We are also struggling with acceptable documentation to include EMS fluids for septic shock. Our state also has protocols for IV fluids for shock. We also have a place on the triage form that is a hard stop for EMS fluids for any patient. A zero must be entered for "none given". There is no MD order for the EMS fluids and our providers are not going to give 30 ml/kg once a patient is admitted to our ED if EMS has already given 3 liters to a 100kg patient. We have long transport times and have been working with our EMS providers for early identification of septic shock and early intervention. I would like to know how others have met the "required MD order" to meet compliance with this portion of the metric. Would including "30ml/kg to include EMS fluids" on our order set meet this part of the metric?
Thank-you. Jeanie Bollinger MSN,RN, ACCNS-AG, CCRN-K Clinical Nurse Specialist Acute Medicine Mission Health 509 Biltmore Avenue Asheville, NC 28801 Office: 828-213-7171 Cell: 828-400-1194 -----Original Message----- From: Sepsisgroups [mailto:[email protected]] On Behalf Of [email protected] Sent: Tuesday, August 15, 2017 9:57 AM To: [email protected] Subject: [EXTERNAL] Sepsisgroups Digest, Vol 258, 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..." Today's Topics: 1. Re: Provider orders or protocols for IVF administered by EMS (Walls, Tammy ER Manager) ---------------------------------------------------------------------- Message: 1 Date: Mon, 14 Aug 2017 16:34:15 +0000 From: "Walls, Tammy ER Manager" <[email protected]> To: 'Mary Draper' <[email protected]>, "Carlson, Brenda L" <[email protected]>, "'[email protected]'" <[email protected]> Subject: Re: [Sepsis Groups] Provider orders or protocols for IVF administered by EMS Message-ID: <ab6658aa61e8e640a49afef178a561fc0170777...@smmc-ex10mb02.st-marys.org> Content-Type: text/plain; charset="utf-8" Is it required that your EMS agencies leave a run sheet in real time? Not dropped into the EMR 24-72 hours later. Our issue is that we have not had documentation from EMS to indicate how much fluid was administered. We are working with one of the EMS agencies and have developed a short form they will complete that documents fluids and any treatment initiated. So far the compliance has been slim to none and its only with one agency (we serve appx.15 EMS agencies). We have issues getting anything besides a oral report from EMS. Does your states require anything different as WV allows the 24-72 hour time frame; however, JC, Risk, and best practice dictates differently. In our physicians order set it states IVF 30mg/kg to include fluids administered by EMS. Thank you, Tammy Walls, RN, BSN Clinical Manager SMMC ER 304-526-1868 phone 304-526-1789 fax [email protected]<mailto:[email protected]> ________________________________ From: Sepsisgroups [mailto:[email protected]] On Behalf Of Mary Draper Sent: Friday, August 11, 2017 6:36 PM To: Carlson, Brenda L; '[email protected]' Subject: Re: [Sepsis Groups] Provider orders or protocols for IVF administered by EMS We are going to work with our ED staff to document in the intake the amount given by EMS so that it can be pulled electronically. We have the EMS record scanned into Epic to verify but it is just a paper report so no discrete fields. Mary Draper RN BSN Coordinator Quality Improvement Peer Review Support CV/CT JMH Quality Management Office (925) 674-2045 Cell (925) 451-8792 Fax (925) 674-2373 [email protected]<mailto:[email protected]> [cid:[email protected]] "O, let us always have a mountain within our soul, with a peak so high that we never quite reach the top... For then we will always strive for greater things and will not be content with merely climbing hills." Ardath Rodale From: Sepsisgroups [mailto:[email protected]] On Behalf Of Carlson, Brenda L Sent: Thursday, August 10, 2017 9:16 AM To: '[email protected]' <[email protected]> Subject: [Sepsis Groups] Provider orders or protocols for IVF administered by EMS Has anyone figured out a way to include IVF given by EMS? We are struggling with this since provider orders or protocols must be found in the hospital record and none of the local EMS companies provide this type of information. The NYSDOH approved protocols used by all EMS agencies in upstate NY are available here: https://www.mlrems.org/GetFile.aspx?fileID=10896<http://sophos2.st-marys.org:32224/?dmVyPTEuMDAxJiYwZjUwNTE4NzcyYzc0NGQ4Nz01OTkxQ0I4OV83NDA1NV82NjAwXzEmJjFkNWIzOTBkZWIwYmRkND0xMjIzJiZ1cmw9aHR0cHMlM0ElMkYlMkZ3d3clMkVtbHJlbXMlMkVvcmclMkZHZXRGaWxlJTJFYXNweCUzRmZpbGVJRCUzRDEwODk2> There are no patient specific orders, these are standing order for all patients with suspected septic shock. Has anyone found a way to comply with provider orders in the hospital record for IVF given by EMS? Thank you for your help. Brenda L. 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