QA Septic Shock

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

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 TMP, L_TmpV2 file.

First SBP<90

• 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 Blood Pressure Guideline guideline
• Comment: only in case of transfer from other ICU, enter transfered from previous ICU with DX of shock already coded; in that case don't code date/time

Special Cases

First low BP may be prior to ICU admission.

If a patient with existing septic shock is transferred from one ICU to another, for next ICU transferred into code Item: First BP <90 with no date/time and enter transfered from previous ICU with DX of shock already coded as the comment.

First NEW Antibiotic

The time of antibiotics is the date and time antibiotics are given for sepsis.

• Project: QASeptic
• Item: First Antibiotic
• Date and Time: Date/Time of first antibiotic given to treat sepsis
• Comment:
  • note reason if an antibiotic was not given
  • state if non-standard source of information was used

Special Cases

Use your judgment to determine the first antibiotic likely given to treat shock.

If a patient was on antibiotics prior to meeting the conditions for shock, then

• if the antibiotic is not changed after going into shock, use the dt/tm of the last antibiotic change or treatment start prior to onset of shock;
• if the antibiotic is changed after or shortly before going into shock then use your judgment to determine the following:
  • if the change/prescription was likely related to the imminent shock, code that change as the antibiotic start date; you can state your reason in the comments field
  • if the change/prescription was likely unrelated, code the first change after, or the most recent change before (again, use your judgment)

• Need clarification of the wording above so no misunderstanding. RE: "change/prescription", is this just the Doc order dt/tm or the actual dt/tm "administered"?--TOstryzniuk 15:08, 20 June 2011 (CDT)
  • I think it is clearly worded in the First New Antibiotic section of this section that it is when the antibiotic is actually given. Writing a prescription would obviously not mean anything as the medication could be delayed in being administered or may not have been given. I think the data collectors are all aware that putting the date and time of administration of the antibiotic is what is required. --LKolesar 12:39, 21 June 2011 (CDT)

If you are using non-standard data sources such as the in/out sheet, note so in the comment field.

If the patient does not receive Antibiotics (e.g. DC treatment) don't enter a date but provide a reason in the comment section of the "First Antibiotic" entry.

Study Run Times

Start date: October 8, 2009

Every qualifying patient sent after this date will need to have a temp entry, not only patients admitted after this date.

Review Date

Feb 2,2010

• Data is showing some good trends for ICU's in the Region. Dr. Kendiss Olafson from the ICU QI team will present at the data collection team meeting in April 2010.--TOstryzniuk 16:30, 2 February 2010 (CST)--TOstryzniuk 16:30, 2 February 2010 (CST)
  • see: Feb 2.2010 Review Meeting

May 4 ,2010 from 1100-1200 hrs

• meeting request sent out Feb 2.10 by TOstryzniuk 22:21, 2 February 2010 (CST)

End Date

• Preliminary End Date: Tentative stop on March 1.2011 for any new admissions. Trish sent an email to Dr. Kendiss Olfason & Dave Easton to provide update. Will confirm.--TOstryzniuk 20:39, 22 December 2010 (CST)

Consistency Checks

Tmp Checker will check for the following:

Date or Comment

Every entry for project QA Septic must have either a date or a time.

Dx but no tmp

L_TmpV2 entry is required if:

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

(implemented by s_tmp_QASeptic_Dx_no_tmp)

Tmp but no dx

A diagnosis must exist if:

• a "QASeptic" entry is present in L_TmpV2
• program must be "CC"
  • implemented by: S tmp QASeptic Dx no tmp

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.

Related articles

• Septic Shock