Yes but the guidelines don't tell us to see if the elevated bili is due to liver failure. The presence of an elevated bili is enough to say yes for organ dysfunction for the purposes of the measure.
Karen Belfi, RN, MSN Quality Outcomes Coordinator Lankenau Medical Center On Jul 6, 2016, at 12:42 PM, Dena Videtic <[email protected]<mailto:[email protected]>> wrote: Yes but in this case the total bilirubin does not necessarily indicate liver failure. Total bilirubin can be elevated due to gallstones and biliary obstruction. I would continue to look for documentation of organ dysfunction or Severe Sepsis. Dena Dena Videtic RN BSN Quality Indicators Doctors Hospital 786-308-3315 From: Belfi, Karen [mailto:[email protected]] Sent: Wednesday, July 06, 2016 10:28 AM To: Dena Videtic <[email protected]<mailto:[email protected]>>; Murray, Sandra <[email protected]<mailto:[email protected]>>; '[email protected]<mailto:[email protected]>' <[email protected]<mailto:[email protected]>> Subject: RE: Sepsis Question on organ dysfunction Following the guidelines, we don’t need physician documentation that the patient has severe sepsis. We need the 3 criteria of infection, 2 SIRS, and organ dysfunction. While the criteria we need to use for the measure isn’t without its faults, it’s what we have to work with currently. IN Q&As, we’ve been told to use the organ dysfunction unless there’s physician/APN/PA documentation that the lab is related to a different condition. Here are a couple examples: Question 215: How will we tell if labs are related to chronic organ dysfunction? Are we to assume? Answer 215: If there is documentation indicating the abnormal lab is due to or may be due to a chronic condition or medication that is acceptable. The measure also provides two examples that are acceptable, creatinine >2 for a patient with end stage renal disease, and an INR > 1.5 for a patient on Warfarin. Question 315: On slide 34 it says not to include evidence of organ dysfunction that is considered chronic. Is the documentation of ESRD in the patient's history enough or does the physician need to specifically link the two in his/her documentation? Answer 315: An association does not need to be documented for Creatinine >2 for a patient with end stage renal disease, and INR >1.5 for a patient on Warfarin, because those are included in the Severe Sepsis Present. For other conditions and medications, there should be documentation indicating the association. Karen Belfi, RN, MSN Quality Outcomes Coordinator Lankenau Medical Center 484-476-8092 Pager: 5240 <image001.png> From: Sepsisgroups [mailto:[email protected]] On Behalf Of Dena Videtic Sent: Tuesday, July 05, 2016 8:13 AM To: Murray, Sandra; '[email protected]<mailto:[email protected]>' Subject: [EXTERNAL] Re: [Sepsis Groups] Sepsis Question on organ dysfunction Sandra, This is a good question. From an abstraction point of view, I would look for physician documentation that the patient has Severe Sepsis because as nurses, it is not in our scope of practice to diagnose patients. The bilirubin could be elevated due to a biliary obstruction. An interesting article was published in April about the subjectivity of sepsis diagnosis even among physicians. If you’re interested it is called: ‘Diagnosing Sepsis is Subjective and Highly Variable: A Survey of Intensivists Using Case Vignettes” http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4822273/ Dena Videtic RN BSN Quality Indicators Doctors Hospital Coral Gables, FL 786-308-3315 From: Sepsisgroups [mailto:[email protected]] On Behalf Of Murray, Sandra Sent: Thursday, June 30, 2016 2:26 PM To: [email protected]<mailto:[email protected]> Subject: [Sepsis Groups] Sepsis Question on organ dysfunction Would you count a t.bili of 9.3 as organ dysfunction if patient comes in with abdominal pain, meets the SIRS criteria and the CT shows pt to have acute cholecystitis? 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