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| {{DX tag | Infection | [[:Category: Medical Problem | Medical Problem]] | [[:Category: Pneumonia | Pneumonia ]]| PNEUMONIA-VAP (ventilator acq'd) | [[3900-Ventilator Associated Pneumonia]] | No | 0 |'''Critical Care and Medicine''' | Currently Collected | July 1, 2006 | |}} | | {{PreICD10 dx | NewDxArticle = Pneumonia, ventilator-associated (VAP)}} |
| | {{DX tag | Infection | Medical Problem| [[:Category: Pneumonia | Pneumonia ]]| PNEUMONIA-VAP (ventilator acq'd) | 3900-Ventilator Associated Pneumonia | No | 0 |'''Critical Care and Medicine''' | Currently Collected | July 1, 2006 | |}} |
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| *See: [[QA_Infection_Audit#A._VAP | QA_Infection_Audit#A._VAP for Collection Instructions]]
| | See criteria in [[Pneumonia, ventilator-associated (VAP)]]. |
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| *see [[Quarterly report]] | | == See Also == |
| | * [[QA Infection]] for info common to the [[QA Infection CLI]] and the [[QA Infection VAP]] project |
| | * alternate diagnoses [[:Category:Pneumonia]] |
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| *For other pneumonia we are also collecting see:
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| :[[Pneumonia Etiology not clear]] (code 36-00)
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| :[[CAP]] Community acquired pneumonia
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| :[[HAP]] Hospital acquired pneumonia
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| *Page needs remodeling here ..........when I have time.......[[User:TOstryzniuk|TOstryzniuk]] 19:05, 16 December 2008 (CST)
| | [[Category:Pneumonia (old)]] |
| | | [[Category:QAInfection]] |
| == When to code VAP ==
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| '''Ventilator Associated Pneumonia (VAP) Criteria''':
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| *NOTE: We are tracking HOSPITAL ACQUIRED VAP's & not patient's who have acquired an pneumonia while on long term home ventilators (LTV) in the community. If a LTV patient is admitted from the community with an pneumonia, they are to coded as '''C'''ommunity '''A'''cquired '''P'''neumonia ([[CAP]]). (as per Dr. Bruce Light).[[User:TOstryzniuk|TOstryzniuk]] 17:38, 15 December 2008 (CST)
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| '''If''' a patient has been on a device to assist respiration (ventilator) continuously through a tracheostomy or endotracheal tube (ETT) for at least '''48 hours''' in a unit '''before onset of infection, or new infection.'''
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| '''and''' if they demonstrate new, worsening or persistent infiltrate on x-ray compatible with pneumonia
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| '''and if at least one''' of the following criteria is met:
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| * Fever (T > 38) with no other cause
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| * Leukopenia WBC(<4X10(9)) or leukocytosis (>12x 10(9)).
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| * Altered mental status with no other causes in >69 year old.
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| '''and if at least one''' of the following criteria is met:
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| * New onset of purulent secretions
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| * Change in character of sputum
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| * Increased volume of purulent secretions
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| * Increased suction requirement
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| * New onset of worsening cough
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| * New onset of dypsnea (SOB) or tachypnea (increased Resp Rate)
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| * Increased oxygen or ventilation requirement
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| '''and if at least one''' of the following criteria is met:
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| * Pathogen isolated from sputum in the last 48 hours
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| * Positive blood cultures not related to another infection
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| * Positive pleural fluid culture.
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| == Clarification of coding VAP when moving patients between units in the city ==
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| When coding VAP's they are coded as "complication" when they occur at a specific center. However, when these patients are transferred to other centers and the VAP is still being treated, then the VAP should be coded as part of the admitting diagnosis.
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| When Julie looks at VAP rates in ICU's she only looks for the VAP code in the complication slots. The site where the patient had the VAP occur in complication codes is the site that is given the credit. A unit where a patient has a VAP in the admitting diagnosis is not included in stats for VAP rates.
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| When a VAP appears in the admission code slots, Julie tracks back to where patient came from and makes sure that the ICU prior to the transfer, coded the VAP in their complications, if not, you will get a query to audit the diagnosis.
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| == VAP acquired in ICU then transferred to Ward==
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| If a patient has a '''VAP''' in the '''ICU''' that is not yet resolved and is still being treated when the patient is transferred to a '''ward''', the ward should code the VAP in the admit diagnosis. If VAP was '''resolved''' in the ICU before the patient was sent to the ward, then don't code it.
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| {{discussion}}
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| Should they really only code it if it is being treated? What about a DC treat? [[User:Ttenbergen|Ttenbergen]] 16:44, 7 July 2011 (CDT)
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| {{discussion}}
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| Collectors used to collect this as a HAP. Would it be correct to add that they should NOT collect it as a HAP [[User:Ttenbergen|Ttenbergen]] 16:44, 7 July 2011 (CDT)?
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| ==Arrived w community acquired pneumonia and develops VAP==
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| *If the patient was admitted to VM with a community acquired pneumonia, then in ICU grows staph aureus and they now diagnose VAP and change antibiotics, the pneumonia is still active when patient discharged to medicine ward. Do I code it as VAP with staph aureus?[[User:WGobert|WGobert]] 09:04, 16 December 2008 (CST)
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| **Just so I am clear: the patient admitted from the community to ICU with primary DX of CAP. In ICU developed a secondary VAP. Sent down to ward with unresolved VAP which continued to be treated? believe this is what you are asking?
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| ***''If pt from ICU with DX VAP then to medicine ward with ongoing VAP requiring continued treatment then YES, must be one of the admitting DX in medicine. If it is the primary reason for ward admission from ICU, then it should be in admit DX 1. ''
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| **''The ICU where the patient was first admitted and developed the "complication" of VAP is given the credit when Julie does stats reporting. Any patient who has VAP in their admitting DX code is not included in the reporting of unit acquired VAP's.''[[User:TOstryzniuk|TOstryzniuk]] 18:56, 16 December 2008 (CST)
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| ***Thanks Trish,just wasn't sure if I could code the VAP on medicine. As you know, we are still not using ventilators on our tower units.....kidding....but i wasn't sure. Norine and I discussed this patient, and with the criteria, have coded this patient as a CAP not a VAP. Thanks Wendy
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| ==Reporting of VAP when patients move units==
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| When the Statistician links admissions in the database between ICU'a & medicine wards in the city, those patient that have VAP in admitting diagnosis are excluded from complication statistics. The patient encounter that had the VAP coded in the '''acquired diagnosis''' slot is the unit that is given credit for the '''complication''' occuring in that unit. [[User:TOstryzniuk|TOstryzniuk]] 14:10, 16 June 2008 (CDT)
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| ===Discussion===
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| {{Discussion}}
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| If a physician does not chart the DX of VAP but patient meets the criteria above for VAP, what do collectors do?
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| **If the criteria all clearly show a VAP then the doctor should be informed about this. I find often the opposite happens, ie they call it a VAP when it does not meet all the criteria and in this case it is likely still a HAP. --[[User:LKolesar|LKolesar]] 15:26, 28 January 2011 (CST)
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| ***What are other collectors doing or finding at their site and do you review with attendings?--[[User:TOstryzniuk|TOstryzniuk]] 13:42, 31 January 2011 (CST)
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| ****I have found the same as Laura re: sometimes the MD is saying VAP when it does not meet our criteria; so, I code it as a HAP. If it meets our criteria of VAP I code it as VAP and discuss with the charge/bedside nurse or MD on shift in the unit (usually not the attending)[[User:Mlaporte|Mlaporte]] 16:52, 3 February 2011 (CST)
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| ****Need further feedback from other ICU's. Dr. Bojan Paunovic who is the acting ICU director had asked the question.--[[User:TOstryzniuk|TOstryzniuk]] 19:35, 3 February 2011 (CST)
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| [[Category:Diagnosis Coding]]
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| [[Category: Pneumonia]] | |