Persistent Hypotension is determined by hypotension that persists in the hour after the conclusion of the 30 ml/kg Crystalloid Fluid Administration:
- The end time of the fluid administration must be determined. This may be clearly documented in the chart or may need to be calculated by the abstractor.
- Review the systolic blood pressure readings and mean arterial pressure readings (MAP) beginning at the end time of the fluid administration and ending one hour later. Example: fluid end time was 1015; reading(s) must be from 1015 through 1115.
- Two consecutive SBP readings <90, equals septic shock and persistent hypotension OR
- Two consecutive MAP readings <65, equals septic shock and persistent hypotension
- Do not use crystalloid fluids administered ONLY prior to severe sepsis presentation time.
- Do not use crystalloid fluid administration at a rate lower than 30 ml/kg.
- This would abstract as Allowable Value 4 – Not Applicable for the persistent hypotension data element.
- Fluids administered at less than 30 ml/kg cannot be used to determine the presence of septic shock. If there is no other documentation of septic shock, then Septic Shock Present would be abstracted as “no”.
- If only one BP is noted in the hour following completion of the 30 ml/kg of crystalloid fluids and it is normal, the patient does not have persistent hypotension – Allowable Value 2 – No
- If only one BP is noted in the hour following completion of the 30 ml/kg of crystalloid fluids and is <90 or <65 for Mean Arterial Pressure, persistent hypotension cannot be determined – that data element would abstract as Allowable Value 3 – (No or UTD)
*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!