Hi Karen, This is the response I got from QNet when I asked them to clarify your first question:
Recently you requested personal assistance from our on-line support center. Below is a summary of your request and our response. If this issue is not resolved to your satisfaction, you may reopen it within the next 1095 days. Thank you for allowing us to be of service to you. To access your question from our support site, click here.<https://urldefense.proofpoint.com/v2/url?u=https-3A__cms-2Dip.custhelp.com_app_account_questions_detail_i-5Fid_303434&d=DQMFAw&c=MS-5dKql6qjhmD6zBX8NdQ&r=KQhQAyB28wX0ryHeUUrvHwtJt_LBhCc_ENWLFE_5OQM&m=qsg9tJUn4wrKyEAAKeVRQNk6Rhk9AqPaw2FrhqwWS0g&s=WP7rAYXwtvTPpZsUmTXyFi4dJ_wO7_UmFQfqLYnLtq4&e=> Subject Organ Dysfunctions Due to Chronic Conditions Discussion Thread Response Via Email (Noel Albritton) 08/24/2016 02:18 PM Hi Amy, Thanks for the question. Version 5.1 Additional Notes for Abstraction state: If there is physician/APN/PA documentation that SIRS criteria or a sign of organ dysfunction is normal for that patient, is due to a chronic condition, is due to an acute condition that is not an infection, or is due to a medication, it should not be used. Inferences should not be made; physician/APN/PA documentation is required. Examples in the data element such as "creatinine >2 for a patient with end stage renal disease, INR >1.5 for a patient on Warfarin, decrease in SBP associated with administration of a blood pressure medication" demonstrate examples of physician documentation that may disregard evidence of organ dysfunction. Hope this helps! Customer By Web Form (Amy Cobb) 08/23/2016 03:42 PM Could you please clarify which notes for abstraction we need to follow in regards to VS and or lab values due to chronic conditions? In the Spec manual for Version 5.1, it states "Do not include evidence of organ dysfunction that is considered to be due to a chronic condition or medication (e.g., Creatinine >2 for a patient with end stage renal disease, INR >1.5 for a patient on Warfarin, decrease in SBP associated with administration of a blood pressure medication)". In FAQ ID #162463 that was updated on 8/12/16, there is a response to the question about a patient with ESRD having an elevated creatinine and having it considered organ dysfunction for severe sepsis. It states that if "an abnormal result is considered due to a chronic condition or medication there needs to be documentation reflecting the abnormal value is related to the chronic condition or medication". Question Reference #160823-000158 Product Level 1: Measures & Data Element Abstraction Category Level 1: Hospital Inpatient - Sepsis Category Level 2: Severe Sepsis Present Date Created: 08/23/2016 03:42 PM Last Updated: 08/24/2016 02:18 PM Status: Solved Discharge Period: 07/1/2016 - 12/31/16 [---001:002036:08232---] Amy Cobb RN, BSN Clinical Data & Quality Coordinator Morton Plant Hospital MS #73 300 Pinellas St. Clearwater, FL 33756 727-298-6953 (Desk) 727-462-3638 (Fax) [email protected]<mailto:[email protected]> From: Sepsisgroups [mailto:[email protected]] On Behalf Of Belfi, Karen Sent: Wednesday, August 24, 2016 9:48 AM To: '[email protected]' Subject: [Sepsis Groups] Chronic condition I'm reviewing the additional notes for abstraction for v 5.1 and I have a couple questions. First, in the spec manual, it states "do not use evidence of organ dysfunction that is considered to be due to a chronic condition or medication (e.g., creat >2 for ESRD, INR > 1.5 for pt on warfarin, decrease in SBP associated with administration of a BP med). However, in the additional notes for abstraction, we are told to not use SIRS criteria or a sign of organ dysfunction if there is physician/APN/PA documentation that it's due to a chronic condition, normal for the pt, not due to an infection, or due to a medication. We are not to infer-documentation is needed. In the past we were allowed to not use the ESRD and INR criteria without physician/APN/PA documentation. Has that changed with these guidelines? Second, the additional notes states that we should not review antibiotic doses given >72 hours prior to severe sepsis presentation. So does that mean, for example, if a pt develops severe sepsis on 8/10 at 0800, and the pt received Rocephin 8/6@ 1000, 8/7 1000, 8/8 1000, 8/9 1000 and 8/10 at 1000, we would pick 8/7 1000 since that's the earliest antibiotic in the prior 72 hours? Thank you. Karen Belfi, RN, MSN Quality Outcomes Coordinator Lankenau Medical Center 484-476-8092 Pager: 5240 ---------------------------------------------------------------------- Confidential: This electronic message and all contents contain information from BayCare Health System which may be privileged, confidential or otherwise protected from disclosure. The information is intended to be for the addressee only. If you are not the addressee, any disclosure, copy, distribution or use of the contents of this message is prohibited. If you have received this electronic message in error, please notify the sender and destroy the original message and all copies.
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