Timing

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Are standing orders needed to be able to answer "yes" to initiation of protocol?
If a standing order is the initiation of your protocol, then yes, the standing order would be needed.

What do you enter if the initial IV was started in the field for patients transported via ambulance?
The protocol would start at the time the patient arrived at the Emergency Room.

What does "at the time of the sepsis protocol" refer to?
The time frame "at the time of the sepsis protocol" refers to when the protocol is started.

If we have both the ED arrival time and the triage time, which should we use?
Both time elements should be reported in the dictionary for their respective data element fields.

If an ED patient was not admitted, should the data be included?
Yes, if the patient had severe sepsis or septic shock then the data is to be reported for this patient.

Specifically, what constitutes "initiation" of a protocol? First lactate, IV bolus?
Hospitals determine what constitutes the initiation of their protocol.

Do we report the 1st lactate or, the 1st lactate >=4?
The first lactate is to be reported.

If a lactate was reported in the ER several days prior to admission, do we report the ER lactate as the first lactate?
The lactate to be reported is the first lactate associated with your sepsis protocol.

Do we include antibiotics given prior to the identification of severe sepsis?

See the Data Dictionary for the data element Antibiotics Given. Use the values to specify if you gave antibiotics prior to or post initiation of the sepsis protocol.

What do you enter if the protocol was not started in the ED?
If the protocol was not started in the ED, then the data element Earliest Time and Triage Datetime will be blank. The data element Protocol Datetime will be completed by the hospital, as it is not limited to the ED.

What if normalization of BP, or other technologies, is used to evaluate response to fluid resuscitation? Is this considered clinical judgment? What is the timeframe for determining responsiveness?
Yes, this is a clinical judgment. The timeframe for determining responsiveness may be detailed in the hospital protocol.

If vascular access is obtained in the ambulance, is the time reported as 'arrival to ED', similar to the protocol initiation time?
The actual time of vascular access should be reported. The actual time of protocol initiation should be reported.

Why was the timeline for blood culture (data element 'Blood Cultures Obtained') set at 24 hours prior to protocol initiation and up to 48 hours post?

This was established to be consistent with current practice guidelines including CDC NHSN strategies for identifying when a positive blood culture is related to the specific infectious episode and Surviving Sepsis Campaign definitions.

Is the date/time of blood culture "obtained," the time blood cultures were drawn or the time when the result was obtained?
Report the date/time when the blood cultures were drawn. Blood cultures should be obtained prior to antibiotic administration and within 3 hours of protocol initiation. Blood cultures can be reported for the period up to 24 hours prior to initiation of the protocol to 48 hours after initiation of the protocol.

One co-morbidity variable states "Indicate if the patient was admitted to the Intensive Care Unit (ICU)." Is this at any time during hospital stay or only at the time of admission? 
Indicate if the patient was admitted at any time during the stay and specify the date and time in the 'ICU Admission Datetime' data element.

How do we report multiple sepsis events during a single admission?

The first event of severe sepsis or septic shock is to be reported.

Will DOH/IPRO be providing clarification in the dictionary surrounding the timelines? For example, Lactate Reported Date/time is the date the first lactate level was reported by the lab, meaning the very first lactate versus the lactate at the time of the severe sepsis/ septic shock event? Can this apply to all adherence measures?
Unless specified differently in the variable description (e.g., blood cultures) the reporting period relates to treatment events in the 3 and 6 hour bundle periods. All reported adherence measures are to be reported for the severe sepsis or septic shock episode.

For the timely crystalloid administration treatment variable, can you please clarify whether you are looking at patients who were administered 30 ml/kg of crystalloid within 3 hours or 6 hours of time of presentation? Typically 20-30 ml/kg is given during the 3 hour bundle for empiric fluid loading. Is DOH only measuring for the initial fluid resuscitation which usually occurs in the 3 hour bundle? If there are subsequent boluses given in the 6 hour bundle which exceeds the 30 ml/kg being measured, should the latest end time be entered instead? Please clarify.
Timely crystalloid administration is reported as adult patients who were hypotensive or had an elevated lactate, severe sepsis or septic shock who were administered at least 30 ml/kg of crystalloid within 6 hours of protocol initiation.

 

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