CMS Sepsis Core Measure 2015

Up until now we had all been using the same definitions for sepsis, severe sepsis and septic shock. CMS has tweaked these familiar definitions a bit (with a bit of controversy) and require we do and document several things.

Complain about this all you want, but you can’t fight City Hall. So here’s a macro to help remember what needs to be done and documented. Note that I passive-aggressively do not call these the “definition of severe sepsis” but the “CMS definition of severe sepsis.” Let me know in the comments how you’d improve this (more compact, easier, etc).

========== SEPSIS ==========

- Suspected source of infection: ***
- 2+ SIRS criteria
- HR > 90
- T >38 C or  20 breaths/min,
- WBC 12 or 10% bands

========== SEVERE SEPSIS ==========

- Sepsis
- sepsis-induced organ dysfunction (any of these):
- sBP<90
- MAP40 mm Hg or  2.0 or UO 2+ h
- BR > 2
- Plt 1.5 or aPTT >60s
- Lactate > 2

~~~~~ required within 3 hours ~~~~~
– Lactate
– Blood Cx → Broad Spec Abx

~~~~~ required within 6 Hours ~~~~~
– if (1st Lac > 2) → Repeat Lactate

========== SEPTIC SHOCK ==========

- CMS Severe Sepsis
- One of these two:
- Sepsis induced hypoperfusion despite adequate fluid (30 mL/kg)
- sBP<90 mm Hg or
- MAP40 mm Hg or  4

~~~~~ required within 3 hours ~~~~~
- 30 mL/kg bolus

~~~~~ required within 6 hours ~~~~~
- still hypotensive? → vasopressors
- repeat volume status exam:
- VS + CV/Pulm + CapRefill + Periph Pulses + Skin exam OR
- 2 of 4
- CVP
- CVO2
- Cardiovasc US
- Passive Leg raise or fluid challenge

References

  1. CMS in their core measures for sepsis
  2. 2003 paper serving as source for new definitions
  3. Surviving Sepsis 2012
  4. EGDT Trial
  5. ProCESS Trial
  6. Arise Trial
  7. ProMISE Trial
  8. EMCrit: We Are Complicit. Current State of Sepsis Quality Measures
  9. Passive leg raise test for fluid responsiveness
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