Re: [Hosp-Quality-Share] Digest for hospital-quality-share@googlegroups.com - 1 update in 1 topic

[Rae Corlis]

When looking at initial hypotension, lactate 4 , or actual MD Documentation  of septic shock, there is a 6h before to 6 h after one of these for crystalloids--so 6h would pass for initial hypotension. However for the septic shock question the fluids only have a 3h window. So if the crystalloid fluid time is more than 3 h after presentation of septic shock it falls out there.

The place to look at this is in the algorithm under the Measure Definitions for the 180 min, and also the extra notes for abstraction for sepsis for the 6h.  

Rae Corlis

On Jun 22, 2017, at 21:54, hospital-qu...@googlegroups.com wrote:

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[No Subject]

Michelle Zacarias <mantipo...@gmail.com>: Jun 22 09:35AM -0700 I have a question regarding Sepsis. I have cases where the Crystalloid Fluid Admin Time <=180 (which is good) but the Shock 6 Hours Counter 0 < 1 so the case falls out. In each of the cases, they get 30 mL/kg fluid, they have septic shock, they do NOT have persistent hypotension or new onset hypotension, they DO fall out because there is no documentation of capillary refill and the CVP, CVO2, bedside CVD US, and passive leg raise are all NO. I know each of the cases fall out because of the lack of documentation but why is Quantros giving the ‘Measure Category Reason’ of “Crystalloid Fluid Admin Time <=180,Shock 6 Hours Counter 0 < 1”? It’s not a clear explanation.       Anyone has similar problem with their vendor utilizing Quantros? I'm new to abstracting Sepsis?       Thank you.     Michelle

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[Rae Corlis]

In rereading your question I see your fluids are less than 180.  Sorry. I don't know then ! 

Rae Corlis

[Peggy Schultes]

With Septic Shock, even without hypotension, if the initial lactate was >= 4 mmol/L, you need the vital signs review, cardiopulmonary exam, etc

ONLY if hypotension persists after fluid administration or  initial lactate >= 4 mmol/L, received within six hours of presentation of septic shock:
• Repeat volume status and tissue perfusion assessment consisting of either
---A focused exam including:

•  Vital signs, AND
•  Cardiopulmonary exam, AND
•  Capillary refill evaluation, AND
•  Peripheral pulse evaluation, AND
•  Skin examination

OR
---Any two of the following four:

•  Central venous pressure measurement
•  Central venous oxygen measurement
•  Bedside Cardiovascular Ultrasound
•  Passive Leg Raise or Fluid Challenge

[Pineda, Erika]

As of 2017 discharges a stamen by physician of “Sepsis Focused Exam Performed” would suffice for the below stated. It would be up to your facility to decide to collect and document the below stated or the blanket statement above.

 

Thanks,

 

Erika

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