CMS does not currently allow for any "opt" out for not providing the correct amount of fluids. It doesn't matter how well the reason is documented by the physician. We have multiple IQR responses regarding this same issue. CMS does not accept any reason. The criteria is 30ml/kg regardless of other co-morbid conditions. If they die from sepsis due to under resuscitation with fluids, then we will not need to worry about their CHF or renal status. Dr. Townsend said it much better than myself in prior email responses.
Thank you, Kim Kim Izard | Team Leader - Clinical Outcomes SSMHealth - St. Louis/Mid-MO/Southern Illinois Regions 1015 Corporate Square Drive Suite 240 Creve Coeur, MO 63132 Office - 314-989-2137 Cell - 618-670-3616 [email protected] This e-mail message is confidential, intended only for the named recipient(s) above and may contain information that is privileged or exempt from disclosure under applicable law. If you are not the intended recipient(s), you are notified that the dissemination, distribution or copying of this message is strictly prohibited. If you received this message in error, or are not the named recipient(s) please notify the sender at the e-mail address or telephone number above and delete this e-mail from your computer. Thank you! -----Original Message----- From: Sepsisgroups [mailto:[email protected]] On Behalf Of Carlson, Brenda L Sent: Thursday, September 13, 2018 9:39 AM To: '[email protected]' <[email protected]> Subject: Re: [Sepsis Groups] Sepsisgroups Digest, Vol 304, Issue 2 CAUTION: This email originated from outside of the SSMHealth organization. Do not click links or open attachments unless you recognize the sender and know the content is safe. Questions? Contact the TSC at 314-644-7345 or your local Help Desk. Perhaps CMS would have accepted this as an appropriate exclusion if the provider had included wording such as "CHF with pulmonary edema and concerns for fluid overload" or "ESRD on HD with anasarca and concerns for fluid overload". The provider didn't clearly state why there was a concern for fluid overload. Brenda L. Carlson MS, BSN, RN Assistant Quality Officer Office of Clinical Practice Evaluation University of Rochester Medical Center 265 Crittenden Blvd., Saunders Research Building, 3.205 585-273-4721 This message may contain information which is confidential and privileged. Unless you are the addressee (or authorized to receive for the addressee), you may not use, copy or disclose to anyone the message or any information contained in the message (including attachments). If you have received the message in error, please advise sender by reply email, and delete the message. Thank you! -----Original Message----- From: Sepsisgroups [mailto:[email protected]] On Behalf Of [email protected] Sent: Wednesday, September 12, 2018 4:06 PM To: [email protected] Subject: Sepsisgroups Digest, Vol 304, Issue 2 Send Sepsisgroups mailing list submissions to [email protected] To subscribe or unsubscribe via the World Wide Web, visit https://na01.safelinks.protection.outlook.com/?url=https%3A%2F%2Furldefense.proofpoint.com%2Fv2%2Furl%3Fu%3Dhttp-3A__lists.sepsisgroups.org_listinfo.cgi_sepsisgroups-2Dsepsisgroups.org%26d%3DDwICAg%26c%3D4sF48jRmVAe_CH-k9mXYXEGfSnM3bY53YSKuLUQRxhA%26r%3DFQX0EdGt2z5AU0WET6IGnDY7hW-OH5oVWIrKTppItnPTAfNZCRPOOCAWFJtHw_aG%26m%3D7329wV9Z4IOW17kRPGK2wreBn9maXVs3QX8R3uLOo4U%26s%3DOBorSBqDM1y0bgHV4KBRf6F7G6GeevuZ1mdyo-Zudus%26e&data=01%7C01%7CKimberly.Izard%40ssmhealth.com%7Cd4c376f0e27b4f4a9d1a08d61cc401e8%7Cfbb1df866d494545bde79583d50eee17%7C0&sdata=f5eywHFu9dB1R%2FL41pygFNUexf5VghhJ3%2F8O48qJwiU%3D&reserved=0= 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. 30mL/Kg Bolus Exemptions (Culver, Danette) 2. Re: Blood cultures false positive (Vickie Robertson) ---------------------------------------------------------------------- Message: 1 Date: Wed, 12 Sep 2018 13:35:59 -0400 From: "Culver, Danette" <[email protected]> To: "[email protected]" <[email protected]> Subject: [Sepsis Groups] 30mL/Kg Bolus Exemptions Message-ID: <6fe413f8a5447e4498be19afc648a354015120393...@nhc0902.nhc.network.local> Content-Type: text/plain; charset="us-ascii" All, We recently queried CMS for accepting the following documentation as refusal to 30ml/kg bolus and they stated it did not meet the criteria. Can anyone provide a rationale as to why this documentation doesn't suffice? My providers prefer taking a more positive approach that is more inclusive of the patient, not the negative tone of 'patient refuses.' Any advice is greatly appreciated as well. The following was documented by one of my MDs - "Patient meets criteria for 30ml/kg bolus, there is concern for fluid overload and cardiogenic shock. The plan was discussed with patient and patient's daughter who agreed to modified plan of care to include gentle hydration and vasopressors, not a 30ml/kg bolus." Thanks so much, Danette Danette Culver, MSN, APRN, ACNS-BC, CCRN-K, RN-BC Clinical Nurse Specialist, Sepsis Coordinator Norton Healthcare, Louisville KY O: 502.629.4058 C: 812.881.0080 A Clinical Nurse Specialist (CNS) is a Master's prepared Advance Practice Nurse whose function is to improve outcomes in patient care. The CNS is a clinical practice expert, an educator, a researcher, and a consultant who influences the three spheres of practice: patient care, nursing, and systems. - National Association of Clinical Nurse Specialists ______________________________________________________________________ This message is confidential, intended only for the named recipient(s) and may contain information that is privileged or exempt from disclosure under applicable law. Any patient health information must be delivered immediately to intended recipient(s). If you are not the intended recipient(s), you are notified that the dissemination, distribution or copying of this message is strictly prohibited. If you receive this message in error, or are not the named recipient(s), please notify the sender at either the e-mail address or telephone number above and discard this e-mail. Thank you. -------------- next part -------------- An HTML attachment was scrubbed... URL: <https://na01.safelinks.protection.outlook.com/?url=https%3A%2F%2Furldefense.proofpoint.com%2Fv2%2Furl%3Fu%3Dhttp-3A__lists.sepsisgroups.org_pipermail_sepsisgroups-2Dsepsisgroups.org_attachments_20180912_56372114_attachment-2D0001.html%26d%3DDwICAg%26c%3D4sF48jRmVAe_CH-k9mXYXEGfSnM3bY53YSKuLUQRxhA%26r%3DFQX0EdGt2z5AU0WET6IGnDY7hW-OH5oVWIrKTppItnPTAfNZCRPOOCAWFJtHw_aG%26m%3D7329wV9Z4IOW17kRPGK2wreBn9maXVs3QX8R3uLOo4U%26s%3Dbf4IqbQsW54P6ilF94AgOlA-twTRLi0ClhzJ7pMG-IA%26e&data=01%7C01%7CKimberly.Izard%40ssmhealth.com%7Cd4c376f0e27b4f4a9d1a08d61cc401e8%7Cfbb1df866d494545bde79583d50eee17%7C0&sdata=3JkiFei%2BiC0e0N0eMfkMvLBEnhU4h%2Bms813rcOYLL2A%3D&reserved=0= > ------------------------------ Message: 2 Date: Mon, 10 Sep 2018 22:34:53 +0000 From: Vickie Robertson <[email protected]> To: jenny clarke <[email protected]> Cc: "[email protected]" <[email protected]> Subject: Re: [Sepsis Groups] Blood cultures false positive Message-ID: <[email protected]> Content-Type: text/plain; charset="iso-8859-1" We had the same issue at a hospital I previously worked for, especially in the ED where we were responsible for drawing our own labs. We found the following contributed to the contaminated specimen: 1. Cultures were being drawn from the IV site which caused them to often be contaminated. (Site cleansed with Chloraprep thoroughly before anything else was set up allowing for the proper drying time between cleansing and sticking) 2. Nurses would draw both sets from the same site (in serviced on 2 sets = 2 sites unless extremely hard stick then only 1 set was obtained) 3. When doing blood cultures, the bottles were often uncapped and left sitting at the bedside while finishing setting up to drawn them. This left them exposed in the room (corrected by when uncapped an alcohol prep was placed over the cap until ready to place the blood) Every month on the BULLETIN BOARD in our breakroom, were the names of all nurses along with their contamination percentage, if we had X amount of contaminates we had to do an in service with 15 of our Co-workers reviewing the proper way to draw a blood culture. Have a Blessed Day. Philippians 4:13 (NKJV)1 "?I can do all things through Christ who strengthens me." Thank you. Vickie Robertson, RN, Case Manager Unity Health | Harris Medical Center 1205 McLain St. | Newport, AR 72112 ?P (870) 512-3224 | F (870) 523-0395 https://na01.safelinks.protection.outlook.com/?url=https%3A%2F%2Furldefense.proofpoint.com%2Fv2%2Furl%3Fu%3Dhttp-3A__www.Unity-2DHealth.org%26d%3DDwICAg%26c%3D4sF48jRmVAe_CH-k9mXYXEGfSnM3bY53YSKuLUQRxhA%26r%3DFQX0EdGt2z5AU0WET6IGnDY7hW-OH5oVWIrKTppItnPTAfNZCRPOOCAWFJtHw_aG%26m%3D7329wV9Z4IOW17kRPGK2wreBn9maXVs3QX8R3uLOo4U%26s%3DB5wLuN-geZL2hNfSg3E-pDx0Lr_yOHfMCcCtpIC1eSc%26e&data=01%7C01%7CKimberly.Izard%40ssmhealth.com%7Cd4c376f0e27b4f4a9d1a08d61cc401e8%7Cfbb1df866d494545bde79583d50eee17%7C0&sdata=92EXY%2Bpt8Zcq%2BzNbwnTBQ6JKpucW0P%2B99kQ1ZnIj2jM%3D&reserved=0= ? ? Disclaimer:? This electronic message may contain information that is Proprietary, Confidential, or Legally privileged or protected.? It is intended only for the individual(s) and entity named in the message.? If you are not an intended recipient of this message, please notify the sender immediately and delete the material from your computer.? Do not deliver, distribute or copy this message and do not disclose its contents or take any action in reliance on the information it contains. ? -----Original Message----- From: Sepsisgroups [mailto:[email protected]] On Behalf Of jenny clarke Sent: Friday, September 7, 2018 1:10 PM To: Angela Craig <[email protected]> Cc: [email protected] Subject: Re: [Sepsis Groups] Blood cultures false positive That is a great idea. Thanks Sent from my iPhone > On Sep 7, 2018, at 1:02 PM, Angela Craig <[email protected]> wrote: > > We are working on this exact issue at our hospital. We are about to go to a > process where we will post all names and contamination rates and celebrate > those who do well and those who have a 3% or greater contamination rate will > have to go to a blood culture refresher class. Hope that helps. > > > > Angela Craig APN,MS,CCNS > ICU Clinical Nurse Specialist > 1 Medical Center Boulevard, Cookeville, TN 38501 > Phone: 931-783-5035 Fax: 931-783-5039 [email protected] | > crmchealth.org |Facebook | Twitter Cookeville Regional Medical Center: > Building Healthier Communities > > -----Original Message----- > From: Sepsisgroups > [mailto:[email protected]] On Behalf Of > Bankert, Eve > Sent: Wednesday, September 05, 2018 11:39 AM > To: jenny clarke; [email protected] > Subject: Re: [Sepsis Groups] Blood cultures false positive > > *** WARNING: This is an EXTERNAL EMAIL that originated outside of > CRMC's Email System. Do not click any links or open any attachments > unless you trust the sender and know the content is safe. *** > > > I would recommend extensive education/training for all personnel collecting > blood cultures. As the microbiology supervisor in a community hospital in NY > that had a 10% contamination rate, we used a multidisciplinary approach and > brought the rate down to 2% in a year's time. > > -----Original Message----- > From: Sepsisgroups > [mailto:[email protected]] On Behalf Of > jenny clarke > Sent: Tuesday, September 04, 2018 12:42 PM > To: [email protected] > Subject: [Sepsis Groups] Blood cultures false positive > > Anyone have any help to curb this issue? I have even tried to make it > sterile process and still running into issues. Thanks ahead > > Sent from my iPhone > _______________________________________________ > Sepsisgroups mailing list > [email protected] > https://na01.safelinks.protection.outlook.com/?url=https%3A%2F%2Furlde > fense.proofpoint.com%2Fv2%2Furl%3Fu%3Dhttp-3A__lists.sepsisgroups.org_ > listinfo.cgi_sepsisgroups-2Dsepsisgroups.o%26d%3DDwICAg%26c%3D4sF48jRm > VAe_CH-k9mXYXEGfSnM3bY53YSKuLUQRxhA%26r%3DFQX0EdGt2z5AU0WET6IGnDY7hW-O > H5oVWIrKTppItnPTAfNZCRPOOCAWFJtHw_aG%26m%3D7329wV9Z4IOW17kRPGK2wreBn9m > aXVs3QX8R3uLOo4U%26s%3D8bos_quxtQkMZ3DJRkqqWwrubHz5nfRzumfGjKTjtBw%26e > &data=01%7C01%7CKimberly.Izard%40ssmhealth.com%7Cd4c376f0e27b4f4a9 > d1a08d61cc401e8%7Cfbb1df866d494545bde79583d50eee17%7C0&sdata=bDjhq > hxXuYCayiZWlZ4xBkmegol3uFYzmEOEPbUpU8g%3D&reserved=0= > rg _______________________________________________ > Sepsisgroups mailing list > [email protected] > https://na01.safelinks.protection.outlook.com/?url=https%3A%2F%2Furlde > fense.proofpoint.com%2Fv2%2Furl%3Fu%3Dhttp-3A__lists.sepsisgroups.org_ > listinfo.cgi_sepsisgroups-2Dsepsisgroups.o%26d%3DDwICAg%26c%3D4sF48jRm > VAe_CH-k9mXYXEGfSnM3bY53YSKuLUQRxhA%26r%3DFQX0EdGt2z5AU0WET6IGnDY7hW-O > H5oVWIrKTppItnPTAfNZCRPOOCAWFJtHw_aG%26m%3D7329wV9Z4IOW17kRPGK2wreBn9m > aXVs3QX8R3uLOo4U%26s%3D8bos_quxtQkMZ3DJRkqqWwrubHz5nfRzumfGjKTjtBw%26e > &data=01%7C01%7CKimberly.Izard%40ssmhealth.com%7Cd4c376f0e27b4f4a9 > d1a08d61cc401e8%7Cfbb1df866d494545bde79583d50eee17%7C0&sdata=bDjhq > hxXuYCayiZWlZ4xBkmegol3uFYzmEOEPbUpU8g%3D&reserved=0= > rg > > This email message has been delivered safely and archived online by > Mimecast. 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