Specs Manual for 1/1/19-6/30/19 states crystalloid fluids within 6 hours prior through 3 hours after either initial hypotension date/time or septic shock presentation date/time, whichever occurs the earliest. According to the information you provided, initial hypotension was at 0420 (as noted by another user, needs to be 2 qualifying readings). The only the IV fluids given 6 hours prior through 3 hours after 0420 was the single 500 ml bag at 0430; the rest of the fluids administered fall outside that time frame. A diagnosis of septic shock at an earlier date/time would change the scenario. The thought process was incorporated into Surviving Sepsis Campaign. Patients with severe sepsis and septic shock may have ineffective arterial circulation due to vasodilation (resulting hypotension) which can cause an elevated lactate. Those patients need fluids to expand circulating volume and effectively restore perfusion pressure so the time frame to administer IV fluids evolves around the period of initial hypotension and/or elevated lactate > 4 rather than "time zero".
You mentioned instances where the provider doesn't feel hypotension was related to sepsis. The Specs Manual "Notes for Abstraction" for the data element "Initial Hypotension" states MD/APN/PA documentation prior to or within 24 hours after severe sepsis presentation time indicating hypotension is normal for the patient, due to a chronic condition or medication, or due to an acute condition that has a non-infectious source you should not use the hypotension. Our system has been encouraging enhanced provider documentation to more clearly identify and distinguish cases of true severe sepsis/septic shock from abnormal values that are related to other conditions. I hope you find this helpful. From: Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On Behalf Of Boyer, Suzette K. Sent: Tuesday, June 04, 2019 7:44 PM To: Duane, Molly; 'sepsisgroups@lists.sepsisgroups.org' Subject: [External] Re: [Sepsis Groups] Fluid resuscitation prior to time zero External Message: This message originated outside Baptist Health. Do not click links or open attachments unless you recognize the sender and know the content is safe. ________________________________ Good evening, We have had several misses for the same thing. No we don't give the whole fluid bolus for all hypotension. Suzette Suzette Boyer RN, BSN Sepsis Coordinator Office: 719-595-8475 suzette_bo...@parkviewmc.com From: Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On Behalf Of Duane, Molly Sent: Wednesday, May 29, 2019 5:26 PM To: 'sepsisgroups@lists.sepsisgroups.org' Subject: [Sepsis Groups] Fluid resuscitation prior to time zero Good Evening, Can someone please explain why we are held accountable to give 30 ml/kg for hypotension prior to time zero? Time zero: 0954 (0420: RR 22, 0435 Temp 35.0; 0420 SBP 87; 0954 H&P: possible sepsis). The patient received 500 ml boluses X4: at 0430, 0929, 1154 & 1210. Pt weighed 53 kg/required 1530 ml. The miss is: we did not give 30 ml/kg within 3 hours of initial hypotension (0420). Do you all give 30 ml/kg for all hypotension, even if the provider does not think sepsis is the cause for the hypotension? In this case we gave more than enough fluid within 3 hours of time zero, but obviously still missed. Any thoughts? Thanks, Molly Molly Duane RN, BSN, CCRN-K Sepsis Program Coordinator Detroit Receiving Hospital Harper-Hutzel Hospital Office: 313-745-4340 Cell: 248-709-6218 Email: mdu...@dmc.org<mailto:mdu...@dmc.org> This message (including any attachments) is confidential and intended solely for the use of the individual or entity to whom it is addressed, and is protected by law. If you are not the intended recipient, please delete the message (including any attachments) and notify the originator that you received the message in error. Any disclosure, copying, or distribution of this message, or the taking of any action based on it, is strictly prohibited. Any views expressed in this message are those of the individual sender, except where the sender specifies and with authority, states them to be the views of Tenet Healthcare Corporation. 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.
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