CMS Sepsis bundle

[Hernandez]

Anyone else have multiple issues with the current updated guidelines and required documentation and some of the over reaching mandated labs and treatments?

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[jdh71]

Lol. Yup. We do it anyway. I just made a quick template in out EMR. I blow it in. Edit quickly and I'm done. The sticky bit is remembering to get the timing correct. I make my NP's set alarms on their phones for me.

 

[Hernandez]

It's as if they got drunk and randomly picked portions of EGDT and Process and added in life saving notes.

 

[jdh71]

It's as if they got drunk and randomly picked portions of EGDT and Process and added in life saving notes.

It's the documentation that has made the difference.

 

[engineeredout]

I know that the guidelines are intended to eliminate all conscious thinking, but how do you best document when you feel that there is a contraindication to 30cc/kg bolus? (Ex: Patient is 500lbs = 6.8L IVF)

 

[Hamhock]

How are you, as physicians, being penalized for non-compliance?

HH

 

[SurfingDoctor]

Anyone else have multiple issues with the current updated guidelines and required documentation and some of the over reaching mandated labs and treatments?

Fortunately, sepsis bundles haven't trickled down to (or over) pediatric care, but they are an utter joke.

"At 3 hours, give some antibiotics and fluids and do the right thing, at 6 hours, continue to do the right thing."

Though I appreciate the efforts of the Surviving Sepsis Campaign, there is clearly a limit with what can be done (or can't be) with it. Cramming the multiple different presentations and pathologies that contribute to sepsis into one treatment algorithm and then attaching the arbitrary values from that algorithm to billing is terrible shortsighted (and also not the original intent of the SSC).

 

[SurfingDoctor]

The sticky bit is remembering to get the timing correct. I make my NP's set alarms on their phones for me.

This is so sad. The "practice" of medicine is so pathetic sometimes.

 

[Hernandez]

How are you, as physicians, being penalized for non-compliance?

HH

Having to listen to "quality" office complain that the hospital is getting dinged, I figure it's only a matter of time before BS like plays into what it takes to get the quality bonus

 

[AdmiralChz]

I know that the guidelines are intended to eliminate all conscious thinking, but how do you best document when you feel that there is a contraindication to 30cc/kg bolus? (Ex: Patient is 500lbs = 6.8L IVF)

Usually you have to give a direct reason in the chart, e.g. "acute decompensated heart failure" or "acute on chronic renal failure" or the like.

Our hospital refuses to count plasmalyte as a typical crystalloid which applies for the 30 mL/kg bolus which is pretty heinous, have others run into this? They claim it's outside of the CMS bundle, but surely they aren't that stupid right?

 

[Hernandez]

Maintenance fluids of 126mL/hr for everyone!

 

[Doctor Bob]

how do you best document when you feel that there is a contraindication to 30cc/kg bolus? (Ex: Patient is 500lbs = 6.8L IVF)

"Patient has been evaluated for suitability for inclusion in the sepsis protocol. However the protocolized volume far exceeds patient's actual needs, and despite the hospital administrator's express insistence I will not murder this patient by drowning them."

 

[Hernandez]

SCCM, ACCP, ATS, and the surviving sepsis guideline need to get on this to lodge objections. This one size fits all approach is idiotic