From the Forum: Help! My pediatricians won’t document respiratory failure!

It’s a problem most CDI professionals reviewing pediatric records know well: physicians are often reticent to diagnose acute respiratory failure for their patients. For those just starting out with pediatric record reviews, it can seem like an uphill battle.

When one new pediatric CDI professional, Randi Monroe, RN, ACM, encountered the problem recently, she brought it to the ACDIS Forum. As is often the case on the Forum threads, the poster received several answers quickly from her peers.

“We’ve all been in your shoes before,” said Jeff Morris, RN, BSN, CCDS, CDI supervisor at the University of Southern Alabama Health System in Mobile. “I think it’s more of a training issue with the [pediatricians]. They feel like respiratory failure means intubation plus vent.”

Since not all pediatric patients experiencing respiratory failure are on a ventilator, one helpful exercise is to consider what would happen if the current treatment was discontinued. According to the book Pediatric CDI: Building Blocks for Success, in many cases, the pediatric patient would need to be ventilated due to respiratory failure.

Pediatric CDI professionals may also encounter physicians hesitant to document respiratory failure when an arterial blood gas (ABG) level wasn’t obtained, according to Claudine Close, RN, CDI specialist at The Children’s Hospital at Saint Francis in Tulsa, Oklahoma.

“We all know that blood gases (especially ABGs) hurt like the dickens and we usually avoid adding stress to the patient when he or she is already in respiratory distress, right? So, what other criteria can I use to base a query on?” she said. Even without an ABG, Close recommended several criteria, including:

• Room air saturation
• Amount of supplemental oxygen
• Signs of work of breathing
• Any treatments such as nebulizers or intravenous steroids

“We also calculate the SF [pulse oximetric saturation Spo2/Fio2] ratio because often kiddos are put on oxygen right away even before a VBG [venous blood gas] is obtained,” says Jackie Touch, RN, MSN, CCDS, CDI specialist at CHOC Children’s in Orange, California.

While the clinical criteria offered on the Forum thread likely answered the original question for the new pediatric CDI professional, the respondents also encouraged further networking to help get up to speed in the world of pediatrics.

“ACDIS is a wealth of knowledge and we have a pediatric sub group, APDIS,” said Morris, offering to connect the poster to the APDIS leadership for support. “I would also recommend trying to attend the conference this year if at all possible. We have an entire pedi track this year.”

Editor’s note: This articles was adapted from a thread on the ACDIS Forum. For more information regarding ACDIS’ new pediatric CDI book, click here. For more information about the pediatric networking group, APDIS, and to get involved, click here. For information about how to post on the Forum and set your notifications, click here. To read the ACDIS white paper on pediatric respiratory failure, click here.