negative sputum/ blood cultures

bea.smithbea.smith
edited May 2016 in CDI Talk Archive
I am curious how/ if some of you are educating your physicians on
documenting more specific pneumonia, even when sputum cultures are
negative. Ex. Gram negative suspected, treated for and patient improved
but cultures may have came back negative.

I am also curious if you have this same problem with sepsis with
negative blood cultures. I have some physicians who think if negative
blood cultures then the patient is not septic, but then I have other
physicians telling me that often times a patient is septic with neg
cultures. Have any of you found any good articles or resources or words
of wisdom to help me in this area.

Thanks.


Bea Smith, RHIT
Clinical Documentation Specialist
Cullman Regional Medical Center
ph: 256-737-2926
fax: 256-737-2504

" I am only one, but still I am one. I cannot do everything, but still I
can do something". - Edward Everett Hale




Comments

  • Unknown
    edited May 2016
    My physicians have indicated that a sputum culture is really not valid (positive or negative) as a good sample is difficult to obtain.


    Charlene



  • bea.smithbea.smith
    edited May 2016
    Thank you Charlene. Do your physicians specify a certain type/ pathogen
    of pneumonia most of the time?

    Bea Smith, RHIT
    Clinical Documentation Specialist
    Cullman Regional Medical Center
    ph: 256-737-2926
    fax: 256-737-2504

    " I am only one, but still I am one. I cannot do everything, but still I
    can do something". - Edward Everett Hale





  • robert.hodges2robert.hodges2
    Here is the newsletter I sent out about 2 weeks ago on documentation of pneumonia and a much older one on Sepsis and SIRS. It is very VA specific, but there are also some tidbits that may help you in some way.

    One note in the pneumonia newsletter (left column) states that if the clinical impression supports the diagnosis, even without a positive chest x-ray then the diagnosis is supported. The same would hold true for sepsis. The hard part is convincing doc's to get out of the test results mode and to trust what they see and assess.

    Robert

    Robert S. Hodges, BSN, MSN, RN
    Clinical Documentation Improvement Specialist
    Aleda E. Lutz VAMC
    Mail Code 136
    1500 Weiss Street
    Saginaw MI 48602
  • bea.smithbea.smith
    edited May 2016
    Amen Robert! Thank you.


  • Unknown
    edited May 2016
    Maybe half the time. "CAPN (community acquired)/ HCAPN (health care acquired) / pneumonia, probable _________."

    The CA and HCA mean a lot to the infection control RN.

    Charlene



  • Unknown
    edited May 2016
    Robert,

    I like it. Thank you for sharing this.


    Charlene



  • nbrunson84nbrunson84
    edited May 2016
    Our Query has some "education" tied into the Clinical Indicators we
    present but it is still a source of difficulty.

    Mostly I educate them on the terms "possibly/probably/suspected to be"
    terminology when they have a thought as to what is causing the Pneumonia
    but they do not have that positive culture in their hands.


    N. Brunson, RHIA
    Clinical Documentation Specialist
    Bay Medical Center


  • kelleywalrathkelleywalrath
    edited May 2016
    There is an excellent article on sepsis that is directed to physicians.
    We have used it many times with those physicians that are blood culture
    needy. It is on uptodateonline.com.

    For the sputum that is negative, which happens a lot, either from pt
    being on abx or because they could not hock up enough, we look at the
    clinical indicators which are on our query form and ask if they are
    covering for gram negative pneumonia. So far, this has not run into any
    compliance issues.

    Kelley Walrath
    Documentation Specialist Coordinator - MRMC, Ocala, FL
    BSN - CCDS
    352-671-2589 or x6978




  • Unknown
    edited May 2016
    Are you able to attach the article or provide a link?


    Charlene



  • mannb1mannb1
    edited May 2016
    Great job, Robert! We try to do a monthly "Hot Topics" for CDI as well, but it's not this impressive!

    Becky Mann, RN, CDS
    Queen of the Valley Medical Center
    Napa, CA


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