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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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| | | [[Category:Pneumonia (old)]] |
| == When to code VAP ==
| | [[Category:QAInfection]] |
| '''Ventilator Associated Pneumonia (VAP) Criteria''':
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| '''If''' a patient has been on a device to assist respiration (ventilator) either continuously or intermittently 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 as of October 5, 2011 meeting==
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| *Data collectors use this criteria only when they code VAP's. The doctors may or may not be calling it a VAP but this has no bearing on the way we collect the information. Be sure to adhere''' strictly to the above criteria only'''.
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| ==Clarification as of December 7, 2011 team meeting==
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| * Two questions were brought forward at this meeting:
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| *1. If there is a possibility of aspiration prior to hospitalization, how do we know if this is not a VAP when the positive cultures come back 2-3 days later?
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| *Answer from Dr. Olafson: Usually pts who have aspiration pneumonia will have some evidence of infiltrates on CXR right away. They will often have an increased WBC or fever and even may begin to have purulent secretions within the first day. If a pt who has possibly aspirated prior to arrival to hospital then look for these signs. If the pt has evidence of any of these signs within the first day or two, then it is an aspiration pneumonia (CAP), not a VAP.
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| It is important to note that early VAPs are often related to aspiration at the time of intubations so these need to be coded as VAPs when they meet the criteria.
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| *2. What window of time should we look for evidence of the signs of VAP?
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| *Answer from Dr. Olafson: You need to look for the WBC, fever, sputum and CXR signs either the day before the positive culture, the day of the positive culture or the next day.
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| Thanks for all the questions.--[[User:LKolesar|LKolesar]] 06:44, 8 December 2011 (CST)
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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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| 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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| *If the patient is admitted to the ward and being treated actively for the VAP, I code it as such. If they have discontinued treatment but were iniatially treated for it on the ward I would still capture it.--[[User:CMarks|CMarks]] 12:58, 5 August 2011 (CDT)
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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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| *The criteria for a HAP is different from a VAP. I have coded them as such.--[[User:CMarks|CMarks]] 12:58, 5 August 2011 (CDT)
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| ==Arrived w community acquired pneumonia and develops VAP==
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| If a patient is admitted with a CAP and then develops a VAP (e.g. grows staph aureus and they now diagnose VAP and change antibiotics, the pneumonia is still active when patient discharged to medicine ward), then code it as a VAP.
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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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| ==Long term ventilator patients with pneumonia==
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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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