Ugh. I feel your frustration - unfortunately, this is correct. CMS does not recognize AMS as a sign of organ dysfunction. Only criteria for organ dysfunction (with nuances, of course...) include: bili >2, or Cr > 2, or PLT < 100K, or INR > 1.5, or PTT > 60, or Lactate > 2, or MAP < 65, or BP < 90 or use of ventilation device for acute illness (BiPap/intubation); so 'bipap at night' doesn't count.
Had the provider(s) documented severe sepsis or septic shock anywhere, that would override the criteria and start the time zero clock. ....I'm not familiar with the lack of use of data in the discharge summary.... Sometimes, the discharge summary is the only place our providers will add "sepsis" as a diagnosis. By doing so, this will officially drop the patient into the sepsis DRG and it's available for abstraction. So then if the patient meets source, 2/4 SIRS, 1 OD, then it would most certainly be abstracted. I'd love to hear other perspectives on the discharge summary. Hope this helps. Thanks, Danette PS - the altered mental status should not stop the providers and nurses from clinically determining sepsis/severe sepsis/septic shock. At Norton we built our sepsis screening tool for nursing to include the abnormality of altered mental status as a SIRS criteria. To date, it's not been brought to my attention that we've over captured or inappropriately screened for sepsis by adding this piece. Danette Culver, MSN, APRN, ACNS-BC, CCRN-K, RN-BC Clinical Nurse Specialist Norton Healthcare 4967 U.S. Hwy 42, Suite 100 Louisville, KY 40222 O: 502.420.4371 C: 812.881.0080 A Clinical Nurse Specialist (CNS) is a Master's prepared Advance Practice Nurse whose function is to improve outcomes in patient care. The CNS is a clinical practice expert, an educator, a researcher, and a consultant who influences the three spheres of practice: patient care, nursing, and systems. - National Association of Clinical Nurse Specialists From: Sepsisgroups [mailto:[email protected]] On Behalf Of Cooke, Susan Sent: Wednesday, February 03, 2021 5:02 PM To: [email protected] Subject: [EXTERNAL] Re: [Sepsis Groups] I need some clarification and would appreciate some input CAUTION: **EXTERNAL EMAIL** Do NOT click links or open attachments unless you recognize the sender and know the content is safe. If you are not sure, please forward the email to [email protected]<mailto:[email protected]> for review. ________________________________ I'm sorry I mean to say the Abstractor said the patient did NOT have evidence of organ failure because CMS does not recognize AMS as organ dysfunction so they did not proceed with examining the case for compliance because it did not meet SEV-SEP criteria. They placed it in the Excluded column. Thanks Susan Cooke MSN RN NEA-BC Sepsis Program Coordinator University Medical Center New Orleans 2000 Canal Street New Orleans, LA 70112 O 504.702.2924 F 504.702.2119 [email protected]@LCMChealth.org<mailto:[email protected]@LCMChealth.org> umcno.org<https://urldefense.proofpoint.com/v2/url?u=https-3A__www.umcno.org_&d=DwMFAg&c=a-fTYuyacsOBdK5dxJm0TrOrF1BT4RdAkNRqW_Js53o&r=JPxSALmxUy5xyHEOvdym-hyL93XcvJhDCEPFRYF80a7aoNWBQpBALyYxCgapSd3h&m=JT2wq76NNB2UxSwqmd-M_O9cP4kGSnfm_Uvr8VJeOkY&s=0As6wVqyTkbZoQsm1-Eu_HkjhzJV8rWTNaStyzO1HRA&e=> From: Cooke, Susan Sent: Wednesday, February 3, 2021 10:41 AM To: [email protected]<mailto:[email protected]> Subject: I need some clarification and would appreciate some input Hi everybody, I am going round and round with our Abstracting company related to a UTI sepsis case. Patient came to ED meeting SIRS criteria and a change in mental status which was reported as definitely improved after antibiotic administration. The Bundle elements were met. The coding was for Sepsis and UTI with a primary of Altered Mental Status. All were POA. The Abstractors excluded the case because they say the patient did have evidence of organ dysfunction because CMS does not recognize Altered Mental Status as Organ dysfunction (but SCCM does). 1. Is this correct that the case should be excluded even though the patient clearly had sepsis. Improved with antibiotics and it was coded as such by the physician? 2. In my email to the Abstractor I had mentioned (because I'm somewhat new to this level of detail and didn't realize the altered mental status wasn't an organ dysfunction) that it was clearly stated in the Discharge Summary that the patient had Altered Mental Status that improved with Antibiotics and the source was a UTI. I was told that -Also,any documentation in the discharge summary is not to be used to determine the presence of severe sepsis/septic shock. Is this true? Isn't the entire chart a possible source for a sepsis diagnosis? Any insight to this type of scenario would be so helpful!! Thanks so much. Sue Susan Cooke MSN RN NEA-BC Sepsis Program Coordinator University Medical Center New Orleans 2000 Canal Street New Orleans, LA 70112 O 504.702.2924 F 504.702.2119 [email protected]@LCMChealth.org<mailto:[email protected]@LCMChealth.org> umcno.org<https://urldefense.proofpoint.com/v2/url?u=https-3A__www.umcno.org_&d=DwMFAg&c=a-fTYuyacsOBdK5dxJm0TrOrF1BT4RdAkNRqW_Js53o&r=JPxSALmxUy5xyHEOvdym-hyL93XcvJhDCEPFRYF80a7aoNWBQpBALyYxCgapSd3h&m=JT2wq76NNB2UxSwqmd-M_O9cP4kGSnfm_Uvr8VJeOkY&s=0As6wVqyTkbZoQsm1-Eu_HkjhzJV8rWTNaStyzO1HRA&e=>
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