There have been questions surrounding what can be used as an indication of organ failure if there is documentation of acute respiratory failure with a new need for mechanical ventilation. (Acute respiratory failure as evidenced by a new need for invasive or non-invasive mechanical ventilation. Invasive mechanical ventilation requires an endotracheal or tracheostomy tube. Non-invasive mechanical ventilation (may be referred to as BiPAP) uses a mask.) There are several pieces that must be present in the medical record in order to use this as organ failure.
1) There must be physician documentation of acute respiratory failure in conjunction with the start of the mechanical ventilation. This specifically must state ACUTE RESPIRATORY FAILURE (which might also be stated as Acute Hypoxemic Respiratory Failure or Acute Hypercapnic Respiratory Failure), not Respiratory Failure, Respiratory Insufficiency, Respiratory Distress, etc. Any of these other conditions will not meet criteria for using a new need for mechanical ventilation as organ dysfunction.
2) If non-invasive mechanical ventilation was implemented, it cannot be a nasal cannula, venti-mask or oro-facial mask. It must be CPAP or Bi-PAP.
3) Base your time for meeting these criteria on the last piece that was documented. For example, if there is physician/APN/PA documentation of acute respiratory failure at 0650 and also documentation that the BiPAP was placed at 0715 you would use the 0715 as the time that criteria was met for organ dysfunction.
*The article is part of the Registry Partners Quality Division Sepsis Newsletter. Follow the blog to read more articles from the Newsletter or contact us to receive a copy of the full newsletter to share with your team!