups.org/pipermail/sepsisgroups-sepsisgroups.org/attachments/20160122/a71ee9b9/attachment.htm> > -------------- next part -------------- > A non-text attachment was scrubbed... > Name: image001.png > Type: image/png > Size: 40233 bytes > Desc: image001.png > URL: > <http://lists.sepsisgroups.org/pipermail/sepsisgroups-sepsisgroups.org/attachments/20160122/a71ee9b9/attachment.png> > > ------------------------------ > > Subject: Digest Footer > > _______________________________________________ > Sepsisgroups mailing list > [email protected] > http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org > > > ------------------------------ > > End of Sepsisgroups Digest, Vol 189, Issue 1 > ******************************************** _______________________________________________ Sepsisgroups mailing list [email protected] http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org
