QA Septic Shock

• See Septic Shock Guideline article

Purpose

Kendiss Olafson & the QA team are monitoring performance and appropriate interventions for Septic Shock in the ICUs.

Data Collection Method

For the first episode of Septic Shock (admit or complication) of any ICU patient, the following two entries must be made in the L_TmpV2 file:

• Project: QASeptic
• Item: First SBP<90
  • Date and Time that the blood pressure (BP) criteria is met for the FIRST TIME as per Septic Shock guideline. Go HERE to see BP criteria.
  • (may be prior to ICU admission)

• Project: QASeptic
• Item: First Antibiotic
  • Date and Time that the first NEW antibiotic is used to treat septic shock
• (may be prior to ICU admission)
  • If the patient does not receive Antibiotics (e.g. DC treatment) in the COMMENT section in TMP: type in a reason why antibiotic not given.

Times

• Start date: likely Thu 2009 Oct 8 (after that week's send)
  • Every qualifying patient sent after this date will need to have a temp entry, not only patients admitted after this date.
• Review Date: (~75 days after start) - meeting booked with Kendiss and Trish for 2009 Dec 22
• Preliminary End Date: (6 months after start) - 2010 Apr 8 (set in ccmdb.mdb consistency checks)

Consistency Checks

Tmp Checker will check for the following:

Dx but no tmp

L_Tmp entry is required if:

• a DX of Septic shock exists
• program is "CC"

(implemented by s_tmp_QASeptic_Dx_no_tmp) Template:Discussion

Tmp but no dx

A diagnosis must exist if:

• a "QASeptic" entry is present in L_Tmp
• program must be "CC"

(implemented by s_tmp_QASeptic_tmp_no_dx)

Send mode

Data for all patients meeting requirements for this study, including patients you are not sending this batch, will be sent every time complete patients are sent.

Discussion:

• I just entered my first pt into this study, and ran into a bit of a snag. The pt had been transfered to us from another ICU. I was able to find the first low BP, but had to take the first AB from the in and out record. I don't have any copies of MAR or any of the ER charting....so I took the first antibiotic given after the low BP. Had it not been recorded on the I&O record, I wouldn't have had anything else to get info from. So, my question is...is this good enough? Does it actually provide the info that you are looking for? BDeVlaming 12:10, 7 October 2009 (CDT)

Discussion

• • Another issue: There are instances where the patient may already be on antibiotics for an infection and then later develops septic shock anyway. Sometimes a new antibiotic is started and in this case the new antibiotic is the one to use in our tmp file. Occasionally, though, a new antibiotic may not be started. We need to know what to do in these cases. Putting a start date of an antibiotic that is likely not the right one would not help. I have one patient like this right now. The patient was on two antibiotics for pneumonia, copd exac. Developed septic shock 2 days later. No new antibiotics started yet. I will keep watching to see if new antibiotics are started as this patient likely has a bug that is not covered by the antibiotics he is on. --LKolesar 15:20, 7 October 2009 (CDT)

• • • Here is another scenario for you: A patient develops septic shock in a community hospital and is coded by the data collector, then a few days later the patient is transferred to a tertiary ICU for continued care. The data collector in the second hospital needs to code septic shock because it is still ongoing. Should she use the same times of low BP and antibiotic start as the first presentation of septic shock at the first hospital? We cannot always derive this information from the bits of chart that the sending hospital copies for us. The only way to be sure of getting the same times would be to email the first data collector and obtain the times from her. Is this the correct process to follow?? --LKolesar 11:08, 16 October 2009 (CDT)