PACS/ Office Facilitator Update

THE
May 2007
The mission of
The Pulse is to
give you the
up-to-date
information you
need to practice
safely and
efficiently at
Touro. Enjoy!
Kevin T. Jordan, M.D.
Vice President Medical Affairs &
Chief Medical Officer
Inside the Pulse...
• Pharmacy Update
• Core Measures
• Medical Records
• LSMS Releases Member
Opinions on Key
Healthcare Issues
• PACS/Office Facilitator
Update
• May/June Calendar
Have questions or comments?
Please forward any inquiries or responses
to mdinfo@touro.com, or contact
Greg Roques, Touro’s physician relations
advocate, at 897-8083.
PULSE
A NEWSLETTER FOR THE TOURO MEDICAL STAFF
Pharmacy Update
Dangerous Abbreviations
Dangerous
Abbreviation
Reason
for Concern
U (unit)
IU (international unit)
Mistaken for zero, number
four, or cc
Mistaken for IV or number ten
QD (daily)
QOD (every other day)
Mistaken for QID
Mistaken for QID and QD
Trailing zero (X.0 mg)
Lack of leading zero
Decimal point is missed
Decimal point is missed
MS
MSO4 and MgSO4
Can mean morphine sulfate
or magnesium sulfate
Instead Use
Write “unit”
Write “international
unit”
Write “daily”
Write “every other
day”
Write X mg
Write 0.X mg
(.X mg)
Write out “morphine
sulfate” or
“magnesium Sulfate”
(Comprises the “do not use list” required for the Joint Commission on Accreditation of
Healthcare Organizations accreditation)
The Pharmacy and Therapeutics Committee at Touro has asked that pharmacists
receiving any medication orders with such abbreviations contact prescribers for
clarification. Medication orders will not be acted on unless the dangerous
abbreviation is clarified or rewritten.
Touro Infirmary Process Improvement and Quality Assurance teams are actively
monitoring the use of these abbreviations and willprovide feedback to providers
about this all important aptient safety initiative.
Micromedex® Drug Information System Available NOW
The number of drugs available today is enormous, and the vast amount of
information about these drugs can be mind boggling. Micromedex® enables a user
to look up medication-related information easily. The system features several
distinct libraries, as well as information to help verify IV compatibility (IV Index),
check for drug interactions (DRUG-REAX), review the safely manage chemicals
with medical/hazard data (TOMES), pharmaceutical MSDS, determine lab and other
tests needed for specific diagnosis, guidance on administration of drugs, interpreting
results, and follow-up (LAB-ADVISOR), PDR, check details on international drugs
(Index-Nominum), and provides access drug info on your PDA.
Micromedex® is available through the inside.Touro.com web site under
NetAccess.
THE
PULSE
The medical affairs office proudly congratulates Touro's physicians, residents and fellows on the successful completion of
JCAHO's assessment this past month.
While the survey team commended Touro for the great strides they have made during the 20 months since Hurricane Katrina,
one area in which our staff has room for improvement is the observance of JCAHO's Core Measures. In order to satisfy
performance measurement requirements, Touro has adopted quality measure sets for acute myocardial infarction (AMI), heart
failure (HF), pneumonia (PN) and Surgical Care Improvement Project (SCIP).
Provided below are 4th quarter 2006 statistics for these measures, comparing Touro's compliance against the aggregate
statistical compliance of more than 400 health care institutions registered with Midas+, a healthcare management agency.
Adherence to Core Measures interventions is proven to inprove patient outcomes; and, compliance is also tied to
reimbursement.
If you have any questions, contact Linda Jacobs, RN, at (504) 897-8778, or at Linda.Jacobs@touro.com. Information also is
available on the physician access link at http://www.touro.com/content/MDinfo.htm.
2
THE
PULSE
Medical Records
The Coding Buzz from the H.I.M. Coding Department
PHYSICIAN DOCUMENTATION REQUIREMENTS TO SUPPORT SEVERITY OF ILLNESS FOR
SEPSIS / UROSEPSIS
Sepsis is a clinical syndrome often suspected when there is a mental status change, leukocytosis, tachycardia, tachypnea,
hypotension, fever or chills. Bacteremia and sepsis are different entities. A diagnosis of sepsis does not require a positive blood
culture although that may be the case. Likewise, not all cases of bacteremia have sepsis. Sepsis results from a systemic
inflammatory response to infection or trauma, and need not be associated with bacteremia.
Sepsis is a systemic disease with the presence of pathogenic microorganisms or toxins in the blood (such as viruses,
bacteria, fungus or other organisms). Sepsis is SIRS ( Systemic Inflammatory Response Syndrome) due to infection or
trauma without organ dysfunction . Infection can originate anywhere in the body and be triggered by a bacterial, viral, fungal,
or parasitic infection.
The systemic response is manifested by a variety of clinical signs and symptoms such as:
a. Fever (oral > 38 C or 100.4 F)
b. Hypothermia (oral <36 C or 96.3 F)
c. Leukocytosis (WBC>12,000) or Leukopenia (WBC<4,000 or > 10% bands)
d. Tachycardia(>100 beats per minute)
e. Tachypnea (respiratory rate > 20 breaths per minute or a pCO2 of < 32 mmHG)
SEPSIS WITHOUT ORGAN DYSFUNCTION SHOULD BE DOCUMENTED AS SEPSIS
Septicemia is an antiquated, ambiguous term which has been used non-specifically in the past to imply either bacteremia or
sepsis; therefore, should be eliminated from the current medical usage
Severe Sepsis is sepsis associated with acute organ dysfunction of one or more organs. This occurs when the sepsis
becomes overwhelming and results in organ dysfunction.
Evidence of reduced organ perfusion ( in the absence of profound hypovolemia):
a. Encephalopathy
b. Oliguria (<2 cc's per hour)
c. Hypotension (systolic blood pressure <90 mmHg or a 40 mmHg drop from the previous normal pressure reading
for > 1 hour, despite fluid resuscitation)
d. Increased anion gap
e. Arterial pH <7.30 ( not secondary to a respiratory etiology)
Evidence of organ dysfunction
a. Congestive Heart Failure
b. DIC (thrombocytopenia - Platelet count <100.00)
c. ARDS (PaO2/FiO2 < 250
d. Liver Dysfunction ( bilirubin or SGOT > 2xULN)
e. Acute Renal Failure ( creatinine >2 ULN or baseline)
SEPSIS WITH ORGAN DYSFUNCTION SHOULD BE DOCUMENTED AS SEVERE SEPSIS
Septic Shock is severe Sepsis. Sepsis with hypotension or a failure of the cardiovascular system.
Septic Shock due to Severe Sepsis should be supported by physician documentation
Bacteremia - denotes a laboratory finding only of viable bacteria in the blood. Coding rules state that bacteremia is a
lab finding only and is coded as a symptom.
Urosepsis refers to pyuria or bacteria in the urine (not the blood) and is coded to 599.0 Urinary Tract Infection. Physicians
should remember that a diagnosis of “Urosepsis” is coded to urinary tract infection” not sepsis. If a urinary tract infection has
progressed to a condition of generalized sepsis, the term urosepsis should not be used. The physician should document UTI
with Sepsis. If the infection is a complication of an indwelling Foley catheter, the relationship should be clearly noted in the
record.
3
THE
PULSE
LSMS Releases Member Opinions On Key Healthcare Issues
The Louisiana State Medical Society (LSMS) released the results of an internal survey of its members taken earlier this year. The
response rate reflects the opinions of approximately 20% of the entire membership, which includes full-time and part-time practicing
physicians, academics, residents, medical students and retired physicians.
The issues identified as most concerning to survey respondents, as related to their practices, were:
c Professional medical liability insurance and the stability of the insurance market;
c Medicare/Medicaid reimbursement and future funding of these programs; and
c Reform of Louisiana's healthcare system.
Medicare/Medicaid
- 81% of respondents provided care to Medicare patients; 58% reported that they would begin restricting the number of Medicare patients
they treated if additional payment cuts are imposed in the future.
- 67% reported providing care to Medicaid patients; this is down 12% from the 2005 member survey results.
- 93% of physicians providing care to Medicaid patients were having difficulty finding physician specialists to refer Medicaid patients for
care.
Electronic Health Records
- Only 24% of respondents had converted their offices to electronic health records and/or paperless record-keeping systems.
- Approximately 30% of physicians who have not converted to electronic health records were planning to do so within 36 months, citing
full cost impact as the most influential reason for their decision to delay implementation.
Louisiana Charity Hospital System
When asked about the future of the Louisiana Charity Hospital System, respondents replied:
- The largest percentage, 45% of respondents, believed the system should be modified to maintain primary teaching hospitals and utilize
outpatient treatment centers. By comparison, in the 2005 Member Survey, only 33% chose this option.
- 24% felt the system should be completely phased out in favor of a new redesigned safety net health system.
- 16% indicated their preference would be to move away from state-owned/operated facilities to existing private sector capabilities.
- 15% believe the system should remain the same, statewide, hospital-based system. In the 2005 survey, 40% of respondents agreed the
system should remain the same, a decline of 25% in two years.
- LSMS policy is the LSUHSC Medical System be continued as one of the educational resources necessary to assure adequate numbers
and quality of health care professionals for the state, and the LSMS supports LSUHSC's need to have public university facilities.
PACS/ Office Facilitator Update
PACS seminars will be available to all physicians at Touro the week of May 14 in the Radiology Conference Room on the third
floor. Each class will last about 15 minutes. To RSVP, request access to PACS or for more information, please contact Eric
Silbernagel at 897-8380, or at eric.silbernagel@touro.com
Touro would also like to remind physicians they can request access to SCI Solution's Order Facilitator, a free web-based
application that provides an electronic bridge between Touro and physician offices for outpatient order submittal, receipt and
tracking. For additional information and to obtain access to Order Facilitator, please contact Susan Martin, System Manager, at
897-8788.
4
THE
PULSE
NEW POLICY
TYPE OF ORDER
c TELEPHONE
c VERBAL - Justification for Verbal Order:
c Emergency
c MD gloved for procedure
c Other: ___________________
c READ BACK & VERIFIED
Ordered by: ____________________________ ________ ________
Name/Title
Time
Date
Received by: ___________________________ ________ ________
Name/Title
Time
Date
_____________________________________ ________ ________
PHYSICIAN SIGNATURE
Time
Date
REQUIRED LABEL USE
Effective
Wednesday, May 9, 2007
• Verbal orders must be restricted in use
• Written justification for verbal orders is required
• Authentication (process of reviewing verbal or telephone orders for
accuracy and then signing) must be done within 72 hours
• Physicians and nurses will share responsibility for the restriction of
abbreviated language with verbal and telephone orders
• Policy information available at inside.touro.com - click on
Verbal/Telephone Orders icon
I N F I R M A R Y
LEADING HEALTHCARE FOR OVER 150 YEARS