POA on surgery pt

cmclose@saintfrancis.com

Need some help~ I think I am making this more difficult than it needs to
be.
Can someone please explain to me how to assign POA status for
conditions/diagnoses on a pt that is admitted for inpatient surgery?

Example case: pt with scoliosis who is admitted after surgery/spinal
fusion; inpatient admit order was at 0755, surgery at ~ 0900, pt
admitted to ICU at ~1530 after surgery. Per ICU H&P: acidosis, anemia,
coagulopathic, Hypoalbuminemia, hypovolemic shock. Pt given PRBCs,
albumin, Ca Chloride, bicarb and cryo & fluid resuscitation shortly
after arrival to ICU.
Preop: H/H normal, INR 1.23 (normal

kbenson@uwhealth.org

I would look for additional results to confirm the presence of DIC on admission.
In DIC you typically see
Abnormal PT/PTT
Increased D-dimer, fibrin monomer
Decreased fibrinogen and usually severe thrombocytopenia
If a peripheral smear was done, look for the presence of schistocytes

There are many reasons why an INR would be abnormal besides DIC and my guess is that the surgery would have at least been postponed until the DIC was addressed.

If a patient goes to surgery and comes out with abnormal lab tests and the preop labs were normal those diagnoses were not present on admission. Hope that helps.

Kathy Benson RN, BSN, CCDS
Supervisor, Clinical Documentation Integrity
University of Wiscon Hospital
________________________________

ssalinas

"Present on admission" is defined as present at the time the order for inpatient admission occurs-conditions that develop during an outpatient encounter, including emergency department, observation, or outpatient surgery, are considered present on admission.

I am a little confused regarding your statement that patient was admitted after surgery but that IP admit order was written prior to time of surgery. I would say the diagnoses were NOT POA IF the IP admission order was issued prior to surgery. Agree with Kathy regarding the DIC.


Sharon Salinas, CCS
Health Information Management
Barlow Respiratory Hospital
2000 Stadium Way, Los Angeles CA 90026
Tel: 213-250-4200 ext 3336
FAX: 213-202-6490
ssalinas@barlow2000.org

kbenson@uwhealth.org

Ann,
The POA status is important if the hospital uses the UHC mortality risk model. It takes all patients into consideration for the O/E numbers, not just the expired ones. The risk model only looks at POA diagnoses.
Kathy

annnd2009@gmail.com

Hi Kathy,

I am not at all familiar with that