View source for HSC Critical Care Collection Guide

'''''See also:
*''''' [[HSC General Collection Guide]] for information that applies to both HSC Medicine and HSC ICU Data collection.
*''''' [[Medicine Curriculum]] for information that applies to Medicine Data Collection at all sites
*''''' [[ICU Curriculum]] for information that applies to ICU Data Collection at all sites

== Information relevant to all HSC ICU collectors ==
Special serial number apply, see [[Serial_number#Serial_numbering_for_HSC_ICU_.28MICU.2C_SICU.2C_CCU.2C_IICU.29 | Serial Numbers article, Heading "Serial numbering for HSC_ICU (MICU, SICU, CCU, IICU)"]].

==HSC MICU/CCU Collection Guide==
'''MICU/CCU'''
The unit is divided into three sections:
*front 1-10
*back  11-15 and 19-20
*CCU   16,17,18
There are two main desk front and back.The filled in TISS sheets green sheets and test information will be kept in a white binder at each desk.The TISS sheets still in progress will be on a clip board at each desk. Test information is kept for 5 days and then the collector can discard into confidential waste.

There is a Black log book for all MICU patients kept at the front desk. Do not change the numbers as the unit keeps their own data on patients and the numbers collectors use are different.

The green log book for CCU is kept at the back desk.CCU patients are identified by green marker over the serial number on the collector's data collection log and by writing CCU in the index beside the log number.The numbers are shared with the MICU patients using 1-50 of every group of 100.The SICU data collector uses numbers 51-100 of every 100 numbers.

A white board by the front desk lists the patients. It also lists who is on the transfer list and other valuable info.

The Efilm room is in JJ363 and is available for counting Xrays,ultrasounds,CT's and MRI tests.Do not log off this computer as others use it.You have to watch when counting CXR that they are not abdominal Xrays which we do not count.Echo dates need to be obtained from the chart and are often done in this unit.

Green Sheets are kept on the rounds table. Collectors should check daily to make sure each patient has one stamped up. The clerks are very good at this but occasionally one gets missed.

== communication ==
For more complex patients you may need to coordinate with other collectors. Use only initials and birth date to identify patients. Once the communication has gone check off the follow up column on the collectors data collection log. Use the transfer Tracker to see what time out of hospital transfers came from other ICU's. If the time is off notify the collector at the other site. If an error with the times occurs notify Pagasa to correct the sent files.

If a MICU patient overflows into another unit, it is still MICU patient in the location. The number must be taken from the home unit log. The data is collected by the collector where the patient resides and put onto the MICU laptop.  Return to the MICU is not a transfer.

== Pharmacy==

If patients are transferred to the wards the medication records may be in the nurses Mar binder or in a thinned chart.The ward clerks will help locate these thinned charts.

25% Albumin is often given and is often not on the intake and output sheet but will be found on the medication record. Cross reference the blood administration record.

==Workload in this unit is very high. It can be frustrating for other collectors who need to collaborate times, diagnosis etc with the MICU collector. Lots of transfers occur between medicine wards at HSC and MICU/CCU and IICU. Every effort will be made to get these transfer times right. Measurement of medications, tests and xrays are done between these times so accuracy is important. Collection in this unit runs a bit behind and occasionally corrections need to be made to data sent by others. The transfer tracker is very useful to see what times collectors are putting.

== Transfer times ==
To determine transfer times the first set of vital signs is the guide. Medicine collectors at HSC can find the transfer time by looking at the first set of vital signs in MICU. Unless there is a clearly documented time elsewhere in the chart the ward transfer time is usually 10 minutes prior to first set of vitals. It is a rare occurrence that those vital signs are not done. Collectors do need to be careful as there can be many days of addendum sheets.

STB CCU is used as a bed borrow sometimes post angio and then patients are sent to HSC CCU. The only way to tell if it was a bed borrow or not is to look for a nursing transfer record or check our data base's transfer tracker.

If patients overflow in to SICU they remain MICU data collectors patients.

]

==HSC SICU Collection Guide==
=== Log Book ===
The SICU log census book is kept at the South Nursing station.  This is seen when first entering the unit.  The log is in a shelf at the desk, next to the Unit Clerk.  The binder with the completed TISS and Record of Special Treatment and Test sheets is in the same shelf.  The test sheets are a good source for admission and discharge dates and times that may not have been put into the log book.  Patients who were not entered into the log book may also be found here, especially after a weekend as they may have float clerks who will not know to do the entry.  Another way to discover unlogged patients is by looking at the TISS sheets collected in the binder if the patient has already been discharged.

=== Green Sheets ===
The [[Green sheets]] are in a binder on the Rounds Table. When not being used in Rounds, it is usually kept in the side corridor which will leads to the new hotel.  Completed Green Sheets are left at the front of the binder after the patient is discharged.
Next to the desk at the North nursing station is an upright set of shelves which has a space for the TISS and Green sheets which the data collector keeps stocked.

=== Work Space ===
* There is a desk space next to the FAX machine at the South desk that may be vacant for a workspace, but there is no electrical outlet available.  
* There is a larger space at the North Nursing Station which may be free.  There are electrical outlets there and a computer which accesses [[KEA]]. 

=== Coding for OR events during admission ===
See [[Coding for OR events during admission]]

( Depending on how that article pans out it may end up back here, or the link might be moved up to ICU instructions or the general curriculum.Ttenbergen 22:39, 2013 August 26 (CDT))

===PACU===
The admission time for a patient admitted from PACU may not be entered accurately in the log book if they have been held in PACU due to lack of space.  Always check to ensure the time used for the database is accurate.  The SICU physician will enter the admission to SICU on the order sheet and that is considered the time of admission. Any extra time in PACU is then considered overflow in PACU.

===Beds 13 & 14 - A3SDU===
Patients in beds 13 & 14 are temporarily A3SDU patients and not SICU patients.  They may be incorrectly put there by the clerks. If they subsequently are moved into an SICU bed, they are considered a ward admission.
* {{discussion}} What's A3SDU?

=== Transfer Ready Date ===
SICU/IICU must have a 'transfer ready date/time; entered, unless they are transferring to another ICU bed (not including IICU).  Transfer to IICU is treated like a transfer to a ward, but the data collection once there is treated like an ICU patient.

The preferred source for the Transfer Ready date and time is the Green Sheet.  If that is blank, the next source is the doctors' order sheet.

=== Patient Type ===
*The [[Registry Patient Type]] is always 'surgical' in SICU and 'medical' in IICU.
**{{discussion}} That seems to disagree with the content at [[Registry Patient Type]]. Which is right? Ttenbergen 23:03, 2013 August 26 (CDT)

===Overflow=== 
If a patient '''overflows into another unit''', it is still called by its home unit in the location, and the number must be taken from the home unit log. The data is collected by the collector where the patient resides and put onto the home unit database.  Return to the home unit is not a transfer.

If a patient is '''overflowed into PACU''', SICU follows them there. The PACU staff do not complete TISS sheets and transfers out may not get into the log book so must be followed up by the Data Collector.

===Diagnoses===
*'''Respiratory Arrest''' cannot be listed as the first admission.
** {{discussion}} is that true, and is it specific to HSC SICU? [[Respiratory Arrest]] does not mention this... Ttenbergen 23:46, 2013 August 26 (CDT)

*Patients coming from PACU who are still intubated are often a "Failure-to-Wean-Post-Op"/[[P-Op Resp Failure]].
** {{discussion}} Joyce, when we talked today I think you had some specific questions about coding surrounding this code, so I am adding the link to a good venue article here. Can delete this line after, I have added it to [[ICU Curriculum]]. Ttenbergen 23:46, 2013 August 26 (CDT)

=== Rounds ===
Rounds start at 09:00 so the chart may not be available at that time. On Wednesdays Rounds start an hour or 2 later.

===APACHE===
*These numbers are collected from the ICU Addendum Sheet/s and the flowsheets. If the patient comes from PACU, they do not use the ICU Addendum sheets.  Under Admit Type, the surgery must be an E1 to qualify as Emergent.  This info is found on the white typed OR sheet which indicated the start and end times, procedure, etc. (Not the Anesthetic Record).

*The best source for the GCS is the admitting RN's notes.  Patients are often initally on Propofol and this is shortly DC'd which then allows a proper assessment.  The neuro patients or head trauma patients may be sedated for long periods of time and the admission GCS may need to be used.  Those patients will generally have a very poor neuro status even without Propofol.   

=== Clipboards ===
These are kept at each bedside and have 
* the current Flowsheet 
* possibly the Flowsheet for the day before for reference during Rounds
* the MARs

===Charts===
The charts are kept at each bedside. Lab sheets are usually in the chart.

Thinned charts and old charts are kept above the desk by the FAX machine at the South Desk.

Charts of deceased or transferred patients are not kept in the Unit for the Data Collector.
* {{discussion}} Where will they find them? This should probably go into article [[HSC General Collection Guide]] instead if it applies to all of HSC.

===Flowsheets===
*The infusion drugs are listed under the vital signs and not on the MAR's.  The IV med's given are listed on the Fluid Balance section of the Flowsheet, as wellas any colloid.  The colloids should be in red, but are not always.  The number of the unit may be listed, but not the type, e.g. FFP vs PRB.  This may require checking the Blood Admin record for clarification.

===Antibiotic counting===
*When counting antibiotics, be sure to check the yellow STAT sheet for antibiotic boluses.
** {{discussion}} Are these unique to HSC SICU? Also used as MICU? How about at other sites?

=== Labs ===
There was a reference to where labs were listed but I lost it. Please replace this section with where they are documented.

==HSC IICU Collection Guide==
If the patients come from a surgical area the SICU data collector will collect on them but they will be typed as medical patients.

A test book is keep on the shelf on the side of the main desk and completed TISS and green sheets are kept there.

TISS are kept on the clipboards at the bedside. You really have to watch the dates and numbers on these as time goes on it is easy to get mixed up!

Green sheets are kept on the front of the chart as far as I can tell,they tend to get moved around.

Go to IICU once a week for pharmacy collection purposes, collect the TISS and hand it in as soon as the page is complete.The data on line counts needs to be as current as possible.


[[Category:Health Sciences Center Office]]
[[Category:Site Specific Collection Guide]]
[[Category: Data Collection Guide]]