In fact you can just say it was completed. Gets easier each time we clarify!
On Aug 26, 2016, at 8:36 AM, Clement, Joseph (DPH) <[email protected]<mailto:[email protected]>> wrote: Oh, thank you for this further clarification. So the results of the reperfusion exam must be specified? I had understood it could say that an exam was completed. Do only the findings of the cardiopulmonary exam need to be referenced? Must they reference other findings, e.g. cap refill or pulses? Joe Joseph Clement, MS, RN, CCNS Clinical Nurse Specialist San Francisco General Hospital ph: 628 206-6174 pg: 415 327-0220 office: H5841 ________________________________ From: Townsend, Sean, M.D. <[email protected]<mailto:[email protected]>> Sent: Friday, August 26, 2016 7:53 AM To: Marlett Amy; Clement, Joseph (DPH) Cc: [email protected]<mailto:[email protected]> Subject: Re: [External] RE: Re: [Sepsis Groups] SEP-1 Specification Manual for January 2017 Discharges One more thing -- I was also unclear below as regards the cardiopulmonary exam. From today until Jan 1 an LIP still has to perform the cardiopulmonary exam. However after that time to satisfy the concept of a reperfusion assessment for a shock patient, an MD/NP/PA may then document simply that they “attest to having reviewed or performed a sepsis focused exam and findings were ____.” The findings can include “within normal limits.” The provider DOES NOT need to state, nor include, nor specifically reference the terms vital signs, cardiopulmonary exam, capillary refill, peripheral pulses, or skin exam. This simple statement of reassessment satisfies the intent that the patient was closely observed. Note as well the LIP can attest to a nurse’s review of the same. Hope that's more clear. Sean On Aug 25, 2016, at 5:06 PM, Townsend, Sean, M.D. <[email protected]<mailto:[email protected]><mailto:[email protected]>> wrote: Amy, you were correct. I mean to say “blood culture” acceptable delay and too quickly typed “antibiotic” acceptable delay. To summarize: To further ensure that blood culture collection does not delay appropriate care, the next specification update, Version 5.2, has a new data element entitled Blood Culture Collection Acceptable Delay which allows for a case to pass the measure if a clinician indicates that “the IV antibiotic was started before the blood culture was drawn because waiting for the blood culture to be drawn would have resulted in a delay of 45 minutes or more in starting the IV antibiotic.” SEP-1 Version 5.2 was published July 1st, 2016, and will cover discharges from January 1st, 2017 through December 31st, 2017. Sean R. Townsend, M.D. Vice President of Quality & Safety California Pacific Medical Center 2330 Clay Street, #301 San Francisco, CA 94115 email [email protected]<mailto:[email protected]><mailto:[email protected]> office (415) 600-5770 fax (415) 600-1541 -----Original Message----- From: Marlett Amy [mailto:[email protected]] Sent: Thursday, August 25, 2016 1:21 PM To: Townsend, Sean, M.D.; Clement, Joseph (DPH) Cc: [email protected]<mailto:[email protected]><mailto:[email protected]> Subject: [External] RE: Re: [Sepsis Groups] SEP-1 Specification Manual for January 2017 Discharges I am looking at the following below from Dr. Townsend " As regards antibiotic acceptable delay the provider has to state a delay of 45 minutes or longer would have transpired." My question is- was this this answer to J. Clement comment below " I see that a new element was added "Blood Culture Collection Acceptable Delay" - but I'm not clear from the manual what constitutes an acceptable delay. Am I missing something? Can anybody clarify?" If so, I do not understand the reply. I only see a change to the BC part of the measure, not Abx. So why I do not understand. If there is another question in these emails regarding Abx, then I missed it. Thank you for clarifying and for this workgroup. I have never sent in a question before, but I find most of the posts very useful and know that eventually someone will ask my questions. Amy Gossett Marlett BSN, RN, CCRN Sepsis Coordinator Denton Regional Medical Center Office: 940.384.3254 Cell: 214.801.2950 [email protected]<mailto:[email protected]><mailto:[email protected]> Enhancing community health through service with compassion, excellence and efficiency. 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. -----Original Message----- From: Sepsisgroups [mailto:[email protected]] On Behalf Of Townsend, Sean, M.D. Sent: Wednesday, August 24, 2016 5:53 PM To: Clement, Joseph (DPH) <[email protected]<mailto:[email protected]><mailto:[email protected]>> Cc: [email protected]<mailto:[email protected]><mailto:[email protected]> Subject: [EXTERNAL] Re: [Sepsis Groups] SEP-1 Specification Manual for January 2017 Discharges You are correct in your reading. The LIP can now attest to the reperfusion assessment without giving greater detail. What is more, nursing documentation and a nursing exam can be the basis of that attestation. The only requirement is that the one exam item LIP has to do as part of that attestation is a cardiopulmonary exam. This is huge. I hope you appreciate the change. Our goal wasn't to make people document but rather to conduct an exam and satisfy themselves that the patient was perfusing adequately. As regards antibiotic acceptable delay the provider has to state a delay of 45 minutes or longer would have transpired. There are other goodies in version 5.2. On Aug 24, 2016, at 1:49 PM, Clement, Joseph (DPH) <[email protected]<mailto:[email protected]><mailto:[email protected]<mailto:[email protected]%3cmailto:[email protected]<http://sfdph.org>>>> wrote: Hello, I'm reviewing the updated specification manual 5.2 for SEP-1, that will go into effect 1/1/17, and I have a few questions - I wonder if others are further along than me. https://na01.safelinks.protection.outlook.com/?url=https%3a%2f%2fwww.qualitynet.org%2fdcs%2fContentServer%3fc%3dPage%26pagename%3dQnetPublic%252FPage%252FQnetTier3%26cid%3d1228775749207&data=01%7c01%7cTownseSR%40sutterhealth.org%7c6a4cac439bc34d189c5b08d3cd2ceb2c%7caef453eadaa243e0be62818066e9ff63%7c0&sdata=no%2bMj06K1%2fmVYusd%2fdgoPBJMdk02vH6DhCx%2fL2W5fMY%3d<https://na01.safelinks.protection.outlook.com/?url=https%3a%2f%2fwww.qualitynet.org%2fdcs%2fContentServer%3fc%3dPage%26pagename%3dQnetPublic%252FPage%252FQnetTier3%26cid%3d1228775749207&data=01%7c01%7ctownsesr%40sutterhealth.org%7c9dad663bd1fe4129e4c108d3cc602cd1%7caef453eadaa243e0be62818066e9ff63%7c0&sdata=Lfj7WQvlpCs3T%2b0LsrjWZtrnfLyK42X5rtVyK7r924w%3d<https://na01.safelinks.protection.outlook.com/?url=https%3a%2f%2fwww.qualitynet.org%2fdcs%2fContentServer%3fc%3dPage%26pagename%3dQnetPublic%252FPage%252FQnetTier3%26cid%3d1228775749207&data=01%7c01%7cTownseSR%40sutterhealth.org%7c6a4cac439bc34d189c5b08d3cd2ceb2c%7caef453eadaa243e0be62818066e9ff63%7c0&sdata=no%2bMj06K1%2fmVYusd%2fdgoPBJMdk02vH6DhCx%2fL2W5fMY%3d%3chttps://na01.safelinks.protection.outlook.com/?url=https%3a%2f%2fwww.qualitynet.org%2fdcs%2fContentServer%3fc%3dPage%26pagename%3dQnetPublic%252FPage%252FQnetTier3%26cid%3d1228775749207&data=01%7c01%7ctownsesr%40sutterhealth.org%7c9dad663bd1fe4129e4c108d3cc602cd1%7caef453eadaa243e0be62818066e9ff63%7c0&sdata=Lfj7WQvlpCs3T%2b0LsrjWZtrnfLyK42X5rtVyK7r924w%3d>> [] The manual says that MD attestation of reassessment, VS review, skin assessment, cardiopulmonary exam, and peripheral pulse exams are acceptable. It also says that "performing, or attesting to performing a physical examination, perfusion (re-perfusion) assessment, or sepsis (severe sepsis or septic shock) focused exam is acceptable." At the risk of asking an obvious question, I just want to make sure I am getting this right. If the MD signs something that says "I attest to having performed a severe sepsis re-perfusion exam at XX:XX", then this would meet the measure requirement? [] I see that a new element was added "Blood Culture Collection Acceptable Delay" - but I'm not clear from the manual what constitutes an acceptable delay. Am I missing something? Can anybody clarify? Thanks in advance! 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