That's what I meant. It used to be Quest. Thank you Sandra! Karen Belfi, RN, MSN Quality Outcomes Coordinator Lankenau Medical Center
> On Jul 7, 2016, at 5:07 PM, Murray, Sandra <[email protected]> > wrote: > > This is the answer from QNet. I don't know what Quest is > > Subject > Organ dysfunction > > Discussion Thread > Response Via Email (Char Teed) 07/07/2016 11:06 AM > Sandra, > > Considering the guidelines: If an abnormal lab value (e.g. elevated > creatinine) is considered due to a chronic condition or medication, the > relation should be supported within the medical record. If a relation > between the abnormal lab value and a chronic condition or medication is not > identified within the medical record, the abnormal lab value can be > considered evidence of organ dysfunction in relation to severe sepsis. > > This type of documentation will most likely be physician/APN/PA but is not > limited to physician/APN/PA documentation. There is no limitation on where > the documentation is located, but it must be in the current medical record. > > Sandra Murray, RN, BSN | Heart Failure & Sepsis Program Coordinator > Performance Improvement-Patient Safety and Risk > T 817.848.4963 | M 682.367.3032 > [email protected] > > > > Follow us on Social Media > > This document was generated by, or was prepared by or at the direction or > request of a medical committee, medical peer review committee, nursing peer > review committee, and/or patient safety committee, including a joint > committee, of Texas Health Resources and its member hospitals as defined > under Texas Health & Safety Code Sec. 161.031, et seq., Texas Occ. Code Secs. > 151.001, et seq., 160.001, et seq. and 303.001, et seq., and is used for > committee purposes, specifically, quality assurance and assessment and the > evaluation of patient safety and medical and healthcare services at the > Hospital. This document and the information contained within it are > considered confidential, privileged and not subject to court subpoena > pursuant to the above-cited statutes and 42 U.S.C. Sec. 11101, et seq. > > > > -----Original Message----- > From: Belfi, Karen [mailto:[email protected]] > Sent: Thursday, July 07, 2016 4:04 PM > To: Dena Videtic > Cc: Greg Stanford; Murray, Sandra; [email protected] > Subject: Re: [EXTERNAL] RE: [EXTERNAL] Re: [Sepsis Groups] Sepsis Question on > organ dysfunction > > I wasn't referring to the cholecystitis as infection. According to the > guidelines, an elevated bilirubin is a sign of organ dysfunction. They don't > tell you to read further. > > Send it in to Quest to confirm. > > > > Karen Belfi, RN, MSN > > Quality Outcomes Coordinator > > Lankenau Medical Center > > > > > > On Jul 7, 2016, at 2:12 PM, Dena Videtic > <[email protected]<mailto:[email protected]>> wrote: > > > > Karen, > > I disagree and would continue to look for documentation that it is in fact > organ dysfunction related to sepsis. Cholecystitis is not necessarily an > infection and an elevated bilirubin is not necessarily organ dysfunction. > > > > Dena > > Dena Videtic RN BSN > > Quality Indicators > > Doctors Hospital > > 786-308-3315 > > > > From: Belfi, Karen [mailto:[email protected]] > > Sent: Thursday, July 07, 2016 9:26 AM > > To: Greg Stanford <[email protected]<mailto:[email protected]>>; Dena > Videtic <[email protected]<mailto:[email protected]>> > > Cc: Murray, Sandra > <[email protected]<mailto:[email protected]>>; > [email protected]<mailto:[email protected]> > > Subject: RE: [EXTERNAL] Re: [Sepsis Groups] Sepsis Question on organ > dysfunction > > > > If we are reviewing concurrently that would be helpful. > > However, if we are retroactively abstracting a chart, we can only go by > documentation in the chart. > > The specification manual is clear that if there is no documentation the organ > dysfunction isn’t documented as related to a different condition, we are to > use it as organ dysfunction criterion. > > It may not always make sense clinically, but we need to follow the guidelines. > > > > 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 Greg Stanford > > Sent: Wednesday, July 06, 2016 9:40 PM > > To: Dena Videtic > > Cc: Murray, Sandra; > [email protected]<mailto:[email protected]> > > Subject: [EXTERNAL] Re: [Sepsis Groups] Sepsis Question on organ dysfunction > > > > I agree with Dena. Cholecystitis doesn’t generally give you a bili that > high, and I would think of obstruction and cholangitis. Without that, sepsis > would be next on my list. but I would query the doctor to better understand > his/her clinical impression. > > > > Greg Stanford, MD > > Medical Director > > Clinical Documentation Improvement and Outcomes > > > > 1840 Amherst Street | Winchester, Va 22601 > > Phone: (540) 596 4999 Cell: 540 664 5736 | > |[email protected]<mailto:[email protected]> > > > > > > > > CONFIDENTIALITY NOTICE: This e-mail is confidential, may be legally > privileged, and for the intended recipient only. Access, disclosure, copying, > forwarding and distribution by any means is strictly prohibited. If received > in error, do not read but delete and e-mail confirmation to the sender. > > > > > > > > On Jul 5, 2016, at 8:12 AM, Dena Videtic > <[email protected]<mailto:[email protected]>> wrote: > > > > 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” > https://urldefense.proofpoint.com/v2/url?u=http-3A__www.ncbi.nlm.nih.gov_pmc_articles_PMC4822273_&d=DQIGaQ&c=tAAbe3VWSXg4_eMSItYKuRlnp5vCb2OrQZQHnRXk_fc&r=YmGf8IzG_BSHAsWPCc-bClR3kFWXmHZEEr52gBMw9tY&m=xhtY51Df4dNMMj35sZsBFoA_lQ_ml9QnXzobBE-HI40&s=HDFQjIK1m-hv7Nc3kvCUTz6OZC79iupbntn7kovTWiU&e= > > > > > > 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? > > > > > > Sandra Murray, RN, BSN | Heart Failure & Sepsis Program Coordinator > > Performance Improvement-Patient Safety and Risk > > T 817.848.4963 | M 682.367.3032 > > [email protected]<mailto:[email protected]> > > > > <image001.png> > > > > Follow us on Social Media > > > > This document was generated by, or was prepared by or at the direction or > request of a medical committee, medical peer review committee, nursing peer > review committee, and/or patient safety committee, including a joint > committee, of Texas Health Resources and its member hospitals as defined > under Texas Health & Safety Code Sec. 161.031, et seq., Texas Occ. Code Secs. > 151.001, et seq., 160.001, et seq. and 303.001, et seq., and is used for > committee purposes, specifically, quality assurance and assessment and the > evaluation of patient safety and medical and healthcare services at the > Hospital. This document and the information contained within it are > considered confidential, privileged and not subject to court subpoena > pursuant to the above-cited statutes and 42 U.S.C. Sec. 11101, et seq. > > > > > > The information contained in this message and any attachments is intended > only for the use of the individual or entity to which it is addressed, and > may contain information that is PRIVILEGED, CONFIDENTIAL, and exempt from > disclosure under applicable law. If you are not the intended recipient, you > are prohibited from copying, distributing, or using the information. 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