Hello, If they use our sepsis order set, we have automatic lactate reorder too (3hrs after the first) if the first lactate was higher than 2. However, the providers orders the order set. I would ask though how this is different from the multitude of other standing orders (ECG if the pt co of CP, ABG if resp distress?). It seems like a repeat lactate would also be reasonable?
Carrie Hayes MHA RN| Sepsis Coordinator Center for Clinical Excellence University of Washington Medical Center Mailbox 356033 Voice:206.598.3818 CONFIDENTIAL! The above email may contain patient identifiable or confidential information protected under Washington State RCW 4.24.250 and 70.41.200(3). Because email is not secure, please be aware of associated risks of email transmission. If you are a patient, communicating with a UW Medicine Provider via email implies your agreement to email communication; see http://www.uwmedicine.org/Global/Compliance/EmailRisk.htm The information is intended for the individual named above. If you are not the intended recipient, any disclosure, copying, distribution or use of the contents of this information is prohibited. Please notify the sender by reply email, and then destroy all copies of the message and any attachments. See our Notice of Privacy Practices at www.uwmedicine.org -----Original Message----- From: Sepsisgroups [mailto:[email protected]] On Behalf Of [email protected] Sent: Thursday, January 11, 2018 7:26 AM To: [email protected] Subject: Sepsisgroups Digest, Vol 275, Issue 5 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: Automated Lactate Orders (Angela Craig) 2. Re: [**External**] Automated Lactate Orders (Barnes-Daly, Mary Ann, MS, RN, CCRN, DC) ---------------------------------------------------------------------- Message: 1 Date: Tue, 9 Jan 2018 11:28:16 -0600 From: Angela Craig <[email protected]> To: "'Rutherford, Richard'" <[email protected]>, "[email protected]" <[email protected]> Subject: Re: [Sepsis Groups] Automated Lactate Orders Message-ID: <343E31412FC9094487B54371286ADDA06D5D6558B8@D109EXCHMB.crmchealth.hospital> Content-Type: text/plain; charset="utf-8" At my hospital we have the repeat lactate as part of our sepsis protocol. It is spelled out in our policy that nurses are to redraw an elevated lactate. It is an automatic reflex order with our lab as well. We have not had an issue. Angela Craig APN,MS,CCNS Clinical Nurse Specialist Intensive Care Unit Cookeville Regional Medical Center 931-783-5035 From: Sepsisgroups [mailto:[email protected]] On Behalf Of Rutherford, Richard Sent: Monday, January 08, 2018 4:54 PM To: [email protected] Subject: [Sepsis Groups] Automated Lactate Orders Hello All, We are having a debate in our organization about whether automatic lactate orders violate nursing standard of practice. Currently if a patient in ED or on floor screens in for sepsis, the nurse follows hospital protocol and orders a lactate which is then routed to the attending physician for cosignature (after drawn). We also have an automated order to repeat lactate at 4 hours for admitted patients with an initial lactate>2. I believe our initial lactate order in ER is covered by Standardized Nursing Procedures. We are having more debate around the initial lactate ordered on inpatients and the automated second lactate on all patients with lactate>2 without a prior physician order. I am interested in knowing if other hospitals use our approach, and if so is nursing leadership feeling comfortable that nursing standards of practice are not being violated. Thanks, Rick Rutherford This email message has been delivered safely and archived online by Mimecast. For more information please visit http://www.mimecast.com -------------- next part -------------- An HTML attachment was scrubbed... URL: <http://lists.sepsisgroups.org/pipermail/sepsisgroups-sepsisgroups.org/attachments/20180109/4a1c1e8d/attachment-0001.html> ------------------------------ Message: 2 Date: Tue, 9 Jan 2018 20:02:53 +0000 From: "Barnes-Daly, Mary Ann, MS, RN, CCRN, DC" <[email protected]> To: "Rutherford, Richard" <[email protected]>, "[email protected]" <[email protected]> Subject: Re: [Sepsis Groups] [**External**] Automated Lactate Orders Message-ID: <dm5pr11mb13728a4bfeae0a6acf6fc5c7f3...@dm5pr11mb1372.namprd11.prod.outlook.com> Content-Type: text/plain; charset="us-ascii" We at Sutter Health use this approach. We have 2 Nursing Standardized Procedures: one for ED and one for RRT (IP) to cover initial lactate draw Reflex orders (redraw for elevation) are fine if they are approved by MEC and lab. Thanks, MARY ANN BARNES-DALY MS RN CCRN DC | Clinical Performance Improvement Consultant Quality & Clinical Effectiveness Team | Office of Patient Experience Sutter Health -2200 River Plaza Drive, Sacramento, CA 95833 Mobile 916.200.5604| [email protected]<mailto:[email protected]> All changes, even the most longed for, have their melancholy; for what we leave behind us is a part of ourselves. Anatole France [https://newsplus.sutterhealth.org/peninsula-coastal/files/2017/04/SH_Pride_Plus400-002-177x177.gif] From: Sepsisgroups [mailto:[email protected]] On Behalf Of Rutherford, Richard Sent: Monday, January 08, 2018 2:54 PM To: [email protected] Subject: [**External**] [Sepsis Groups] Automated Lactate Orders WARNING: This email originated outside of the Sutter Health email system! DO NOT CLICK links if the sender is unknown and never provide your User ID or Password. Hello All, We are having a debate in our organization about whether automatic lactate orders violate nursing standard of practice. Currently if a patient in ED or on floor screens in for sepsis, the nurse follows hospital protocol and orders a lactate which is then routed to the attending physician for cosignature (after drawn). We also have an automated order to repeat lactate at 4 hours for admitted patients with an initial lactate>2. I believe our initial lactate order in ER is covered by Standardized Nursing Procedures. We are having more debate around the initial lactate ordered on inpatients and the automated second lactate on all patients with lactate>2 without a prior physician order. I am interested in knowing if other hospitals use our approach, and if so is nursing leadership feeling comfortable that nursing standards of practice are not being violated. Thanks, Rick Rutherford -------------- next part -------------- An HTML attachment was scrubbed... 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