Here it is. Jeanie
-----Original Message-----
From: Sepsisgroups [mailto:[email protected]] On
Behalf Of [email protected]
Sent: Tuesday, January 26, 2016 10:40 PM
To: [email protected]
Subject: Sepsisgroups Digest, Vol 189, Issue 6
Send Sepsisgroups mailing list submissions to
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Today's Topics:
1. Re: Septic Shock Presentation Time (Belfi, Karen)
2. Re: Sepsisgroups Digest, Vol 188, Issue 7 (Belfi, Karen)
3. Re: Crystalloid Fluid Administration element (Belfi, Karen)
4. Re: Sepsisgroups Digest, Vol 189, Issue 1 (Home)
----------------------------------------------------------------------
Message: 1
Date: Tue, 26 Jan 2016 07:20:46 -0500
From: "Belfi, Karen" <[email protected]>
To: "Townsend, Sean, M.D." <[email protected]>
Cc: "[email protected]"
<[email protected]>
Subject: Re: [Sepsis Groups] Septic Shock Presentation Time
Message-ID:
<[email protected]>
Content-Type: text/plain; charset="utf-8"
I thought one of the criteria is physician documentation, according to the
guidelines.
There are 3 ways septic shock can be met.
1) Physician/APN/PA documentation
2) Lactate >4
3) Hypotension after 30 mL/kg fluids
Karen Belfi, RN, MSN
Quality Outcomes Coordinator
Lankenau Medical Center
484-476-8092
Pager: 5240
-----Original Message-----
From: Townsend, Sean, M.D. [mailto:[email protected]]
Sent: Monday, January 25, 2016 4:12 PM
To: Belfi, Karen
Cc: [email protected]; [email protected]
Subject: Re: [Sepsis Groups] Septic Shock Presentation Time
I don't see criteria met at 10:47. MD say so is not enough.
On Jan 25, 2016, at 1:02 PM, Belfi, Karen
<[email protected]<mailto:[email protected]>> wrote:
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
<image001.png>
From: Sepsisgroups [mailto:[email protected]] On
Behalf Of [email protected]<mailto:[email protected]>
Sent: Wednesday, January 20, 2016 9:15 PM
To:
[email protected]<mailto:[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
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------------------------------
Message: 2
Date: Tue, 26 Jan 2016 07:22:04 -0500
From: "Belfi, Karen" <[email protected]>
To: Susan Meyerer <[email protected]>,
"[email protected]"
<[email protected]>
Subject: Re: [Sepsis Groups] Sepsisgroups Digest, Vol 188, Issue 7
Message-ID:
<[email protected]>
Content-Type: text/plain; charset="us-ascii"
The handwritten doesn't list the vital signs. It just says vital signs stable,
which isn't an inclusion. All 4 vital signs: T, P, R, BP, must be documented.
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 Susan Meyerer
Sent: Thursday, January 21, 2016 4:05 PM
To: [email protected]
Subject: Re: [Sepsis Groups] Sepsisgroups Digest, Vol 188, Issue 7
You should be able to use the written documentation time as long as it is part
of the medical record.
Susan Meyerer RN, BSN, CEN, CHCQM
Flagler Hospital,St. Augustine Fl
904-819-4765
Nursing Administration
[email protected]
EXCELLENCE IN NURSING
EVERY NURSE. EVERY PATIENT. EVERY TIME
----Original Message-----
From: Sepsisgroups [mailto:[email protected]] On
Behalf Of [email protected]
Sent: Thursday, January 21, 2016 3:06 PM
To: [email protected]
Subject: Sepsisgroups Digest, Vol 188, Issue 7
Send Sepsisgroups mailing list submissions to
[email protected]
To subscribe or unsubscribe via the World Wide Web, visit
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or, via email, send a message with subject or body 'help' to
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When replying, please edit your Subject line so it is more specific than "Re:
Contents of Sepsisgroups digest..."
Today's Topics:
1. Re: [sepsis group] focused exam- septic shock (Belfi, Karen)
----------------------------------------------------------------------
Message: 1
Date: Wed, 20 Jan 2016 14:16:38 -0500
From: "Belfi, Karen" <[email protected]>
To: "Osburn, Jennifer R. RN" <[email protected]>,
"[email protected]"
<[email protected]>
Subject: Re: [Sepsis Groups] [sepsis group] focused exam- septic shock
Message-ID:
<[email protected]>
Content-Type: text/plain; charset="utf-8"
This, I believe, would be an outlier for vital signs. If the handwritten note
had the vital signs written out, you would be compliant. But you can?t take
VSS, and the dictated is timed after the 6 hour window.
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 Osburn, Jennifer R. RN
Sent: Monday, January 18, 2016 12:33 PM
To: [email protected]
Subject: [Sepsis Groups] [sepsis group] focused exam- septic shock
I need to know how to document a focused exam when you have a hand written H&P
note but the full report, which includes the required information, is not
dictated until after the 6 hour timeframe. Would I be able to use the
handwritten note date and time for my focused exam?
Example- septic shock presentation is 1300. Handwritten note is 1500- states
VS stable and includes all other elements required in the focus exam. Dictated
H&P is at 2000 which includes the actual VS results- BP, temp, pulse, etc.
Thanks
Jennifer Osburn, RN, BSN
Quality and Accreditation
St. Mary's Medical Center
304-526-1506
[email protected]<mailto:mailt:[email protected]>
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------------------------------
Message: 3
Date: Tue, 26 Jan 2016 07:28:24 -0500
From: "Belfi, Karen" <[email protected]>
To: "Cox, Debra M. (RN)" <[email protected]>, "'Townsend, Sean, M.D.'"
<[email protected]>
Cc: "[email protected]"
<[email protected]>
Subject: Re: [Sepsis Groups] Crystalloid Fluid Administration element
Message-ID:
<[email protected]>
Content-Type: text/plain; charset="us-ascii"
In the power point in October, Bob Dickerson stated that fluids should run at a
rate faster than 125 mL/hr in order to count for this measure.
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 Cox, Debra M. (RN)
Sent: Thursday, January 21, 2016 4:13 PM
To: 'Townsend, Sean, M.D.'
Cc: [email protected]
Subject: Re: [Sepsis Groups] Crystalloid Fluid Administration element
Dr. Townsend,
I also have a question and would like clarification on the data element,
Crystalloid Fluid Administration. In this scenario, suppose the patient's
weight determines 2200 mls of crystalloid fluids should be ordered to meet the
30 ml/kg. The EC Physician orders an initial 1000 ml NS bolus to be given. The
admitting physician orders a second liter of NS to be given as a bolus.
However, the 3rd liter of NS is ordered and administered at a rate of 100
ml/hr. The patient receives a total of 2200 ml of NS in the EC over a time
period of about 3 hours before transferring to the floor. Yet, the last 200 mls
are given at a rate of 100 ml/hr. How should the abstractor answer the data
element "Crystalloid Fluid Administration?"
Thank you,
Debra M Cox, RN, BSN
Corporate Quality Specialist | Quality Services
Spartanburg Regional Medical Center
101 East Wood Street | Spartanburg, SC 29303
O: 864-560-2694 | c: 864-327-5731 | f: 864-560-7365
e: [email protected]| w: SpartanburgRegional.com
-----Original Message-----
From: Sepsisgroups [mailto:[email protected]] On
Behalf Of Bruce Ushkow, MD, FACEP
Sent: Wednesday, January 20, 2016 2:05 PM
To: Krall, Eva; Murray, Theresa; Prabhakar, Brenda; Angela Craig; 'Townsend,
Sean, M.D.'; Cobb, Amy L.
Cc: Sullivan-Wright, Dawn M.; Gieselman, Morris;
[email protected]
Subject: Re: [Sepsis Groups] Repeat volume assessment and tissue perfusion CMS
requirements
Agree with you completely it is not the abstractor's job to determine the
"appropriate" amount of resuscitation fluid. It is in incumbent on the
clinician to document clearly, specifically why < 30 mL/Kg was infused. If
documenting rationale meets the measure - excellent for both patient care and
the abstraction.
Thank you for the comment. I too would appreciate direction in this area for
our abstractors.
For our patients,
Bruce Ushkow, MD, MS, FACEP
Director, Emergency Critical Care
Samaritan Hospital, Troy NY
________________________________________
From: Krall, Eva <[email protected]>
Sent: Wednesday, January 20, 2016 1:53 PM
To: Bruce Ushkow, MD, FACEP; Murray, Theresa; Prabhakar, Brenda; Angela Craig;
'Townsend, Sean, M.D.'; Cobb, Amy L.
Cc: Sullivan-Wright, Dawn M.; [email protected]; Gieselman,
Morris
Subject: RE: [Sepsis Groups] Repeat volume assessment and tissue
perfusion CMS requirements
I do not feel the chart abstractors should be the ones deciding if the correct
volume was given, given the patient situation. I thought the measure was not
met if 30ml/kg is not given and the provider has not documented rationale for
not giving the full amt.
Be anxious to hear feedback
Eva "Bunny" Krall RN MSN ACNS-BC CMSRN CDE Clinical Nurse Specialist, Quality
and Patient Safety Patient Experience Division Palomar Health
2185 Citracado Parkway
Escondido, CA 92029
442-281-4268
[email protected]
-----Original Message-----
From: Sepsisgroups [mailto:[email protected]] On
Behalf Of Bruce Ushkow, MD, FACEP
Sent: Thursday, January 14, 2016 3:58 PM
To: Murray, Theresa; Prabhakar, Brenda; Angela Craig; 'Townsend, Sean, M.D.';
Cobb, Amy L.
Cc: Sullivan-Wright, Dawn M.; [email protected]; Gieselman,
Morris
Subject: Re: [Sepsis Groups] Repeat volume assessment and tissue perfusion CMS
requirements
If I may expand the key question posed by Ms. Murray: Per SEP-1, CMS, may
chart abstractors give credit for less than 30 mL/Kg intentionally not being
infused in "at risk"of fluid overload patients? Based on clinical judgement or
better yet judgement linked with objective measures as bedside Cardiovascular
Ultrasound as per Surviving Sepsis?
For our patients,
Bruce Ushkow, MD, MS, FACEP
Director, Emergency Critical Care
Samaritan Hospital, Troy NY
________________________________________
From: Sepsisgroups <[email protected]> on behalf of
Murray, Theresa <[email protected]>
Sent: Wednesday, January 13, 2016 1:09 PM
To: Prabhakar, Brenda; Angela Craig; 'Townsend, Sean, M.D.'; Cobb, Amy L.
Cc: Sullivan-Wright, Dawn M.; Gieselman, Morris;
[email protected]
Subject: Re: [Sepsis Groups] Repeat volume assessment and tissue perfusion
CMS requirements
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
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------------------------------
Message: 4
Date: Mon, 25 Jan 2016 17:29:58 -0500
From: Home <[email protected]>
To: [email protected]
Subject: Re: [Sepsis Groups] Sepsisgroups Digest, Vol 189, Issue 1
Message-ID: <[email protected]>
Content-Type: text/plain; charset=us-ascii
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
>>>
>>> _______________________________________________
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>>> _______________________________________________
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>>>
>>>
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>>> 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
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>> _______________________________________________
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>>
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>> information contained in this email message is privileged and confidential
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>> in the address. If you are not the intended recipient, you are hereby
>> notified that any dissemination, distribution, or copying of this
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>
>
>
> ------------------------------
>
> 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..."
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> 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]>
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> 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]>
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