Definition of Catheter Associated UTI for CDI queries
A question has come up about querying for catheter associated UTI.
We are interested in hearing whether you all use the CAUTI definition as criteria for querying or if you are querying even if the definition is not met and it is possible that the UTI is related to a foley catheter.
Example: Initial UA in ED was negative. No culture done. Foley placed in ED and removed approximately 4 hours later on the Med Surg floor. 3 days after the foley was removed a UA was repeated and culture done revealing E. Coli UTI.
Would you query? Not query as it doesn't meet the CAUTI criteria?
Thanks for your help,
Jan
Janice Potter, RN, CCDS
Clinical Documentation Specialist
Care Management Department
(406) 327-4298
jpotter@communitymed.org
We are interested in hearing whether you all use the CAUTI definition as criteria for querying or if you are querying even if the definition is not met and it is possible that the UTI is related to a foley catheter.
Example: Initial UA in ED was negative. No culture done. Foley placed in ED and removed approximately 4 hours later on the Med Surg floor. 3 days after the foley was removed a UA was repeated and culture done revealing E. Coli UTI.
Would you query? Not query as it doesn't meet the CAUTI criteria?
Thanks for your help,
Jan
Janice Potter, RN, CCDS
Clinical Documentation Specialist
Care Management Department
(406) 327-4298
jpotter@communitymed.org
Comments
Thanks!
Katy Good, RN, BSN, CCDS, CCS
Clinical Documentation Program Coordinator
AHIMA Approved ICD-10CM/PCS Trainer
Flagstaff Medical Center
Kathryn.Good@nahealth.com
Cell: 928.814.9404
Thanks, PE
Paul Evans, RHIA, CCS, CCS-P, CCDS
Manager, Regional Clinical Documentation & Coding Integrity
Sutter West Bay
633 Folsom St., 7th Floor, Office 7-044
San Francisco, CA 94107
Cell: 415.412.9421
evanspx@sutterhealth.org
-----Original Message-----
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Tuesday, December 02, 2014 9:53 AM
To: Evans, Paul
Subject: RE: [cdi_talk] Definition of Catheter Associated UTI for CDI queries
Great question. I am very curious what everyone has to say. We are having the same question here as there is dissonance between what our Infection Prevention team determines as a CAUTI versus general medical opinions of the providers.
Thanks!
Katy Good, RN, BSN, CCDS, CCS
Clinical Documentation Program Coordinator AHIMA Approved ICD-10CM/PCS Trainer Flagstaff Medical Center Kathryn.Good@nahealth.com
Cell: 928.814.9404
-----Original Message-----
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Tuesday, December 02, 2014 8:37 AM
To: Kathryn Good
Subject: [cdi_talk] Definition of Catheter Associated UTI for CDI queries
A question has come up about querying for catheter associated UTI.
We are interested in hearing whether you all use the CAUTI definition as criteria for querying or if you are querying even if the definition is not met and it is possible that the UTI is related to a foley catheter.
Example: Initial UA in ED was negative. No culture done. Foley placed in ED and removed approximately 4 hours later on the Med Surg floor. 3 days after the foley was removed a UA was repeated and culture done revealing E. Coli UTI.
Would you query? Not query as it doesn't meet the CAUTI criteria?
Thanks for your help,
Jan
Janice Potter, RN, CCDS
Clinical Documentation Specialist
Care Management Department
(406) 327-4298
jpotter@communitymed.org
---
CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.
You are receiving this message as a member of CDI Talk as: kathryn.good@nahealth.com If you would like to be removed from CDI Talk, please send a blank email to leave-cdi_talk-12649561.a6bbaf3538c19e934e5136fbd051a6b1@hcprotalk.com
---
Copyright 2013
HCPro, Inc., 75 Sylvan Street, Danvers MA 01923
---
CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.
You are receiving this message as a member of CDI Talk as: evanspx@sutterhealth.org If you would like to be removed from CDI Talk, please send a blank email to leave-cdi_talk-12940161.4b24e9352adc7dfa247d8332246d4e2a@hcprotalk.com
---
Copyright 2013
HCPro, Inc., 75 Sylvan Street, Danvers MA 01923
It is interesting you should ask this question today. I have just participated in a meeting here ( our CDI department is part of quality) to attempt to determine the correct way to handle CAUTIs and NHSN criteria.
We came to the conclusion they may not always agree. The criteria for NHSN is different in relationship to POA of the UTI.
We have decided to proceed as follows:
CDI will work on determining if the documentation can show whether the UTI was POA or not.
ICP will work on the NHSN criteria and we will keep a spreadsheet to be sent out once a week to review these cases.
The rationale for this is that our hospital requires a root cause analysis for every CAUTI.
I am also trying to collect enough data to convince our doctors that the orders need to be written to collect the UA prior to placing the foley. It seems our ED staff will place a foley and then the UA is not collected for several days.
I hope this makes sense and helps a little.
Lisa
Lisa Romanello, RN,BSN,FNS,CCDS
Manager, Clinical Documentation Improvement
Quality and Compliance
CJW Medical Center
Office phone: 804-228-6527
Cell phone: 804-629-0396
AHIMA Approved ICD-10 CM/PCS Trainer
Angelisa.Romanello@HCAHealthcare.com
Sharon
Sharon Cooper, RN-BC, CCS, CCDS, CDIP, CHTS-CP
AHIMA-Approved ICD-10-CM/PCS Trainer/Ambassador
Manager Clinical Documentation/Appeals
sharon.cooper@owensborohealth.org
(270) 417-4612 Office
(270) 316-9088 Cell
(270) 417-4609 Fax
Owensboro Health Regional Hospital
P.O. Box 20007
Owensboro, KY 42304-0007
I don’t think this is a place for CDI. I know we are able to query for diagnoses without clinical indicators but this is not generally the case in these instances. For example, a patient may develop a UTI 3 days after foley insertion and document a CAUTI but our IP team may not consider this a CAUTI because the patient was afebrile and they were sedated and therefore unable to communicate any pain. However, the providers independent opinion is that this patient has a CAUTI and I think that’s a reasonable diagnosis even if it doesn’t meet NHSN criteria. I think a query would only be indicated in a circumstance where (for example) a CAUTI was documented on a patient that did not have a foley or something overt like that.
I think about this as similar in ways to malnutrition. If a provider assesses a patient with cancer and determines weight loss, low albumin, and decreased intake indicate malnutrition, I would not query simply because the patient does not meet ASPEN criteria even though that may be my preferred criteria. Cheryl Ericson wrote a blog about this last year. I think we should trust physician judgment in most cases.
On another note, at a presentation at the ACDIS conference (I think in 2013??) someone suggested that the terminology of 'CAUTI' does not indicate causation. Their feeling was 'associated' does not mean 'due to'. They suggested that we should not be coding based on documentation of 'CAUTI'. I have never seen this anywhere else????
Katy Good, RN, BSN, CCDS, CCS
Clinical Documentation Program Coordinator
AHIMA Approved ICD-10CM/PCS Trainer
Flagstaff Medical Center
Kathryn.Good@nahealth.com
Cell: 928.814.9404