Core Measures SEPSIS UPDATES

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1 Patricia Walker, RN-BC, BSN Evidence Based Practice Manager Quality Management Services UCLA Health System, Ronald Reagan Medical Center Core Measures SEPSIS UPDATES Sepsis Core Measures Bundle Requirements 2 Severe Sepsis and Septic Shock Based on our understanding of the New Core Measures Severe Sepsis and Septic Shock Criteria & The current UCLA process for Severe Sepsis and Septic Shock we created a Process Map and Disease Continuum Note: UCLA Requirements may differ slightly from CMS requirements due to current processes and practices already in place. 3 1

2 UCLA s Adult Sepsis Screening Tool Complete Adult Screens for ALL pts 18y/o 4 SEPSIS: Defining a Disease Continuum Initiate *Severe Sepsis and **Septic Shock Bundle (TOP) SIRS ANY 2 of the following Temp >38.3C (101F) or <36C (96.9F) HR > 90 /minute RR > 20/minute WBC > 12,000 or <4,000 or >10%bands SEPSIS 2 SIRS (+) suspected or confirmed infection (i.e UTI, PNA, wound etc.) Severe Sepsis* Sepsis (+) NEW or ACUTE onset organ dysfunction &/or failure OR provider documentation of severe sepsis Septic Shock** Severe Sepsis (+) hypotension (SBP 90 or 40mm/Hg) OR lactate 36mg/dL OR provider documentation of septic shock *Initiate Severe Sepsis/Septic Shock: Early Management Bundle as soon as patient meets criteria for Severe Sepsis &/or Septic Shock 5 Core Measures Early Bundle Elements (*) Severe Sepsis Implement bundle within 3 hours of TOP Draw lactate Draw and Document Blood Cultures x 2 sets (4 bottles) before abx Administer Broad Spectrum IV Abx (*) Severe Sepsis Follow-up If initial lactate > 18, must repeat lactate within 3 hours after initial lactate (**) Septic Shock Implement bundle within hour of TOP Initiate all elements required for Severe Sepsis plus: Administer IVF bolus of 0.9% NS or LR 30ml/kg ( infusion must be complete within 3 hours of TOP) If hypotension persists within 1 hour of completion of IVF bolus, administer vasopressors and perform volume and tissue perfusion assessment. If initial lactate 36, repeat lactate within 3 hours after initial lactate AND perform a volume and tissue perfusion assessment. For additional details, see Process Map of Severe Sepsis & Septic Shock: Early Management Bundle 6 2

3 Sepsis Nursing Panel 7 Adult Sepsis Order Set Sepsis Core Measures are Coming October 1 st

4 In addition to our current practice CMS Requires the following documentation Re-measure lactate if initial lactate elevated > 2 mmol/l OR >18 mg/dl Administer vasopressors (for hypotension that does not respond to initial fluid resuscitation) to maintain a mean arterial pressure (MAP) 65mmHg In the event of persistent hypotension after initial fluid administration (MAP < 65 mm Hg) or if initial lactate is 4 mmol/l or 36 mg/dl, a complete volume status and tissue perfusion assessment must be documented by a Physician/APN/PA 10 Physician/APN/PA Documentation of Volume Status and Tissue Perfusion by Completing A Repeat focused exam (after initial fluid resuscitation) by a Physician/APN/PA including vital signs, cardiopulmonary, capillary refill, pulse and skin findings Or Two of the following: Measure CVP Measure ScvO2 Bedside cardiovascular ultrasound Dynamic assessment of fluid responsiveness with passive leg raise or fluid challenge 11 Time Zero = The Earliest Time Noted Can equal triage time if all signs and symptoms are present at triage At the time chart documentation notes signs and symptoms are present (2 SIRS, Physician/APN/PA Documentation of a real or possible infection, and NEW or ACUTE onset of organ dysfunction and/or failure) When a Physician/APN/PA documents the patient has Severe Sepsis or Septic Shock *Documentation of the above can be found in nursing documentation, labs, flow sheets, Physician/APN/PA documentation, or anything with a time stamp 12 4

5 Questions or Comments Quality Management Services Ronald Reagan Santa Monica

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