One of the common errors when determining severe sepsis presentation occurs when a lab value is used as the last of the indicators. Remember, when using a lab value to determine the presentation time for severe sepsis, you must use the RESULT time, not the collection or order time.
The other challenge related to lab results is the question of chronic conditions. In the current data dictionary, version 5.0b for discharges through June 30, 2016, the following applies:
- Do not include evidence of organ dysfunction that is considered to be due to a chronic condition or medication (e.g., Creatinine >2 for a patient with end stage renal disease, INR >1.5 for a patient on Warfarin).
- A linkage does not need to be documented for Creatinine >2 for a patient with end stage renal disease, and INR >1.5 for a patient on Warfarin, because those are included in the Severe Sepsis Present.
- For other conditions and medications, there should be documentation indicating the association.
- If a physician attributes the lab value to another condition, do not use it to determine presentation of severe sepsis.
- If a physician notes a ‘normal’ for a patient with a chronic condition, and the lab result is out of range with what the physician documents as ‘normal’, you can then use that lab value as an indicator.
*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!