Below is an email chain from Quality Net related to a question I sent in regarding the use of an antibiotic order time & date to identify suspected infection. The original question is at the bottom of the email with the clarifications I requested as you then scroll up. Not sure if anyone else was aware of this, but wanted to let everyone know what the final reply was and ask for any comments/thoughts on this. Thanks! Pam
Pamela Anderson, BSN, RN Clinical Data Abstractor Loyola University Health System Center for Clinical Excellence 2160 S. First Avenue | Bldg 105-3908 | Maywood, IL 60153 (O) 708-216-5228 | (F) 708-216-7867 | (E) [email protected]<mailto:[email protected]> Discussion Thread Response Via Email (Noel Albritton) 01/17/2017 01:37 PM If criteria B and C were met within 6 hours of the antibiotic order containing the infection, the time of the order would be used for criteria A. If criteria B and C were not met within 6 hours of the order containing the infection, but the antibiotic was documented as administered within 6 hours of criteria B and C, the time of the antibiotic administration would be used for criteria A. Customer By Email (Pamela Anderson) 01/17/2017 01:30 PM Just to be sure, then - would I use the time the cefepime was ORDERED or the ADMINISTRATION time to determine if all the criteria was met in the 6hr window? Thanks, Noel- Pam Subject Antibiotic order time & date Discussion Thread Response Via Email (Noel Albritton) 01/17/2017 09:49 AM "Infection" would need to be documented within 6 hours of criteria B and C to use for criteria A. With the documentation "cefepime ordered for infection," documentation on a MAR of the administration of cefepime within 6 hours of criteria B and C would suffice criteria A. Per the example in the data element: Levaquin is documented in MAR for pneumonia and nursing documentation indicates a dose was given within 6 hours of criteria b and c, pharmacy note that patient is on vancomycin for pneumonia). Customer By Email (Pamela Anderson) 01/16/2017 11:15 AM Thanks for the reply - and just to be sure, even though the word "infection" was documented outside the 6hr window, because it referenced the antibiotic that WAS ordered in the 6hr window, we CAN use it for the infection criteria with the SIRS x2 and organ dysfunction also present to support the presence of severe sepsis? Thank you! Pam Response Via Email (Noel Albritton) 01/16/2017 10:58 AM Thanks for the input. The documentation "cefepime started overnight for possible infection" could be used for criteria A with the inclusion of "infection." At this time, documentation of the rational for starting an antibiotic that includes signs or symptoms of an infection would not be acceptable. You certainly make a valid point, as the antibiotics administered for leukocytosis and tachycardia, etc. were likely for a suspected infection. However, the measure is seeking documentation of the suspected infection to suffice criteria A. This may be expanded in a future version of the manual as we are continuing discussions within the measure steward regarding these scenarios and the best way to address them in the manual. Customer By Email (Pamela Anderson) 01/13/2017 01:30 PM Thank you for the quick reply. I understand the issue if no clarification at all as to why an antibiotic was ordered, but often times there is specific reference as to why without actually documenting "infection" (or the acceptable terminology for "infection), an antibiotic was ordered. For example, the daily progress note 11/2 at 11:00am documents "patient febrile with leukocytosis and tachycardia; started cefepime overnight"; or "patient febrile with leukocytosis & tachycardia; cefepime started overnight for possible infection" (ordered 11/1 @ 20:00). I think that this is quite obvious that the antibiotic was not for prophylaxis but was started for coverage of a possible infection. With this kind of documentation, I would think that the antibiotic order date & time would be more accurate in identifying the time infection was suspected. Just putting it out there! Pam Response Via Email (Noel Albritton) 01/13/2017 01:09 PM Hi Pamela, Thanks for the question/input. Since antibiotics may be ordered for reasons other than treatment of a specific infection (such as prophylactic antibiotics), the infection is required to be documented. If an infection is documented in an antibiotic order, the time of the order could be used. Otherwise, the specified time of documentation in a note or the note opened time would be used for infections documented in a physician's note. The note opened time simply provides a consistent point to abstract. Hope this helps! Customer By Web Form (Pamela Anderson) 01/12/2017 01:20 PM Just wondering why can't the time and date an antibiotic was ordered (if no indication is present in the order) be used as time and date for possible/suspected infection? It appears to me that if a LIP is ordering an antibiotic, he/she is covering for a possible bacterial infection, even if the verbiage in the notes doesn't specifically say that. Also, for the sake of accurate identification of Severe sepsis time of presentation, wouldn't the order time be more specific than the note documentation that might be hours later? Just wanted to put it out there for thought- Thank you- Pam Pamela Anderson, BSN, RN Clinical Data Abstractor Loyola University Health System Center for Clinical Excellence 2160 S. First Avenue | Bldg 105-3915 | Maywood, IL 60153 (O) 708-216-5544 | (F) 708-216-7867 | (E) [email protected]<mailto:[email protected]> CONFIDENTIALITY NOTICE** This email communication and any attachments may contain confidential and privileged PHI for the use of the designated recipients named above. Distribution, reproduction or any other use of this transmission by any party other than the intended recipient is prohibited. If you have received this communication in error, please notify the sender immediately. Question Reference #170112-000090 Product Level 1: Measures & Data Element Abstraction Category Level 1: Hospital Inpatient - Sepsis Category Level 2: Severe Sepsis Presentation Date and Time Date Created: 01/12/2017 01:20 PM Last Updated: 01/17/2017 09:49 AM Status: Solved Discharge Period: 01/01/2017 - 12/31/2017 Pamela Anderson, BSN, RN Clinical Data Abstractor Loyola University Health System Center for Clinical Excellence 2160 S. First Avenue | Bldg 105-3908 | Maywood, IL 60153 (O) 708-216-5228 | (F) 708-216-7867 | (E) [email protected]<mailto:[email protected]> CONFIDENTIALITY NOTICE** This email communication and any attachments may contain confidential and privileged PHI for the use of the designated recipients named above. Distribution, reproduction or any other use of this transmission by any party other than the intended recipient is prohibited. If you have received this communication in error, please notify the sender immediately. Confidentiality Notice: This e-mail, including any attachments is the property of Trinity Health and is intended for the sole use of the intended recipient(s). It may contain information that is privileged and confidential. Any unauthorized review, use, disclosure, or distribution is prohibited. If you are not the intended recipient, please delete this message, and reply to the sender regarding the error in a separate email.
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