The way I understand it, if patient is severe sepsis and lactate is >4 it will be coded as septic shock unless the provider documents that it is "not septic shock" or "not septic shock, elevated lactate due to.....". otherwise, it will fall into the measure for septic shock.
Starlynn Burnett, RN Concurrent Review West Hills Hospital and Medical Center 7300 Medical Center Drive West Hills, CA 91307 818-676-4513 818-529-3651 pgr -----Original Message----- From: Sepsisgroups [mailto:[email protected]] On Behalf Of [email protected] Sent: Friday, February 03, 2017 12:17 PM To: [email protected] Subject: [EXTERNAL] Sepsisgroups Digest, Vol 232, Issue 15 Send Sepsisgroups mailing list submissions to [email protected]<mailto:[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]<mailto:[email protected]> You can reach the person managing the list at [email protected]<mailto:[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: question (Haywood, Pamela) 2. Reflex Lactate (Jeanie Bollinger) 3. Re: Focused exam 2017 (Osburn, Jennifer R. RN) ---------------------------------------------------------------------- Message: 1 Date: Thu, 2 Feb 2017 15:55:56 +0000 From: "Haywood, Pamela" <[email protected]<mailto:[email protected]>> To: "[email protected]<mailto:[email protected]>" <[email protected]<mailto:[email protected]>>, "[email protected]<mailto:[email protected]>" <[email protected]<mailto:[email protected]>> Subject: Re: [Sepsis Groups] question Message-ID: <604D2B910FFBEC4DAEDD859CAAA418BD53A4ACB3@email-2010> Content-Type: text/plain; charset="windows-1252" OR is it septic shock only if lactic acid is still at >= 4 AFTER appropriate 30ml/kg IVF given? Pamela J Haywood, BSN, RN Clinical Documentation Specialist Jones Memorial Hospital 191 N Main St Wellsville, NY 14895 585-593-1100 ext 5209 ________________________________ From: Sepsisgroups [[email protected]] on behalf of [email protected]<mailto:[email protected]> [[email protected]] Sent: Wednesday, February 01, 2017 9:13 To: [email protected]<mailto:[email protected]> Subject: [Sepsis Groups] question Hello group, I am being told by our quality department that if a patient is documented with severe sepsis and has a lactic acid greater than 4 that it is automatically coded as septic shock even though it?s not documented. Is this true? Thanks, Debbie Chambless Sepsis Coordinator Osceola Regional Medical Center Kissimmee, Fl 34371 407-518-3949 -------------- next part -------------- An HTML attachment was scrubbed... URL: <http://lists.sepsisgroups.org/pipermail/sepsisgroups-sepsisgroups.org/attachments/20170202/09d7c0d7/attachment-0001.htm> ------------------------------ Message: 2 Date: Thu, 2 Feb 2017 17:06:38 +0000 From: Jeanie Bollinger <[email protected]<mailto:[email protected]>> To: "[email protected]<mailto:[email protected]>" <[email protected]<mailto:[email protected]>> Subject: [Sepsis Groups] Reflex Lactate Message-ID: <mwhpr04mb05741d9d8e223a44f6ac60ce82...@mwhpr04mb0574.namprd04.prod.outlook.com<mailto:mwhpr04mb05741d9d8e223a44f6ac60ce82...@mwhpr04mb0574.namprd04.prod.outlook.com>> Content-Type: text/plain; charset="us-ascii" Lori, We have an automatic repeat lactic acid order for >2. It fires at 3 hrs from the first lactate result. We have had good success with this process. Jeanie Bollinger MSN,RN,ACCNS-AG, CCRN Clinical Nurse Specialist Acute Medicine Mission Health Asheville, NC Phone:828-213-7171 -----Original Message----- From: Sepsisgroups [mailto:[email protected]] On Behalf Of [email protected]<mailto:[email protected]> Sent: Thursday, February 02, 2017 10:48 AM To: [email protected]<mailto:[email protected]> Subject: Sepsisgroups Digest, Vol 232, Issue 6 WARNING: This email originated outside of Mission Health email system DO NOT CLICK links or attachments unless you recognize the sender and know the content is safe. Send Sepsisgroups mailing list submissions to [email protected]<mailto:[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]<mailto:[email protected]> You can reach the person managing the list at [email protected]<mailto:[email protected]> When replying, please edit your Subject line so it is more specific than "Re: Contents of Sepsisgroups digest..." Today's Topics: 1. Sepsis Screen in ED (Gena Henriques) 2. question ([email protected]<mailto:[email protected]>) 3. Core measure: VS in the OR (Jeanie Bollinger) 4. Re: repeat lactate levels ([email protected]<mailto:[email protected]>) ---------------------------------------------------------------------- Message: 1 Date: Fri, 27 Jan 2017 21:25:50 -0600 From: Gena Henriques <[email protected]<mailto:[email protected]>> To: [email protected]<mailto:[email protected]> Subject: [Sepsis Groups] Sepsis Screen in ED Message-ID: <caa3yf25tsvn5modurhcsfrgst_-ccf5s-wwwbxf4xo7dnbi...@mail.gmail.com<mailto:caa3yf25tsvn5modurhcsfrgst_-ccf5s-wwwbxf4xo7dnbi...@mail.gmail.com>> Content-Type: text/plain; charset="utf-8" Hi, Would anyone mind sharing what the sepsis screen looks like in your ED? Thanks, Gena Henriques, MSN. RN Sepsis Coordinator Touro Infirmary New Orleans, LA -------------- next part -------------- An HTML attachment was scrubbed... URL: <http://lists.sepsisgroups.org/pipermail/sepsisgroups-sepsisgroups.org/attachments/20170127/2a873e05/attachment-0001.htm> ------------------------------ Message: 2 Date: Wed, 1 Feb 2017 14:13:59 +0000 From: <[email protected]<mailto:[email protected]>> To: <[email protected]<mailto:[email protected]>> Subject: [Sepsis Groups] question Message-ID: <23319868f1cf9c4ca1a7ba82cfd6131526e8f...@fwdcwpmsghcmd4b.hca.corpad.net<mailto:23319868f1cf9c4ca1a7ba82cfd6131526e8f...@fwdcwpmsghcmd4b.hca.corpad.net>> Content-Type: text/plain; charset="us-ascii" Hello group, I am being told by our quality department that if a patient is documented with severe sepsis and has a lactic acid greater than 4 that it is automatically coded as septic shock even though it's not documented. Is this true? Thanks, Debbie Chambless Sepsis Coordinator Osceola Regional Medical Center Kissimmee, Fl 34371 407-518-3949 -------------- next part -------------- An HTML attachment was scrubbed... URL: <http://lists.sepsisgroups.org/pipermail/sepsisgroups-sepsisgroups.org/attachments/20170201/9ef5c884/attachment-0001.htm> ------------------------------ Message: 3 Date: Wed, 1 Feb 2017 20:57:20 +0000 From: Jeanie Bollinger <[email protected]<mailto:[email protected]>> To: "[email protected]<mailto:[email protected]>" <[email protected]<mailto:[email protected]>> Subject: [Sepsis Groups] Core measure: VS in the OR Message-ID: <bn6pr04mb0565ea586ed2afa3a957309b82...@bn6pr04mb0565.namprd04.prod.outlook.com<mailto:bn6pr04mb0565ea586ed2afa3a957309b82...@bn6pr04mb0565.namprd04.prod.outlook.com>> Content-Type: text/plain; charset="us-ascii" We have received some fall outs of the Sepsis Measure due to vital signs in the OR being used for time zero. I sent this to QNet and below is the response that I received: Unless there is physician documentation that the low BP or MAP is due to the medications or other condition within the OR, the BP's may be used to meet criteria. The anesthesiologist or CRNA does not document a narrative note as to "why" the BP dropped. Is this a reasonable expectation? The patient is in the OR for source control and is being monitored constantly. Is there consideration for excluding these patients from the measure or at least excluding vital signs recorded in the OR? Jeanie Bollinger MSN,RN,ACCNS-AG, CCRN Clinical Nurse Specialist Acute Medicine Mission Health Asheville, NC Phone:828-213-7171 ------------------------------------------------------------------------------ This message and its attachments may contain confidential and/or legally-sensitive information that is intended for the sole use of the addressee(s). Any unauthorized review, use, disclosure, or distribution of the information contained in this message and its attachments is prohibited. If you have received this message or any of its attachments in error, please destroy all originals and copies of the same and notify the sender immediately. -------------- next part -------------- An HTML attachment was scrubbed... URL: <http://lists.sepsisgroups.org/pipermail/sepsisgroups-sepsisgroups.org/attachments/20170201/208da2ce/attachment-0001.htm> ------------------------------ Message: 4 Date: Thu, 2 Feb 2017 15:45:58 +0000 From: <[email protected]<mailto:[email protected]>> To: <[email protected]<mailto:[email protected]>>, <[email protected]<mailto:[email protected]>> Cc: [email protected]<mailto:[email protected]> Subject: Re: [Sepsis Groups] repeat lactate levels Message-ID: <57e29d65be6c56458a495d277a4ce7721191f...@fwdcwpmsghcmd3d.hca.corpad.net<mailto:57e29d65be6c56458a495d277a4ce7721191f...@fwdcwpmsghcmd3d.hca.corpad.net>> Content-Type: text/plain; charset="us-ascii" Lori, we have the reflex order here set for 2 hours post the initial lactate level. It has been working well for us. I know originally some wanted to push the reflex back to 4 hours, but I am worried that if we do that we might experience a delay that leads to a fallout. Maggie Macias, RN Sepsis Program Coordinator Valley Regional Medical Center Brownsville, TX (956) 350-7179 (O) [email protected]<mailto:[email protected]<mailto:[email protected]%3cmailto:[email protected]>> From: Sepsisgroups [mailto:[email protected]] On Behalf Of Bly, Lori Sent: Friday, January 27, 2017 10:51 AM To: [email protected]<mailto:[email protected]> Cc: Verdi, Rachel C. <[email protected]<mailto:[email protected]>> Subject: [EXTERNAL] [Sepsis Groups] repeat lactate levels At our facility we are considering placing a reflex order on initial lactate levels >2.0. Has anyone else initiated this and how is it working? Thank you Lori Bly, RN Quality Management Department ACMH Hospital One Nolte Drive Kittanning, PA 16201 Extension: 8459 email: [email protected]<mailto:[email protected]<mailto:[email protected]%3cmailto:[email protected]>> Confidentiality Notice: This e-mail message, including any attachments, is for the sole use of the intended recipient(s) and may contain confidential and privileged information. Any unauthorized review, use, disclosure or distribution is prohibited. If you are not the intended recipient, please contact the sender by reply e-mail and destroy all copies of the original message. -------------- next part -------------- An HTML attachment was scrubbed... URL: <http://lists.sepsisgroups.org/pipermail/sepsisgroups-sepsisgroups.org/attachments/20170202/ae5b88d7/attachment.htm> ------------------------------ Subject: Digest Footer _______________________________________________ Sepsisgroups mailing list [email protected]<mailto:[email protected]> http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org ------------------------------ End of Sepsisgroups Digest, Vol 232, Issue 6 ******************************************** ------------------------------------------------------------------------------ This message and its attachments may contain confidential and/or legally-sensitive information that is intended for the sole use of the addressee(s). Any unauthorized review, use, disclosure, or distribution of the information contained in this message and its attachments is prohibited. If you have received this message or any of its attachments in error, please destroy all originals and copies of the same and notify the sender immediately. ------------------------------ Message: 3 Date: Thu, 2 Feb 2017 16:35:05 +0000 From: "Osburn, Jennifer R. RN" <[email protected]<mailto:[email protected]>> To: 'Tish Poserina' <[email protected]<mailto:[email protected]>>, "[email protected]<mailto:[email protected]>" <[email protected]<mailto:[email protected]>> Subject: Re: [Sepsis Groups] Focused exam 2017 Message-ID: <61eb11df76bc404baa706e7a14a9dbc5dca2a...@smmc-ex10mb03.st-marys.org<mailto:61eb11df76bc404baa706e7a14a9dbc5dca2a...@smmc-ex10mb03.st-marys.org>> Content-Type: text/plain; charset="utf-8" I asked for clarification from CMS regarding the focused exam. CMS response: If the physician documents "exam completed" it would be sufficient documentation that an exam was performed. I hope this helps. Jennifer Osburn, RN, BSN Performance Improvement St. Mary's Medical Center 304-526-1506 [email protected]<mailto:mailt:[email protected]<mailto:[email protected]%3cmailto:mailt:[email protected]>> Confidential & Privileged Peer Review/Quality Improvement Activity Pursuant to West Virginia Code 30-3C-1, et seq. and Ohio Revised Code 2305.25, et seq. Important Notice: This e-mail message and any attachments are from the above sender at St. Mary's Medical Center and are intended solely for the individual or entity to which it is addressed and may contain information that is privileged, confidential and exempt from disclosure under applicable law. If you are not the intended recipient of this communication or the employee or agent responsible for delivering the message to the intended recipient, or if it has been sent to you in error, please notify the sender immediately. Do not examine, review, use, disclose, deliver, distribute, reproduce or take any action in reliance on it and immediately delete the message and any attachments. From: Sepsisgroups [mailto:[email protected]] On Behalf Of Tish Poserina Sent: Tuesday, January 31, 2017 9:05 AM To: [email protected]<mailto:[email protected]> Subject: [Sepsis Groups] Focused exam 2017 Can I get a clarification re focused assessment? Most recently, if a physician documents "a sepsis exam" or "perfusion exam" completed, would that prompt the abstractor to say "yes" to the components required for a focused exam? And if so, would that still mean the components must be documented individually in the record? I may be mis-interpreting the latest CMS update. Thank you Tish Poserina RN, MSN-Ed, CCRN-CMC, CNRN Sepsis Coordinator St Mary Medical Center 1201 Langhorne-Newtown Road Langhorne, PA [email protected]<mailto:[email protected]<mailto:[email protected]%3cmailto:[email protected]>> Contact: 215-710-4347 Spectralink: 215-710-7644 [stmaryLOGO][trinity logo] Confidentiality Notice: This e-mail, including any attachments is the property of Trinity Health and is intended for the sole use of the intended recipient(s). It may contain information that is privileged and confidential. Any unauthorized review, use, disclosure, or distribution is prohibited. If you are not the intended recipient, please delete this message, and reply to the sender regarding the error in a separate email. Important Notice: This e-mail message and any attachments are from the above sender at St. Mary?s Medical Center and are intended solely for the individual or entity to which it is addressed and may contain information that is privileged, confidential and exempt from disclosure under applicable law. If you are not the intended recipient of this communication or the employee or agent responsible for delivering the message to the intended recipient, or if it has been sent to you in error, please notify the sender immediately. Do not examine, review, use, disclose, deliver, distribute, reproduce or take any action in reliance on it and immediately delete the message and any attachments. -------------- next part -------------- An HTML attachment was scrubbed... URL: <http://lists.sepsisgroups.org/pipermail/sepsisgroups-sepsisgroups.org/attachments/20170202/6042d510/attachment.htm> -------------- next part -------------- A non-text attachment was scrubbed... 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