PSI Events

I have a question related to PSI events. I work in a very small CDI department (two CDI RN’s) and we are both new. 

My Question is in regard to PSI events such as PSI 15 (Abd accidental puncture or Laceration) or PSI 11 (Postoperative Respiratory Failure). If the provider does a good job stating that the event was expected and inherent due to pt’s physiology or medical history is there any way that that wording would then exclude the reportable PSI event. I do not see any exclusion criteria on the AHRQ PSI that would allow these to be excluded if the provider states inherent to procedure or expected. However, on ACDIS PSI 90 tip sheet several slides indicate that it would be important to query the providers to specify this. However, even with that being specified it is not a part of the exclusion criteria on the AHRQ PSI Technical Specifications. How do other CDI departments deal with these situations? Is there an exclusion process that we are unaware of if the provider states something like “Accidental puncture inherent to procedure due to pt’s extensive adhesions”?

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