Among the confusing rules for sepsis abstractions, is the one regarding which lactate is the initial lactate collected when multiple lactates are drawn. Additionally, clarification has been received from Qnet regarding differences in wording between the related data elements.
- For abstraction, arterial and venous lactate levels may be used. Point of care lactate can be used.
- For purposes of the measure the initial lactate is not necessarily always going to be the first lactate drawn. The Initial Lactate Level Collection data element indicates that if there are multiple lactate levels, only abstract the level drawn closest to the time of presentation of Severe Sepsis. This lactate level is considered the initial lactate for purposes of the measure. Use this lactate to abstract the lactate level collection date and time:
- Example 1:
- Patient arrives and a lactate level is collected on 05/03/16 at 1323.
- Another lactate is collected on 05/03/16 at 1605.
- Clinical indicators or physician documentation indicate a severe sepsis presentation date/time of 05/03/16 at 1610.
- Which is the initial lactate level?
- The lactate level drawn closest to the presentation time of severe sepsis. In this example 05/03/16 at 1605.
- Example 2:
- Lactate level is collected on 06/07/16 at 0854
- Clinical indicators or physician documentation indicate a severe sepsis presentation date/time of 06/07/16 at 0915.
- Another lactate level is collected on 06/07/16 at 1001.
- Which is the initial lactate level?
- The one collected at 06/07/16 at 0854
- Example 3:
- Lactate collected 4/1/16 at 0815
- Lactate collected 4/1/16 at 0915
- Severe Sepsis presentation time 4/1/16 at 0900
- Which is the initial lactate level?
- The one collected at 04/01/16 at 0915
- A repeat lactate level is defined as the next lactate level drawn after the initial lactate level. It is not dependent on or part of the three hour bundle (completed within three hours of Severe Sepsis presentation). The repeat lactate level must be drawn in the time period of six hours after the date and time of Severe Sepsis presentation (drawn within six hours of Severe Sepsis presentation).
*Content is based on Specifications Manual Version 5.0b – October 2015 through June 2016 discharges.
**The article is part of the Registry Partners Quality Division Sepsis Newsletter. Follow the blog to read more articles from the Newsletter or contact us to receive a copy of the full newsletter to share with your team!