What are the recommendations for reevaluating sepsis under the Merit-based Incentive Payment System (MIPS)?

MIPS Sepsis Reevaluation Recommendations

For patients with suspected sepsis, the National Early Warning Score 2 (NEWS2) should be recalculated at specific intervals based on risk stratification: every 30 minutes for high-risk patients, hourly for moderate-risk patients, every 4-6 hours for low-risk patients, and according to local protocol for very low-risk patients. 1

Risk Stratification Using NEWS2

NEWS2 is the recommended tool for evaluating sepsis risk and determining reevaluation frequency:

• High risk (NEWS2 score ≥7): Reevaluate every 30 minutes 1
• Moderate risk (NEWS2 score 5-6): Reevaluate every hour 1
• Low risk (NEWS2 score 1-4): Reevaluate every 4-6 hours 1
• Very low risk (NEWS2 score 0): Follow local protocol 1

Key Components of Sepsis Reevaluation

Clinical Assessment

• Reassess for signs of deterioration or improvement since previous evaluation 1
• Consider risk as higher than suggested by NEWS2 if condition is deteriorating or has not improved since previous assessment 1
• Evaluate for specific signs indicating high risk regardless of NEWS2 score:
  • Mottled or ashen appearance 1
  • Non-blanching petechial or purpuric rash 1
  • Cyanosis of skin, lips, or tongue 1

Antimicrobial Management

• Reassess effectiveness of antimicrobial regimen regularly 1
• Review antimicrobial choice when source of infection is confirmed or microbiological results become available 1
• Consider narrowing antibiotic spectrum based on culture results within one hour of calculating NEWS2 score 1
• Evaluate for treatment failure if worsening or ongoing organ dysfunction and persistence of infectious signs for more than 48-72 hours 1

Special Considerations

Antibiotic Administration Timing Based on Risk

• High-risk patients: Administer antibiotics within 1 hour 1
• Moderate-risk patients: Administer antibiotics within 3 hours 1
• Low-risk patients: Administer antibiotics within 6 hours 1

Performance Improvement

• Implement sepsis performance improvement programs focused on earlier recognition through formal screening 1
• Monitor compliance with sepsis bundles as this has been associated with decreased mortality 1
• Utilize sepsis screening tools as they are associated with earlier treatment and decreased mortality 1

Common Pitfalls in Sepsis Reevaluation

• Failure to interpret NEWS2 in context: Always consider the patient's underlying physiology and comorbidities when interpreting scores 1
• Missing single parameter significance: A score of 3 in any single parameter may indicate increased risk from sepsis even if total score is low 1
• Overlooking deterioration: Consider risk as higher than suggested by NEWS2 if condition is deteriorating despite interventions 1
• Inadequate source control: Regular assessment is essential to promptly recognize inadequate source control 1
• Delayed antibiotic adjustment: Failure to narrow antibiotic spectrum when culture results become available 1

Documentation Requirements for MIPS

• Document time of sepsis recognition 1
• Record all NEWS2 scores with timestamps 1
• Document reassessments at appropriate intervals based on risk stratification 1
• Record antibiotic administration times and any adjustments to therapy 1
• Document response to interventions 1

By following these evidence-based recommendations for sepsis reevaluation, clinicians can optimize patient outcomes while meeting MIPS requirements for sepsis management.