Chronic Respiratory Failure (Diagnosis of the Month)

Chronic respiratory failure is caused by abnormalities of oxygenation and carbon dioxide elimination due to chronic lung disease. Classification of chronic respiratory failure: Hypoxic Hypercapnic Unspecified Common causes of chronic respiratory failure: Severe COPD Pulmonary fibrosis Interstitial lung disease Cystic fibrosis Diagnostic Criteria: Hypoxemia of variable severity (often with baseline pO2 <60 on room air) Elevated…

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Surgical Site Infection Task Force

Steven E. Ochs, M.D., chairman of Mercy Medical Center’s Department of Surgery, has a goal to hardwire surgical site infection prevention processes in the perioperative areas. After research, utilizing CDC and AORN guidelines and the expertise of the Mercy IC team, guidelines were developed. Colon and abdominal hysterectomy procedures are a major area of focus,…

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What Do Patients Really Want from Their Physician?

Research from our Patient Satisfaction vendor, NRC Health, concludes the number one thing that patients want in a doctor–the factor that beats out reputation, personality, and even providing high quality care–is “a doctor that listens to me.” Patients were then asked, “What do you think are the most important aspects of communicating with a doctor?”…

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Timely Response to CDI Queries

Many of you make an effort to answer your Clinical Documentation Improvement (CDI) queries in a timely manner, and your efforts are greatly appreciated. The CDI staff would appreciate it if everyone made this a priority, as it is an important part of your clinical documentation responsibilities. Most queries will occur on inpatients, and it…

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Documentation Tips

Documentation Continuity Any diagnosis/conditions that are being treated and/or monitored should be documented continuously throughout the medical records. Example: Patient admitted with diagnosis of Sepsis due to Pneumonia and Acute Respiratory Failure. During the hospital stay, patient received initial treatment for these diagnoses. Once the patient is no longer receiving treatment     for Sepsis and…

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Diagnosis of the Month: Respiratory Infections

Follow these guidelines when diagnosing respiratory infections: The more specificity that you can provide for any respiratory diagnosis, the better. Avoid “lower respiratory tract infection” (LRTI) when at all possible. Instead, indicate a bronchitis or pneumonia diagnosis if you are able. Also, indicate acute bronchitis if that is the case, in order to differentiate it…

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Documentation Inconsistencies

Physicians frequently ask CDI staff, “Why am I being queried?” Querying a physician is a vital part of the documentation process to ensure complete and accurate health record documentation. When to Query Lack of consistent documentation of the diagnosis through the progress notes and discharge summary. Inconsistencies or conflicts between physician documentation. Symptoms not linked…

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Medical Staff Performance Improvement

Mercy Medical Center physicians are engaged in the 2018 quality initiatives improving hand hygiene compliance and decreasing surgical site infections. Hand hygiene is important for every person and every patient encounter to reduce the spread of infection, especially C-diff. One area of physician concern was the lack of accessible sinks and accessibility of hand sanitizer.  Mercy Plant…

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Accumen’s Recommended Transfusion Guidelines: Adult Red Blood Cell

GUIDANCE STATEMENT: These represent guidelines for transfusion. Not all patients who meet the criteria set forth in these guidelines will require transfusion. In certain clinical circumstances the provider may consider transfusion to be appropriate outside these guidelines. The decision to transfuse is a clinical decision based on real-time clinical assessment of the patient by the…

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Comprehensive Patient Blood Management: An Urgent Need for a New Clinical Strategy

Published studies suggest that 40 to 60 percent of all blood transfusions may be unnecessary, excessive or avoidable. Blood transfusion is one of the most common medical procedures performed at Mercy Medical Center with approximately 9,000 transfusions administered annually. Growing evidence continues to associate transfusion with a higher incidence of infections, renal injury, pulmonary injury,…

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Post Discharge Phone Calls

Mercy has an automatic call system to discharged patients giving patients an opportunity to request a follow-up call from the hospital. This initiative is to reduce patient anxiety, reduce readmission, improve satisfaction, and influence quality and performance. These requests go to the director/manager of the discharging unit. The response has been very positive from the…

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Physician Education in March, April, and May 2018

CRITICAL CARE GRAND ROUNDS CONFERENCES 11:45 a.m.  Registration/Lunch 12:15 p.m.  Lecture Medical Marijuana in Ohio: 
Ready or Not? Wed., March 21 Mercy Hall Auditorium Presented by: Kyle A. Sobecki, PharmD, BCPS, director of Mercy Pharmacy Save Blood Save Lives: Comprehensive Patient Blood Management Wed., April 18 ACC Auditorium Presented by: Kirby Sweitzer, MD, Katie Simmons,…

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Documentation Inconsistencies

Physicians frequently ask CDI staff, “Why am I being queried?” A few of the main reasons include diagnosis documentation inconsistencies or conflicts with another treating physician and not linking a cause to a diagnosis present on admission. Example 1: A patient is admitted with infiltrates and started on antibiotics; cxr impression indications “suspected pneumonia.” The…

Mercy Implements SNAP Huddles

To help prepare the hospital for the future of health care delivery, Mercy Medical Center has partnered with Care Logistics, a company with more than a decade of experience working with hospital partners to implement breakthrough approaches to care coordination and throughput efficiency, combined with innovative human logistics software. This process is a transformational journey,…

Lane Appointed Quality & Patient Safety Director

Dan Lane, RN, MSN, NE-BC, has been appointed director of Quality & Patient Safety at Mercy Medical Center. Lane reports to Paul Hiltz, interim CEO. Quality initiatives for 2018 will focus on: • Increasing patient satisfaction scores • Decreasing surgical infection rates • Increasing hand hygiene rates • Increasing staff perception of safety “I want…

Guidelines to Manage Heart Failure Patients

Approximately 5.1 million Americans have symptoms of heart failure (HF), according to the American Heart Association. The 2013 AACF/HF guidelines updated the previous 2005 Heart Failure Guidelines and the 2009 focused update to help providers in decision-making for individual patients. It provides a comprehensive guide to the evaluation and management of heart failure patients. It…

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Decreasing CAUTI

Medical Executive Committee supports and approved the evidence based practice of decreasing CAUTI through the approval of a nurse driven protocol to remove foley catheters based on the following: Criteria for Continuing Indwelling Urinary Catheter Known or suspected urinary tract obstruction Neurogenic bladder dysfunction/urinary retention Recent urological surgery, bladder surgery, pelvis surgery or recent surgery…

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Malnutrition Criteria

What criteria do Mercy dietitians use to assess for malnutrition? These guidelines recommend that the diagnosis of adult malnutrition be based on the presence of two or more of the following characteristics: Insufficient energy intake Weight loss Loss of subcutaneous muscle Loss of subcutaneous fat Localized or generalized fluid accumulation Diminished functional status as measured…

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Joint Commission Update

Thank you for your preparedness and willingness to participate with The Joint Commission surveyors during their visit last month. Although we have a few corrections to make, the overall survey went extremely well. Areas identified as needing improvement involved informed consent. Surveyors identified that patients’ rights were violated based on the fact that the risk,…

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Isolation and Clearance for C.diff Patients

Mercy Medical Center Infection Prevention and Control Policy # 8.00 “Isolation” states nurses may exercise emperic precautions by isolating patients suspicious of an illness requiring transmission-based precautions (isolation). In cases of patients that have a history that places them at risk for Clostridium difficile infection (CDI) and who are exhibiting signs and symptoms, isolation may…

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Unity Health Provides Expanded Coverage

We are pleased to announce that Unity Health Network Physicians will now provide inpatient nursing unit call coverage, ambulatory office coverage, sleep medicine and Lung Cancer Program consultation services for Mercy and your patients. This will be in addition to their current critical care intensivist coverage of the Mercy Intensive Care Unit. Consult services will…

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