VAP - Ventilator Associated Pneumonia

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Revision as of 18:17, 9 September 2011 by GHall (talk | contribs) (→False Negatives)
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Legacy Content

This page is about the pre-ICD10 diagnosis coding schema. See the ICD10 Diagnosis List, or the following for similar diagnoses in ICD10:Pneumonia, ventilator-associated (VAP)

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Category/Organ
System: 		Category: Infection (old)

Type:

[[:Category: Medical Problem (old)]][[Category: Medical Problem (old)]]

Main Diagnosis: Pneumonia
Sub Diagnosis: PNEUMONIA-VAP (ventilator acq'd)
Diagnosis Code: 3900-Ventilator Associated Pneumonia
Comorbid Diagnosis: No
Charlson Comorbid coding (pre ICD10): 0
Program: Critical Care and Medicine
Status: Currently Collected
Start Date: July 1, 2006
  • For other pneumonia we are also collecting see:
Pneumonia Etiology not clear (code 36-00)
CAP Community acquired pneumonia
HAP Hospital acquired pneumonia
  • Page needs remodeling here ..........when I have time.......TOstryzniuk 19:05, 16 December 2008 (CST)

When to code VAP

Ventilator Associated Pneumonia (VAP) Criteria:

  • 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 Community Acquired Pneumonia (CAP). (as per Dr. Bruce Light).TOstryzniuk 17:38, 15 December 2008 (CST)


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.

and if they demonstrate new, worsening or persistent infiltrate on x-ray compatible with pneumonia

and if at least one of the following criteria is met:

  • Fever (T > 38) with no other cause
  • Leukopenia WBC(<4X10(9)) or leukocytosis (>12x 10(9)).
  • Altered mental status with no other causes in >69 year old.

and if at least one of the following criteria is met:

  • New onset of purulent secretions
  • Change in character of sputum
  • Increased volume of purulent secretions
  • Increased suction requirement
  • New onset of worsening cough
  • New onset of dypsnea (SOB) or tachypnea (increased Resp Rate)
  • Increased oxygen or ventilation requirement

and if at least one of the following criteria is met:

  • Pathogen isolated from sputum in the last 48 hours
  • Positive blood cultures not related to another infection
  • Positive pleural fluid culture.

Clarification of coding VAP when moving patients between units in the city

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. 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. 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.

VAP acquired in ICU then transferred to Ward

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.

Template:Discussion Should they really only code it if it is being treated? What about a DC treat? Ttenbergen 16:44, 7 July 2011 (CDT)

  • 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.--CMarks 12:58, 5 August 2011 (CDT)

Template:Discussion Collectors used to collect this as a HAP. Would it be correct to add that they should NOT collect it as a HAP Ttenbergen 16:44, 7 July 2011 (CDT)?

    • The criteria for a HAP is different from a VAP. I have coded them as such.--CMarks 12:58, 5 August 2011 (CDT)

Arrived w community acquired pneumonia and develops VAP

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.

Reporting of VAP when patients move units

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. TOstryzniuk 14:10, 16 June 2008 (CDT)

False positives and negatives

Template:Discussion

  • This really applies to all diagnoses, no? Should we have a separate article that addresses how to deal with Dxs that should be present but aren't, or that shouldn't be present but are? Or, is this already addressed in General Diagnosis Coding Guidelines (or should it be included there?). Ttenbergen 16:58, 7 July 2011 (CDT)
  • What are other collectors doing or finding at their site and do you review with attendings?--TOstryzniuk 13:42, 31 January 2011 (CST)
  • Need further feedback from other ICU's. Dr. Bojan Paunovic who is the acting ICU director had asked the question.--TOstryzniuk 19:35, 3 February 2011 (CST)

False Negatives

  • If a physician does not chart the DX of VAP but patient meets the criteria above for VAP, what do collectors do?
    • If the criteria all clearly show a VAP then the doctor should be informed about this. (...) --LKolesar 15:26, 28 January 2011 (CST) (partial comment moved)
    • (...) 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)
      • My understanding is that those are guidelineseven if it says criteria. I have no problem with the 48 hour rule, the infiltrate present and the treatment with antibiotics. The second set of rules I think are unrealistic. For many reasons. If they are ventilated for 48hours, have a new infiltrate and a bug growing and the doctors are calling it VAP I think we should regardless of our guidelines.If we don't get this right it will look like some sites are over reporting and some under reporting.I'll add it to the team meeting agendaGHall 18:17, 9 September 2011 (CDT)

Mlaporte 16:52, 3 February 2011 (CST) (partial comment moved)

False Positives

  • 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. --LKolesar 15:26, 28 January 2011 (CST) (partial comment moved)
  • 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. (...) and discuss with the charge/bedside nurse or MD on shift in the unit (usually not the attending)Mlaporte 16:52, 3 February 2011 (CST)
    • Marie, don't mean to misquote you: do you also discuss the False Positives with the nures or MD on shift? Ttenbergen 16:57, 7 July 2011 (CDT)
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