Septic Shock Without a continuous quality initiative (CQI), even these compliance rates will not improve and will decrease over time (Ferrer, 2008). As soon as the causative organism is identified, based on subsequent culture and susceptibility testing, de-escalation is encouraged by selecting the most appropriate antimicrobial therapy to cover the identified pathogen, safely and cost effectively (Dellinger, 2012). o Bedside cardiovascular ultrasound This is increasingly important as the health care system moves towards value-based reimbursement models. Returns all measures which contain both aspirin AND cardiac. Severe sepsis clinical criteria are met when A, B and C are documented within six … According to CMS, “The purpose of the Severe Sepsis and Septic Shock Early Management Bundle measure is to facilitate the efficient, effective, and timely delivery of high quality sepsis care in support of the Institute of Medicine’s aims for quality improvement. Conditions that are common to health disparities. • If hypotension (systolic blood pressure (SBP) < 90 mmHg or mean arterial pressure (MAP) <65mmHg) persists after fluid administration, the following treatments must be initiated: Severe sepsis is defined as sepsis plus one or more variable of organ … For 2014, CMS is not requiring the submission of a core set of CQMs. This study was submitted for institutional review … Received within three hours of presentation of severe sepsis: • Initial lactate level measurement • Broad spectrum or other antibiotics administered • Blood cultures drawn prior to antibiotics AND received within six hours of presentation of severe sepsis: • Repeat lactate level measurement … The SEP-1 core measure treatment bundle is based on recommendations from the 2012 Surviving Sepsis Guidelines. o Passive leg raise or fluid challenge, Hospital documentation policies for sepsis have real world financial impacts https://www.the-hospitalist.org/.../cms-sepsis-measure-challenge-report Consistent with Surviving Sepsis Campaign guidelines, the measure contains several elements, including measurement of lactate, obtaining blood cultures, administering broad spectrum antibiotics, fluid resuscitation, vasopressor administration, reassessment of volume status and tissue perfusion, and repeat lactate measurement. Time Zero for CMS Core Measure SEP-1 • Severe sepsis – time zero is identified in one of two ways: 1. CMS selected the recommended core set of CQMs for EPs based on analysis of several factors: Conditions that contribute to the morbidity and mortality of the most Medicare and Medicaid beneficiaries. or "-" to indicate that the term must appear or must not appear respectively; you can ** The Adult Core Set includes the NCQA version of the measure, which is adapted from the CMS measure (NQF #1879). Broad spectrum or other antibiotics must be administered AND received within six hours of presentation of severe sepsis Centers for Medicare & Medicaid Services (CMS), Make Care Safer by Reducing Harm Caused in the Delivery of Care, Hospital Inpatient SEPSIS BUNDLE PROJECT (SEP) NATIONAL HOSPITAL INPATIENT QUALITY MEASURES SEP Measure Set Table Set Measure ID # Measure Short Name SEP-1 Early Management Bundle, Severe Sepsis/Septic Shock Specifications Manual for National Hospital Inpatient Quality Measures Discharges 01-01-18 (1Q18) through 06-30-18 (2Q18) SEP-1 There is a great demand today for accurate, useful information on health care quality that can inform the decisions of consumers, employers, physicians and other clinicians, and policymakers. • Broad spectrum or other antibiotics must be administered Patients with a Directive for Comfort Care or Palliative Care within 6 hours of presentation of septic shock Severe Sepsis Once a sepsis patient is identified, the goal is to get antibiotics started as quickly as possible. 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