Title: Order of antibiotic administration can affect compliance with CMS sepsis measure <br/>Author: Wesley Oliver<br/><a href='mailto:1911'>[Click to email author]</a><hr/><div class="OutlineElement Ltr SCXW10181406" segoe="" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; overflow: visible; cursor: text; clear: both; position: relative; direction: ltr; color: rgb(0, 0, 0); font-family: " ui="">
<p class="Paragraph SCXW10181406" paraeid="{5d016861-9dac-430e-9e3a-8dbc65473fbb}{162}" paraid="545570575" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; word-wrap: break-word; vertical-align: baseline; background-color: transparent; color: windowtext;">
<span class="TextRun SCXW10181406" lang="EN-US" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; font-variant-ligatures: none !important; font-size: 12pt; font-family: Arial, Arial_MSFontService, sans-serif; line-height: 21px;" xml:lang="EN-US">The Centers for Medicare and Medicaid Services (CMS)</span><span class="TextRun SCXW10181406" lang="EN-US" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; font-variant-ligatures: none !important; font-size: 12pt; font-family: Arial, Arial_MSFontService, sans-serif; line-height: 21px;" xml:lang="EN-US"> require broad spectrum antibiotics to be administered within 3 hours of presentation of sepsis to be in compliance with the sepsis measure.</span><span class="EOP SCXW10181406" data-ccp-props="{}" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; font-size: 12pt; line-height: 21px; font-family: Arial, Arial_MSFontService, sans-serif;"> </span></p>
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<span class="EOP SCXW10181406" data-ccp-props="{}" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; font-size: 12pt; line-height: 21px; font-family: Arial, Arial_MSFontService, sans-serif;"> </span></p>
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<div class="OutlineElement Ltr SCXW10181406" segoe="" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; overflow: visible; cursor: text; clear: both; position: relative; direction: ltr; color: rgb(0, 0, 0); font-family: " ui="">
<p class="Paragraph SCXW10181406" paraeid="{5d016861-9dac-430e-9e3a-8dbc65473fbb}{170}" paraid="421104827" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; word-wrap: break-word; vertical-align: baseline; background-color: transparent; color: windowtext;">
<span class="TextRun SCXW10181406" lang="EN-US" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; font-variant-ligatures: none !important; font-size: 12pt; font-family: Arial, Arial_MSFontService, sans-serif; line-height: 21px;" xml:lang="EN-US">Not only do the antibiotics that are chosen determine compliance with this measure, but the order in which antibiotics are given can also significantly affect compliance.</span><span class="EOP SCXW10181406" data-ccp-props="{}" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; font-size: 12pt; line-height: 21px; font-family: Arial, Arial_MSFontService, sans-serif;"> </span></p>
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<span class="EOP SCXW10181406" data-ccp-props="{}" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; font-size: 12pt; line-height: 21px; font-family: Arial, Arial_MSFontService, sans-serif;"> </span></p>
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<div class="OutlineElement Ltr SCXW10181406" segoe="" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; overflow: visible; cursor: text; clear: both; position: relative; direction: ltr; color: rgb(0, 0, 0); font-family: " ui="">
<p class="Paragraph SCXW10181406" paraeid="{5d016861-9dac-430e-9e3a-8dbc65473fbb}{176}" paraid="1039032824" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; word-wrap: break-word; vertical-align: baseline; background-color: transparent; color: windowtext;">
<span class="TextRun SCXW10181406" lang="EN-US" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; font-variant-ligatures: none !important; font-size: 12pt; font-family: Arial, Arial_MSFontService, sans-serif; line-height: 21px;" xml:lang="EN-US">According to CMS, f</span><span class="TextRun SCXW10181406" lang="EN-US" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; font-variant-ligatures: none !important; font-size: 12pt; font-family: Arial, Arial_MSFontService, sans-serif; line-height: 21px;" xml:lang="EN-US">or combination antibiotic therapy, both </span><span class="TextRun SCXW10181406" lang="EN-US" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; font-variant-ligatures: none !important; font-size: 12pt; font-family: Arial, Arial_MSFontService, sans-serif; line-height: 21px;" xml:lang="EN-US">antibiotics </span><span class="TextRun SCXW10181406" lang="EN-US" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; font-variant-ligatures: none !important; font-size: 12pt; font-family: Arial, Arial_MSFontService, sans-serif; line-height: 21px;" xml:lang="EN-US">m</span><span class="TextRun SCXW10181406" lang="EN-US" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; font-variant-ligatures: none !important; font-size: 12pt; font-family: Arial, Arial_MSFontService, sans-serif; line-height: 21px;" xml:lang="EN-US">ust be started within the three hours following presentation; however, they do not need to be completely infused </span><span class="TextRun SCXW10181406" lang="EN-US" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; font-variant-ligatures: none !important; font-size: 12pt; font-family: Arial, Arial_MSFontService, sans-serif; line-height: 21px;" xml:lang="EN-US">within this time frame.</span><span class="EOP SCXW10181406" data-ccp-props="{}" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; font-size: 12pt; line-height: 21px; font-family: Arial, Arial_MSFontService, sans-serif;"> </span></p>
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<span class="EOP SCXW10181406" data-ccp-props="{}" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; font-size: 12pt; line-height: 21px; font-family: Arial, Arial_MSFontService, sans-serif;"> </span></p>
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<div class="OutlineElement Ltr SCXW10181406" segoe="" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; overflow: visible; cursor: text; clear: both; position: relative; direction: ltr; color: rgb(0, 0, 0); font-family: " ui="">
<p class="Paragraph SCXW10181406" paraeid="{5d016861-9dac-430e-9e3a-8dbc65473fbb}{192}" paraid="497428249" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; word-wrap: break-word; vertical-align: baseline; background-color: transparent; color: windowtext;">
<span class="TextRun SCXW10181406" lang="EN-US" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; font-variant-ligatures: none !important; font-size: 12pt; font-family: Arial, Arial_MSFontService, sans-serif; line-height: 21px;" xml:lang="EN-US">Combination therapy typically includes a monotherapy antibiotic (see list in detailed information below) plus vancomycin </span><span class="TextRun SCXW10181406" lang="EN-US" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; font-variant-ligatures: none !important; font-size: 12pt; font-family: Arial, Arial_MSFontService, sans-serif; line-height: 21px;" xml:lang="EN-US">(daptomycin</span><span class="TextRun SCXW10181406" lang="EN-US" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; font-variant-ligatures: none !important; font-size: 12pt; font-family: Arial, Arial_MSFontService, sans-serif; line-height: 21px;" xml:lang="EN-US"> or linezolid</span><span class="TextRun SCXW10181406" lang="EN-US" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; font-variant-ligatures: none !important; font-size: 12pt; font-family: Arial, Arial_MSFontService, sans-serif; line-height: 21px;" xml:lang="EN-US"> could also be used</span><span class="TextRun SCXW10181406" lang="EN-US" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; font-variant-ligatures: none !important; font-size: 12pt; font-family: Arial, Arial_MSFontService, sans-serif; line-height: 21px;" xml:lang="EN-US">).</span><span class="EOP SCXW10181406" data-ccp-props="{}" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; font-size: 12pt; line-height: 21px; font-family: Arial, Arial_MSFontService, sans-serif;"> </span></p>
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<span class="EOP SCXW10181406" data-ccp-props="{}" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; font-size: 12pt; line-height: 21px; font-family: Arial, Arial_MSFontService, sans-serif;"> </span></p>
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<p class="Paragraph SCXW10181406" paraeid="{5d016861-9dac-430e-9e3a-8dbc65473fbb}{206}" paraid="1794873566" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; word-wrap: break-word; vertical-align: baseline; background-color: transparent; color: windowtext;">
<span class="TextRun Underlined SCXW10181406" lang="EN-US" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; font-style: italic; text-decoration-line: underline; font-size: 12pt; font-family: Arial, Arial_MSFontService, sans-serif; line-height: 21px; font-variant-ligatures: none !important;" xml:lang="EN-US"><span class="NormalTextRun SCXW10181406" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; background-color: inherit;">So which antibiotic should be give</span></span><span class="TextRun Underlined SCXW10181406" lang="EN-US" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; font-style: italic; text-decoration-line: underline; font-size: 12pt; font-family: Arial, Arial_MSFontService, sans-serif; line-height: 21px; font-variant-ligatures: none !important;" xml:lang="EN-US"><span class="NormalTextRun SCXW10181406" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; background-color: inherit;">n</span></span><span class="TextRun Underlined SCXW10181406" lang="EN-US" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; font-style: italic; text-decoration-line: underline; font-size: 12pt; font-family: Arial, Arial_MSFontService, sans-serif; line-height: 21px; font-variant-ligatures: none !important;" xml:lang="EN-US"><span class="NormalTextRun SCXW10181406" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; background-color: inherit;"> first?</span></span><span class="EOP SCXW10181406" data-ccp-props="{}" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; font-size: 12pt; line-height: 21px; font-family: Arial, Arial_MSFontService, sans-serif;"> </span></p>
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<span class="EOP SCXW10181406" data-ccp-props="{}" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; font-size: 12pt; line-height: 21px; font-family: Arial, Arial_MSFontService, sans-serif;"> </span></p>
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<div class="OutlineElement Ltr SCXW10181406" segoe="" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; overflow: visible; cursor: text; clear: both; position: relative; direction: ltr; color: rgb(0, 0, 0); font-family: " ui="">
<p class="Paragraph SCXW10181406" paraeid="{5d016861-9dac-430e-9e3a-8dbc65473fbb}{218}" paraid="1145006405" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; word-wrap: break-word; vertical-align: baseline; background-color: transparent; color: windowtext;">
<span class="TextRun SCXW10181406" lang="EN-US" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; font-variant-ligatures: none !important; font-size: 12pt; font-family: Arial, Arial_MSFontService, sans-serif; line-height: 21px;" xml:lang="EN-US">If a monotherapy antibiotic is given first within the 3 hours</span><span class="TextRun SCXW10181406" lang="EN-US" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; font-variant-ligatures: none !important; font-size: 12pt; font-family: Arial, Arial_MSFontService, sans-serif; line-height: 21px;" xml:lang="EN-US"> of presentation</span><span class="TextRun SCXW10181406" lang="EN-US" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; font-variant-ligatures: none !important; font-size: 12pt; font-family: Arial, Arial_MSFontService, sans-serif; line-height: 21px;" xml:lang="EN-US">, then compliance for the </span><span class="TextRun SCXW10181406" lang="EN-US" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; font-variant-ligatures: none !important; font-size: 12pt; font-family: Arial, Arial_MSFontService, sans-serif; line-height: 21px;" xml:lang="EN-US">sepsis </span><span class="TextRun SCXW10181406" lang="EN-US" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; font-variant-ligatures: none !important; font-size: 12pt; font-family: Arial, Arial_MSFontService, sans-serif; line-height: 21px;" xml:lang="EN-US">measure is met. These antibiotics </span><span class="TextRun SCXW10181406" lang="EN-US" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; font-variant-ligatures: none !important; font-size: 12pt; font-family: Arial, Arial_MSFontService, sans-serif; line-height: 21px;" xml:lang="EN-US">cover a broader range of bacteria and </span><span class="TextRun SCXW10181406" lang="EN-US" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; font-variant-ligatures: none !important; font-size: 12pt; font-family: Arial, Arial_MSFontService, sans-serif; line-height: 21px;" xml:lang="EN-US">are typically infused over ~30 minutes, which allows plenty of time for your second antibiotic to be initiated.</span><span class="TextRun SCXW10181406" lang="EN-US" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; font-variant-ligatures: none !important; font-size: 12pt; font-family: Arial, Arial_MSFontService, sans-serif; line-height: 21px;" xml:lang="EN-US"> </span><span class="EOP SCXW10181406" data-ccp-props="{}" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; font-size: 12pt; line-height: 21px; font-family: Arial, Arial_MSFontService, sans-serif;"> </span></p>
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<p class="Paragraph SCXW10181406" paraeid="{5d016861-9dac-430e-9e3a-8dbc65473fbb}{238}" paraid="606791250" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; word-wrap: break-word; vertical-align: baseline; background-color: transparent; color: windowtext;">
<span class="TextRun SCXW10181406" lang="EN-US" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; font-variant-ligatures: none !important; font-size: 12pt; font-family: Arial, Arial_MSFontService, sans-serif; line-height: 21px;" xml:lang="EN-US">If vancomycin is given first</span><span class="TextRun SCXW10181406" lang="EN-US" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; font-variant-ligatures: none !important; font-size: 12pt; font-family: Arial, Arial_MSFontService, sans-serif; line-height: 21px;" xml:lang="EN-US">,</span><span class="TextRun SCXW10181406" lang="EN-US" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; font-variant-ligatures: none !important; font-size: 12pt; font-family: Arial, Arial_MSFontService, sans-serif; line-height: 21px;" xml:lang="EN-US"> compliance with this measure can become difficult. </span><span class="TextRun SCXW10181406" lang="EN-US" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; font-variant-ligatures: none !important; font-size: 12pt; font-family: Arial, Arial_MSFontService, sans-serif; line-height: 21px;" xml:lang="EN-US">First, v</span><span class="TextRun SCXW10181406" lang="EN-US" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; font-variant-ligatures: none !important; font-size: 12pt; font-family: Arial, Arial_MSFontService, sans-serif; line-height: 21px;" xml:lang="EN-US">ancomycin </span><span class="TextRun SCXW10181406" lang="EN-US" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; font-variant-ligatures: none !important; font-size: 12pt; font-family: Arial, Arial_MSFontService, sans-serif; line-height: 21px;" xml:lang="EN-US">has a narrower spectrum of activity and is not a monotherapy antibiotic. Second, vancomycin </span><span class="TextRun SCXW10181406" lang="EN-US" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; font-variant-ligatures: none !important; font-size: 12pt; font-family: Arial, Arial_MSFontService, sans-serif; line-height: 21px;" xml:lang="EN-US">infusion rates </span><span class="TextRun SCXW10181406" lang="EN-US" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; font-variant-ligatures: none !important; font-size: 12pt; font-family: Arial, Arial_MSFontService, sans-serif; line-height: 21px;" xml:lang="EN-US">range</span><span class="TextRun SCXW10181406" lang="EN-US" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; font-variant-ligatures: none !important; font-size: 12pt; font-family: Arial, Arial_MSFontService, sans-serif; line-height: 21px;" xml:lang="EN-US"> from 1 to 2 hours. Given that antibiotics are usually given after sepsis is flagged, this </span><span class="TextRun SCXW10181406" lang="EN-US" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; font-variant-ligatures: none !important; font-size: 12pt; font-family: Arial, Arial_MSFontService, sans-serif; line-height: 21px;" xml:lang="EN-US">infusion rate </span><span class="TextRun SCXW10181406" lang="EN-US" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; font-variant-ligatures: none !important; font-size: 12pt; font-family: Arial, Arial_MSFontService, sans-serif; line-height: 21px;" xml:lang="EN-US">only gives a short period of time for the second antibiotic to be </span><span class="TextRun SCXW10181406" lang="EN-US" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; font-variant-ligatures: none !important; font-size: 12pt; font-family: Arial, Arial_MSFontService, sans-serif; line-height: 21px;" xml:lang="EN-US">initiated</span><span class="TextRun SCXW10181406" lang="EN-US" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; font-variant-ligatures: none !important; font-size: 12pt; font-family: Arial, Arial_MSFontService, sans-serif; line-height: 21px;" xml:lang="EN-US">. Thus, vancomycin should almost always be the second antibiotic infused.</span><span class="EOP SCXW10181406" data-ccp-props="{}" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; font-size: 12pt; line-height: 21px; font-family: Arial, Arial_MSFontService, sans-serif;"> </span></p>
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<p class="Paragraph SCXW10181406" paraeid="{b6d4e3e1-386a-4948-bdef-d3e553cd3ba7}{11}" paraid="1923339244" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; word-wrap: break-word; vertical-align: baseline; background-color: transparent; color: windowtext;">
<span class="EOP SCXW10181406" data-ccp-props="{}" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; font-size: 12pt; line-height: 21px; font-family: Arial, Arial_MSFontService, sans-serif;"> </span></p>
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<p class="Paragraph SCXW10181406" paraeid="{b6d4e3e1-386a-4948-bdef-d3e553cd3ba7}{13}" paraid="1044449192" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; word-wrap: break-word; vertical-align: baseline; background-color: transparent; color: windowtext;">
<span class="TextRun SCXW10181406" lang="EN-US" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; font-variant-ligatures: none !important; font-size: 12pt; font-family: Arial, Arial_MSFontService, sans-serif; line-height: 21px;" xml:lang="EN-US">In addition, p</span><span class="TextRun SCXW10181406" lang="EN-US" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; font-variant-ligatures: none !important; font-size: 12pt; font-family: Arial, Arial_MSFontService, sans-serif; line-height: 21px;" xml:lang="EN-US">atients may also have limited intravenous access or antibiotics may not be compatible with resuscitation fluids. All of these factors together must be considered when trying to gain compliance with this measure.</span><span class="EOP SCXW10181406" data-ccp-props="{}" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; font-size: 12pt; line-height: 21px; font-family: Arial, Arial_MSFontService, sans-serif;"> </span></p>
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<span class="EOP SCXW10181406" data-ccp-props="{}" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; font-size: 12pt; line-height: 21px; font-family: Arial, Arial_MSFontService, sans-serif;"> </span></p>
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<p class="Paragraph SCXW10181406" paraeid="{b6d4e3e1-386a-4948-bdef-d3e553cd3ba7}{22}" paraid="2108143519" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; word-wrap: break-word; vertical-align: baseline; background-color: transparent; color: windowtext;">
<span class="TextRun Underlined SCXW10181406" lang="EN-US" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; font-weight: bold; text-decoration-line: underline; font-size: 12pt; font-family: Arial, Arial_MSFontService, sans-serif; line-height: 21px; font-variant-ligatures: none !important;" xml:lang="EN-US"><span class="NormalTextRun SCXW10181406" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; background-color: inherit;">Take-Home Point:</span></span><span class="EOP SCXW10181406" data-ccp-props="{}" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; font-size: 12pt; line-height: 21px; font-family: Arial, Arial_MSFontService, sans-serif;"> </span></p>
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<p class="Paragraph SCXW10181406" paraeid="{b6d4e3e1-386a-4948-bdef-d3e553cd3ba7}{28}" paraid="674691956" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; word-wrap: break-word; vertical-align: baseline; background-color: transparent; color: windowtext;">
<span class="TextRun SCXW10181406" lang="EN-US" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; font-variant-ligatures: none !important; font-size: 12pt; font-family: Arial, Arial_MSFontService, sans-serif; line-height: 21px;" xml:lang="EN-US">Administer monotherapy antibiotics </span><span class="TextRun SCXW10181406" lang="EN-US" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; font-variant-ligatures: none !important; font-size: 12pt; font-family: Arial, Arial_MSFontService, sans-serif; line-height: 21px;" xml:lang="EN-US">(e.g. piperacillin/</span><span class="TextRun SCXW10181406" lang="EN-US" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; font-variant-ligatures: none !important; font-size: 12pt; font-family: Arial, Arial_MSFontService, sans-serif; line-height: 21px;" xml:lang="EN-US">tazobactam</span><span class="TextRun SCXW10181406" lang="EN-US" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; font-variant-ligatures: none !important; font-size: 12pt; font-family: Arial, Arial_MSFontService, sans-serif; line-height: 21px;" xml:lang="EN-US"> and </span><span class="TextRun SCXW10181406" lang="EN-US" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; font-variant-ligatures: none !important; font-size: 12pt; font-family: Arial, Arial_MSFontService, sans-serif; line-height: 21px;" xml:lang="EN-US">cefepime</span><span class="TextRun SCXW10181406" lang="EN-US" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; font-variant-ligatures: none !important; font-size: 12pt; font-family: Arial, Arial_MSFontService, sans-serif; line-height: 21px;" xml:lang="EN-US">) </span><span class="TextRun SCXW10181406" lang="EN-US" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; font-variant-ligatures: none !important; font-size: 12pt; font-family: Arial, Arial_MSFontService, sans-serif; line-height: 21px;" xml:lang="EN-US">prior to administering vancomycin in your septic patients to improve compliance with the sepsis measure.</span><span class="EOP SCXW10181406" data-ccp-props="{}" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; font-size: 12pt; line-height: 21px; font-family: Arial, Arial_MSFontService, sans-serif;"> </span></p>
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<fieldset><legend>References</legend>
<p>
<span class="TextRun SCXW153075881" lang="EN-US" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; color: rgb(0, 0, 0); font-size: 12pt; font-family: Arial, Arial_MSFontService, sans-serif; line-height: 21px; font-variant-ligatures: none !important;" xml:lang="EN-US"><span class="NormalTextRun SCXW153075881" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; background-color: inherit;">Specifications Manual for National Hospital Inpatient Quality Measures v5.4. The Joint Commission. </span></span><a class="Hyperlink SCXW153075881" href="https://www.jointcommission.org/specifications_manual_for_national_hospital_inpatient_quality_measures.aspx" rel="noreferrer" segoe="" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; font-family: " target="_blank" text-decoration-line:="" ui=""><span class="TextRun Underlined SCXW153075881" lang="EN-US" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; color: rgb(5, 99, 193); text-decoration-line: underline; font-size: 12pt; font-family: Arial, Arial_MSFontService, sans-serif; line-height: 21px; font-variant-ligatures: none !important;" xml:lang="EN-US"><span class="NormalTextRun SCXW153075881" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; background-color: inherit;">https://www.jointcommission.org/specifications_manual_for_national_hospital_inpatient_quality_measures.aspx</span></span></a><span class="TextRun SCXW153075881" lang="EN-US" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; color: rgb(0, 0, 0); font-size: 12pt; font-family: Arial, Arial_MSFontService, sans-serif; line-height: 21px; font-variant-ligatures: none !important;" xml:lang="EN-US"><span class="NormalTextRun SCXW153075881" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; background-color: inherit;">. Updated December 29, 2017. Accessed August 31, 2018.</span></span><span class="EOP SCXW153075881" data-ccp-props="{}" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; color: rgb(0, 0, 0); font-size: 12pt; line-height: 21px; font-family: Arial, Arial_MSFontService, sans-serif;"> </span></p>
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