The Q&A from the CMS presentation in October, as noted below, notes that if fluids were not administered then the answer to septic shock present is NO. My understanding has been that this was the issue if the patient was hypotensive NOT if septic shock was due to the lactic acid. (See question 158 noted below) Is my assumption incorrect?
Question 158 What if the patient's initial lactate level is greater than 4? Is septic shock present time the same as the severe sepsis present in this case if fluids have not yet been administered? Answer to this question states (only part of answer) - Determination of septic shock based upon a lactate ≥4 does not require crystalloid fluid administration to determine the presence of septic shock. Example: The patient meets SIRS criteria at 0600 and has documented infection at 0800 but the 1st documented organ dysfunction is a lactic acid of 6.0 at 0900. My question: 1. Severe sepsis presentation is 0900 since lactic acid is >2? 2. Septic shock presentation is 0900 also even though fluids have not been given yet? Thanks Jennifer Osburn, RN, BSN Quality and Accreditation St. Mary's Medical Center -----Original Message----- From: Sepsisgroups [mailto:[email protected]] On Behalf Of Belfi, Karen Sent: Thursday, January 28, 2016 6:56 AM To: Cobb, Amy L.; Townsend, Sean, M.D. Cc: [email protected] Subject: Re: [Sepsis Groups] Septic Shock Presentation Time There is a bullet point in 5.0b that states if crystalloid fluids are not given, to select value 2 (no). Here are some questions from the Q&A from the CMS presentation in October that clarifies the issue. Question 159: If no crystalloid fluids were administered, the answer to septic shock present is no even if the physician documents septic shock? Answer 159: Correct. Question 161: If there is MD documentation of "possible septic shock" but no crystalloid fluids were administered or were not administered at 30 ml/kg, would I answer the "Septic Shock Present" data element as a "No?" Answer 161: If no fluids were given after the presentation of severe sepsis, you would select "No" for Septic Shock Present, regardless of physician documentation or clinical criteria. If fluids were given but not 30 ml/kg, you would select "Yes" for Septic Shock Present because of the physician documentation of possible septic shock. Question 176: If the physician states septic shock in their notes but no crystalloid fluids were administered, do we select "Yes" or "No" for septic shock? Answer 176: If no crystalloid fluids were given after presentation of severe sepsis, you would select "No" for Septic Shock Present, regardless of how septic shock is identified. Question 144: On slide 103, the Specifications Manual says: "If there has not been crystalloid administration, select "No" for septic shock. Patients with initial lactate >4 and severe sepsis present have septic shock without the administration of crystalloids." Is this being addressed in the manual page 1-332? Answer 144: For purposes of the SEP-1 measure, if crystalloid fluids were not given following presentation of severe sepsis, you should select "No" for Septic Shock Present. This allows the case to be excluded from the crystalloid fluid data elements. The case would fail if crystalloid fluids were not given. This does not mean the patient does not clinically have septic shock Karen Belfi, RN, MSN Quality Outcomes Coordinator Lankenau Medical Center 484-476-8092 Pager: 5240 -----Original Message----- From: Cobb, Amy L. [mailto:[email protected]] Sent: Thursday, January 28, 2016 6:45 AM To: Townsend, Sean, M.D.; Belfi, Karen Cc: [email protected] Subject: RE: [Sepsis Groups] Septic Shock Presentation Time Has something changed in the Spec Manual since the v5.0b came out? This is copied and pasted from the manual: *If criteria for Septic Shock are not met, but there is physician/APN/PA documentation of Septic Shock, choose Value “1.” Allowable Values: 1 (Yes) There is documentation of Septic Shock 2 (No) There is no documentation of Septic Shock, or unable to determine Dr. Townsend, can you clarify this if physician documentation is not enough and let us know if this was changed/updated? Thank you Amy Cobb RN, BSN Sepsis Coordinator Research Outcomes Morton Plant Hospital MS #73 300 Pinellas St. Clearwater, FL 33756 727-298-6953 (Desk) 727-462-3638 (Fax) [email protected] -----Original Message----- From: Sepsisgroups [mailto:[email protected]] On Behalf Of Townsend, Sean, M.D. Sent: Monday, January 25, 2016 4:12 PM To: Belfi, Karen Cc: [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 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. 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