Sepsis Quality Initiative Update: NEW! Lactic Acid Reflex Order
Situation: In order to improve Columbia St. Mary’s (CSM) compliance in obtaining
repeat lactate level measurements for severe sepsis/septic shock patients with an initial
lactate level > 2.0 mmol/L, a new Lactic Acid Reflex order has been developed and
activated in Cerner.
Background: Data collection for the new severe sepsis/septic shock inpatient quality
measure went into effect October 2015. Based upon CSM’s quality outcomes for the last
three months, there have been numerous instances in which providers have failed to
consistently order repeat lactate levels, which is one of the severe sepsis interventions
required by the Centers for Medicare and Medicaid Services (CMS). It has also been
noted that ED Sepsis PowerPlans and Sepsis Admission PowerPlans, which contain
repeat lactic acid orders, are infrequently utilized which has contributed to the low
compliance rate.
Assessment: It became necessary to develop a new Lactic Acid Reflex order that would
not be dependent upon the utilization of PowerPlans and could be selected by inpatient
providers from Ad Hoc Orders.
Recommendation: Select the new Lactic Acid Reflex order whenever placing a
lactic acid order. The Lactic Acid order that providers have used in the past remains an
orderable and cannot be hidden from viewing because of the way that the new Lactic
Acid Reflex order has been designed; however, please do not select the Lactic Acid order
and instead always select the Lactic Acid Reflex order. If you place a Lactic Acid Reflex
order via Ad Hoc orders and later initiate a Sepsis PowerPlan with the Lactic Acid
Reflex order, please remember to uncheck the Lactic Acid Reflex order within the
Sepsis PowerPlan in order to avoid unnecessary order duplication.
Specific details regarding the Lactic Acid Reflex order are as follows:
1. It is a system-generated order for a repeat lab draw for an initial lactate > 2.0
mmol/L.
2. If the Lactic Acid Reflex result is > 2.0 mmol/L, one new order for a Lactic Acid
(not reflex) will be collected in 4 hours.
3. No additional parameters are evaluated on the result of the second order.
4. Lactic Acid orders that were included in providers’ PowerPlan Favorites have
been automatically updated with the new Lactic Acid Reflex order.
5. PowerPlans that contain a Lactic Acid Order have been updated to now include
the Lactic Acid Reflex Order in place of the Lactic Acid Order.
Thank you for supporting this new quality measure at CSM.
The Sepsis Performance Improvement Team