Rick, In the state of Texas, long as they are following an algorithm type standing order set a nurse can initiate standing orders. "Nurses may initiate physician's standing medical orders or standing delegation orders by selecting specific tasks or functions for patient management." I would presume there would be something similar in all state BON websites???
Diane Long PhD, RN, SCRN| ED Clinical Education Specialist THRU Texas Health Harris Methodist Hospital Fort Worth T 817.250.3039 | F 817.250.3344 [email protected] Follow us on Social Media -----Original Message----- From: Sepsisgroups [mailto:[email protected]] On Behalf Of [email protected] Sent: Thursday, January 11, 2018 9:30 AM To: [email protected] Subject: Sepsisgroups Digest, Vol 275, Issue 7 [EXTERNAL] Send Sepsisgroups mailing list submissions to [email protected] To subscribe or unsubscribe via the World Wide Web, visit https://urldefense.proofpoint.com/v2/url?u=http-3A__lists.sepsisgroups.org_listinfo.cgi_sepsisgroups-2Dsepsisgroups.org&d=DwICAg&c=tAAbe3VWSXg4_eMSItYKuRlnp5vCb2OrQZQHnRXk_fc&r=H8Csqcp6Vlk8BONZmXWjUg2pPIwnjtB8l2Zo6o_sPg4&m=wSBc59jY20xG5DUScNeca_rsUR7Z4LVc64p_BU6kqMk&s=GQZPuBRv4olsFNLZF-5hclMDqC36YX0YXfo6vVgSpmQ&e= 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 (Pamela Green) 2. Re: Procalcitonin and Lactate Questions (Pamela Green) 3. Re: Sepsisgroups Digest, Vol 275, Issue 3 (Pender.Linda) ---------------------------------------------------------------------- Message: 1 Date: Tue, 9 Jan 2018 14:57:54 +0000 From: Pamela Green <[email protected]> To: "Rutherford, Richard" <[email protected]>, "[email protected]" <[email protected]> Subject: Re: [Sepsis Groups] Automated Lactate Orders Message-ID: <cb8b1d4c6616c649be06e4604857ee86471...@hmhexchange.howardmemorial.com> Content-Type: text/plain; charset="us-ascii" We obtain an initial lactate on all patients who are suspected and screen for risk of severe sepsis. We felt that if initial blood draws are being done with placement of saline lock access we go ahead and draw blood cultures and lactate at that time since we will drawing for CBC and CMP most likely. Our practice is to not miss these tests and to try to save patient as many additional sticks as possible. We have been drawing blood cultures this way for quite a while. We just added the initial lactate as part of any and all sepsis workup with screening. I heard a lot about costly tests but doing a lactate in our facility is reasonably cheap according to the lab director. 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 -------------- next part -------------- An HTML attachment was scrubbed... URL: <https://urldefense.proofpoint.com/v2/url?u=http-3A__lists.sepsisgroups.org_pipermail_sepsisgroups-2Dsepsisgroups.org_attachments_20180109_e8bfd680_attachment-2D0001.html&d=DwICAg&c=tAAbe3VWSXg4_eMSItYKuRlnp5vCb2OrQZQHnRXk_fc&r=H8Csqcp6Vlk8BONZmXWjUg2pPIwnjtB8l2Zo6o_sPg4&m=wSBc59jY20xG5DUScNeca_rsUR7Z4LVc64p_BU6kqMk&s=IfbDXcZWW-Du_dKeny7AqEzW4nbqPYi36pFajbE9tV0&e=> ------------------------------ Message: 2 Date: Tue, 9 Jan 2018 22:39:17 +0000 From: Pamela Green <[email protected]> To: Pamela Green <[email protected]>, Robert Hattabaugh <[email protected]>, "'[email protected]'" <[email protected]> Subject: Re: [Sepsis Groups] Procalcitonin and Lactate Questions Message-ID: <cb8b1d4c6616c649be06e4604857ee86471...@hmhexchange.howardmemorial.com> Content-Type: text/plain; charset="us-ascii" Sorry I was referring to initial Lactate on the second statement From: Sepsisgroups [mailto:[email protected]] On Behalf Of Pamela Green Sent: Tuesday, January 09, 2018 8:43 AM To: Robert Hattabaugh <[email protected]>; '[email protected]' <[email protected]> Subject: Re: [Sepsis Groups] Procalcitonin and Lactate Questions We use it for ABX stewardship on all patients for Antibiotic effectiveness. We count as meeting the compliance if it was attempted within the 3 and 6 hour time frame, however our expectation is that we document a result if at all possible in presence of Sever or Septic Shock. From: Sepsisgroups [mailto:[email protected]] On Behalf Of Robert Hattabaugh Sent: Wednesday, January 03, 2018 12:03 PMmeasured To: '[email protected]' <[email protected]<mailto:[email protected]>> Subject: [Sepsis Groups] Procalcitonin and Lactate Questions 1. Procalcitonin: is anyone using this in their sepsis protocol, as a routine lab with Sepsis patients or how is it being used in your facility overall; ABX stewardship... 2. If the provider or nurse is unable to obtain blood for initial or repeat lab work, lactate, etc..., secondary to shock, etc... are you abstracting the cases as meeting the measure or falling out of the measure. CMS SEP-1 notes for Abstraction- "if a lactate level is ordered and there is an attempt to collect it, but the attempt results in failure to collect the specimen (too dehydrated to get a vein) or the specimen was contaminated during or after the draw." Thanks in advance for your response Robert Hattabaugh MSN, RN, ACNS-BC, CMSRN Adult Health Clinical Nurse Specialist -------------- next part -------------- An HTML attachment was scrubbed... URL: <https://urldefense.proofpoint.com/v2/url?u=http-3A__lists.sepsisgroups.org_pipermail_sepsisgroups-2Dsepsisgroups.org_attachments_20180109_d0696cbd_attachment-2D0001.html&d=DwICAg&c=tAAbe3VWSXg4_eMSItYKuRlnp5vCb2OrQZQHnRXk_fc&r=H8Csqcp6Vlk8BONZmXWjUg2pPIwnjtB8l2Zo6o_sPg4&m=wSBc59jY20xG5DUScNeca_rsUR7Z4LVc64p_BU6kqMk&s=OfzxGsEsi-lkd4UAT6mbOBCEwUFLFsZ761gjH1Szobc&e=> ------------------------------ Message: 3 Date: Tue, 9 Jan 2018 14:51:38 +0000 From: Pender.Linda <[email protected]> To: "[email protected]" <[email protected]> Cc: "[email protected]" <[email protected]> Subject: Re: [Sepsis Groups] Sepsisgroups Digest, Vol 275, Issue 3 Message-ID: <blupr11mb06759a3d78623e112703a797f6...@blupr11mb0675.namprd11.prod.outlook.com> Content-Type: text/plain; charset="iso-8859-1" Rick, We are in the process of a Nursing Workflow change in response to the exact scenario you are facing. The way we are proposing to handle the inpatient situation is to give nursing the ability to cancel the automatic order if there is no suspicion of new or worsening infection. This allows the nurse to stay within the nursing standards of practice. We are also hoping to decrease excessive Lactic Acids that are unnecessary. Wish us luck! Linda G. Pender RRT-NPS Sepsis Coordinator Patient Care Services Administration phone: 478-633-6806 pager: 4444 KNOW Sepsis: Inside & Out Confidential Quality Improvement: Not for Disclosure Email: [email protected] -----Original Message----- From: Sepsisgroups [mailto:[email protected]] On Behalf Of [email protected] Sent: Tuesday, January 09, 2018 9:43 AM To: [email protected] Subject: Sepsisgroups Digest, Vol 275, Issue 3 [ W A R N I N G ] This email originated outside of Navicent Health. Do not click on links or attachments unless you recognize the sender and know the content is safe. Sender: [email protected] ========================================================================================================= * ** Send Sepsisgroups mailing list submissions to [email protected] To subscribe or unsubscribe via the World Wide Web, visit https://urldefense.proofpoint.com/v2/url?u=http-3A__lists.sepsisgroups.org_listinfo.cgi_sepsisgroups-2Dsepsisgroups.org&d=DwICAg&c=tAAbe3VWSXg4_eMSItYKuRlnp5vCb2OrQZQHnRXk_fc&r=H8Csqcp6Vlk8BONZmXWjUg2pPIwnjtB8l2Zo6o_sPg4&m=wSBc59jY20xG5DUScNeca_rsUR7Z4LVc64p_BU6kqMk&s=GQZPuBRv4olsFNLZF-5hclMDqC36YX0YXfo6vVgSpmQ&e= 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. Automated Lactate Orders (Rutherford, Richard) 2. Re: Antibiotics/ normal saline shortage (Hodge - Garrett, Sara Mical) ---------------------------------------------------------------------- Message: 1 Date: Mon, 8 Jan 2018 22:53:36 +0000 From: "Rutherford, Richard" <[email protected]> To: "[email protected]" <[email protected]> Subject: [Sepsis Groups] Automated Lactate Orders Message-ID: <by2pr09mb0723511ec299b385b3c847249b...@by2pr09mb0723.namprd09.prod.outlook.com> Content-Type: text/plain; charset="iso-8859-1" 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... URL: <https://urldefense.proofpoint.com/v2/url?u=http-3A__lists.sepsisgroups.org_pipermail_sepsisgroups-2Dsepsisgroups.org_attachments_20180108_38db5cac_attachment-2D0001.html&d=DwICAg&c=tAAbe3VWSXg4_eMSItYKuRlnp5vCb2OrQZQHnRXk_fc&r=H8Csqcp6Vlk8BONZmXWjUg2pPIwnjtB8l2Zo6o_sPg4&m=wSBc59jY20xG5DUScNeca_rsUR7Z4LVc64p_BU6kqMk&s=_utO4r0IisR6aOGX-P9b73VPVBHiGP4CnCRU_OUq6lU&e=> ------------------------------ Message: 2 Date: Wed, 3 Jan 2018 17:41:33 +0000 From: "Hodge - Garrett, Sara Mical" <[email protected]> To: 'Angela Craig' <[email protected]>, 'Tara Miller' <[email protected]>, "[email protected]" <[email protected]> Subject: Re: [Sepsis Groups] Antibiotics/ normal saline shortage Message-ID: <[email protected]> Content-Type: text/plain; charset="utf-8" In Houston, many of the hospitals are being affected by the saline shortage. In order to be proactive, we are doing IVP medications as well. Sara M. Hodge-Garrett, MSN, RN, MSCRN, CPHQ Quality Manager Ben Taub Hospital Quality Programs HARRIS HEALTH SYSTEM 1504 Taub Loop | Houston, TX 77030 | phone 713.873.4452 [email protected]<mailto:[email protected]> CONFIDENTIALITY NOTICE: If you have received this e-mail in error, please immediately notify the sender by return e-mail and delete this e-mail and any attachments from your computer system. To the extent the information in this e-mail and any attachments contain protected health information as defined by the Health Insurance Portability and Accountability Act of 1996 ("HIPAA"), PL 104-191; 45 CFR Parts 160 and 164; or Chapter 181, Texas Health and Safety Code, it is confidential and/or privileged. This e-mail may also be confidential and/or privileged under Texas law. The e-mail is for the use of only the individual or entity named above. If you are not the intended recipient, or any authorized representative of the intended recipient, you are hereby notified that any review, dissemination or copying of this e-mail and its attachments is strictly prohibited. From: Sepsisgroups [mailto:[email protected]] On Behalf Of Angela Craig Sent: Tuesday, January 02, 2018 11:34 AM To: 'Tara Miller'; [email protected] Subject: Re: [Sepsis Groups] Antibiotics/ normal saline shortage We are starting to give IVP antibiotics for these instances. Yes we are feeling this in TN as well. 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 Tara Miller Sent: Tuesday, January 02, 2018 9:16 AM To: [email protected]<mailto:[email protected]> Subject: [Sepsis Groups] Antibiotics/ normal saline shortage Is anyone else having issues with no spike bags or normal saline bags available for mixing antibiotics? Our hospital and pharmacy are completely out of most saline bags. We are mixing all antibiotics manually. Have you heard of CMS allowing IM/IO antibiotics due to this shortage? Thanks. Tara R Miller, RN Team Leader, Quality Management Mobile Infirmary Medical Center Office: 435-5109 Cell: 605-8270 [IH_Logo_20170609] Confidentiality Notice: This electronic 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, you are hereby notified that any disclosure, copying, distribution, or action taken in reliance on the contents of this electronic message and/or any attachments is strictly prohibited. This quality assurance document is for the use of Infirmary Health and is prepared and maintained pursuant to Section 22-21-8 of the 1975 Code of Alabama. Prepared in an anticipation of litigation. 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. CONFIDENTIALITY NOTICE: If you have received this e-mail in error, please immediately notify the sender by return e-mail and delete this e-mail and any attachments from your computer system. To the extent the information in this e-mail and any attachments contain protected health information as defined by the Health Insurance Portability and Accountability Act of 1996 ("HIPAA"), PL 104-191; 45 CFR Parts 160 and 164; or Chapter 181, Texas Health and Safety Code, it is confidential and/or privileged. This e-mail may also be confidential and/or privileged under Texas law. 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