Blood culture template by 7h1ksWzN

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									In support of the Fiscal Year (FY) 2012 Hospital Inpatient Prospective Payment Systems (IPPS) for Acute Care Hospitals and the Long-Term Care Hospital (LTCH) Prospective
Payment System (PPS) final rule (76 FR 51646-51647, August 2011) , we are providing an excel spreadsheet template to assist hospitals in providing the information
required to validate reporting of central line-associated bloodstream infections (CLABSI) as part of the inpatient quality reporting program.
According to FY 2012 IPPS/LTCH PPS final rule (FR 51646-51647), each hospital selected for validation is to produce a list of positive blood cultures for ICU patients, which is
annotated to identify patients with central venous catheters (CVCs).
• The line list should include all positive blood cultures drawn during an ICU stay, during the episode of care for each patient with an ICU stay that was discharged in the
reporting quarter.
• The hospital should take care to ensure that all patients with positive blood cultures and an ICU stay in any prior quarter that are discharged in the relevant quarter are
also included on the list.
For each patient confirm, patient had:
1) An ICU admission during this hospital stay; and
2) A positive blood culture drawn during or within 48 hours after the ICU stay. The list should include all positive blood cultures for patients in the ICU at the time of or
within 48 hours after the culture was drawn and
3) A central venous catheter in place at any time during the hospital stay.
                                                                         Positive Blood Culture Template

               FIELD                                                            DESCRIPTION
NHSN Facility ID*                   The NHSN-assigned facility ID under which your hospital submits NHSN data.
Provider ID/CCN*                    Hospitals CMS Certification Number.
Hospital Name*                      Hospital Name associated with CCN.
State*                              Enter the 2 character abbreviation for the state in which the hospital is located.
                                                                                                                                        These cells only need to be completed
Calendar Quarter*                   Select the calendar quarter to which the blood culture list pertains.
                                                                                                                                        for the first row in the spreadsheet.
Date of Report*                     Enter the date blood culture list is sent in MM/DD/YY format.
                                                                                                                                        They will be applied to all positive
Hospital Contact Name*              Hospital contact name for CMS to contact with questions.
                                                                                                                                        blood cultures listed on this template.
Contact Phone*                      Phone number for hospital contact listed.
Contact Email*                      Email address for hospital contact listed.
                                    Select Yes or No. Does the hospital have positive blood cultures for ICU patients in the calendar
Positive Blood Cultures (Y/N)*
                                    quarter referenced?
                                    The patient identifier assigned by the hospital. Follow guidance for CMS Inpatient Quality
Patient Identifier*                 Reporting (IQR) Program regarding patient ID requirements. If discharge has been submitted          Complete for every positive blood
                                    for any IQR measures, use this ID.                                                                  culture.
Birthdate*                          The patient date of birth using MM/DD/YY format.
Sex*                                Select Female, Male or other to indicate the gender of the patient.
                                    Select Yes or No. Did the patient have a central line in place at anytime during their hospital
CVC Y/N*
                                    stay. Please include CVCs already in place when the patient was admitted.
Admit Date*
                                    Enter date patient was admitted to hospital in MM/DD/YY format.                                     Complete these cells once per patient.
Discharge Date*                     Enter date patient was discharged from the hospital in MM/DD/YY format.
First Name                          First name of patient.
Middle Name                         Middle name of patient.
Last Name                           Last name of patient.
                              Enter the NHSN ICU location to which the patient was assigned when the positive blood culture
NHSN ICU Location*
                              was drawn. Only cultures drawn from ICU patients or from patients discharged from ICU within
                              48 hours prior to the blood culture draw should be included on the list.
Lab ID*                       Lab ID, accession number or specimen number corresponding to positive blood culture.
Blood Culture Date*           Provide the date the blood culture was collected in MM/DD/YY format.
                                                                                                                            Complete for every positive blood
Blood Culture Time            Provide the time the blood was drawn if easily available in h:mm AM/PM format.
                                                                                                                            culture.
Pathogen Name (A)*
                              Specify pathogen identified. The drop down menu includes the most common pathogens.
Pathogen Name (B)
                              Specify pathogen identified. The drop down menu includes the most common pathogens.
Pathogen Name (C)
                              Specify pathogen identified. The drop down menu includes the most common pathogens.

* indicates required fields

                              This material was prepared by Telligen, Hospital Inpatient Quality Reporting Program Support Contractor,
                              under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department
                              of Health and Human Services. 10SoW-IA-HIQRP-03/12-140
Hospital Inpatient Quality Reporting Program                                Positive Blood Culture Tracking


                                                                                                                                                                    Positive Blood
NHSN Facility ID*   Provider ID/CCN*    Hospital Name*   State* Calendar Quarter*   Date of Report*      Hospital Contact Name*   Contact Phone*   Contact Email*
                                                                                                                                                                    Cultures (Y/N)*
Hospital Inpatient Quality Reporting Program                          Positive Blood Culture Tracking


Patient
            Birthdate* Sex* CVC Y/N* Admit Date* Discharge Date*   First Name Middle Name      Last Name NHSN ICU Location*   Lab ID* Blood Culture Date*
Identifier*
Hospital Inpatient Quality Reporting Program                                 Positive Blood Culture Tracking



Blood Culture Time    Pathogen Name (A)*       Pathogen Name (B)   Pathogen Name (C)
                                                                                NHSN Locations Included in the Hospital IQR Program's CLABSI Reporting
                                          Adult Burn Critical Care                        Critical care area specializing in the care of patients with significant/major burns.       IN:ACUTE:CC:B

                                          Adult Cardiac Critical Care                        Critical care area specializing in the care of patients with serious heart problems      IN:ACUTE:CC:C
                                                                                             that do not require heart surgery.
                                          Adult Medical Critical Care                        Critical care area for patients who are being treated for nonsurgical conditions.        IN:ACUTE:CC:M
Inpatient Adult Critical Care Units




                                          Adult Medical/Surgical Critical Care               An area where critically ill patients with medical and/or surgical conditions are        IN:ACUTE:CC:MS
                                                                                             managed.
                                          Adult Neurologic Critical Care                     Critical care area specializing in treating life-threatening neurological diseases.      IN:ACUTE:CC:N

                                          Adult Neurosurgical Critical Care                  Critical care area specializing in the surgical management of patients with severe IN:ACUTE:CC:NS
                                                                                             neurological diseases or those at risk for neurological injury as a result of surgery.

                                          Adult Prenatal Critical Care                       Critical care area specializing in the management of the pregnant patient with           IN:ACUTE:CC:PNATL
                                                                                             complex medical or obstetric problems requiring a high level of care to prevent the
                                                                                             loss of the fetus and to protect the life of the mother.
                                          Adult Respiratory Critical Care                    Critical care area for the evaluation and treatment of the patient with severe           IN:ACUTE:CC:R
                                                                                             respiratory conditions.
                                          Adult Surgical Cardiothoracic Critical Care        Critical care area specializing in the care of patients following cardiac and thoracic   IN:ACUTE:CC:CT
                                                                                             surgery.
                                          Adult Surgical Critical Care                       Critical care area for the evaluation and management of patients with serious            IN:ACUTE:CC:S
                                                                                             illness before and/or after surgery
                                          Adult Trauma Critical Care                         Critical care area specializing in the care of patients who require a high level of      IN:ACUTE:CC:T
                                                                                             monitoring and/or intervention following trauma or during critical illness related to
                                                                                             trauma.
                                          Pediatric Burn Critical Care                       Critical care area specializing in the care of patients ≤ 18 years old with              IN:ACUTE:CC:B_PED
                                                                                             significant/major burns
                                          Pediatric Cardiothoracic Cricial Care              Critical care area specializing in the care of patients ≤ 18 years old following         IN:ACUTE:CC:CT_PED
Inpatient Pediatric Critical Care Units




                                                                                             cardiac and thoracic surgery.
                                          Pediatric Medical Critical Care                    Critical care area for patients ≤ 18 years old who are being treated for nonsurgical     IN:ACUTE:CC:M_PED
                                                                                             conditions. In the NNIS system, this was called Pediatric ICU (PICU).

                                          Pediatric Medical Surgical Critical Care           An area where critically ill patients ≤ 18 years old with medical and/or surgical        IN:ACUTE:CC:MS_PED
                                                                                             conditions are managed.
                                          Pediatric Neurosugical Critical Care               Critical care area specializing in the surgical management of patients ≤ 18 years        IN:ACUTE:CC:NS_PED
                                                                                             old with severe neurological diseases or those at risk for neurological injury as a
                                                                                             result of surgery.
                                          Pediatric Respiratory Critical Care                Critical care area for the evaluation and treatment of the patients ≤ 18 years old       IN:ACUTE:CC:R_PED
                                                                                             with severe respiratory conditions.
                                          Pediatric Surgical Critical Care                   Critical care area for the evaluation and management of patients ≤ 18 years old          IN:ACUTE:CC:S_PED
                                                                                             with serious illness before and/or after surgery.
                                          Pediatric Trauma Critical Care                     Critical care area specializing in the care of patients ≤ 18 years old who require a IN:ACUTE:CC:T_PED
                                                                                             high level of monitoring and/or intervention following trauma or during critical
                                                                                             illness related to trauma.
Neonatal Units




                                          Neonatal Critical Care Level II/III                Combined nursery housing both Level II and III newborns and infants.                 IN:ACUTE:CC_STEP:NURS
                                          Neonatal Critical Care Level III                   A hospital neonatal intensive care unit (NICU) organized with personnel and          IN:ACUTE:CC:NURS
                                                                                             equipment to provide continuous life support and comprehensive care for
                                                                                             extremely high-risk newborn infants and those with complex and critical illness.
                                                                                             Level III is subdivided into 4 levels differentiated by the capability to provide
                                                                                             advanced medical and surgical care.

								
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