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'''''Note:''' This is a proposed project only at this time. Please feel free to comment if any instructions are unclear, though!''
{{Project
|ProjectActive=legacy
|ProjectProgram=Med
|ProjectRequestor=Kimberly Jabusch
|ProjectCollectionStartDate=2009-10-29
|ProjectCollectionStopDate=2010-01-31
|Project={{PAGENAME}}
}}


The Nursing Leadership Counsel at St Boniface is working on reducing the incidence and duration of urinary catheterizations without appropriate clinical indications for medicine patients at St Boniface.  We will collect some data for them as part of our temporary studies, initially for three months, but possibly longer pending the results at that time.


== Times ==
{{LegacyContent
|content= }}


*Estimated Start Date: ???
The Nursing Leadership Counsel at '''St Boniface General Hospital''' is working on '''reducing''' the '''incidence''' and '''duration''' of urinary catheterizations '''without appropriate clinical indications''' for '''medicine''' patients at '''St Boniface General Hospital'''.  We will collect some data for them as part of our temporary studies, initially for three months, but possibly longer pending the results at that time.  
*Review Date (~75 days after start):
*Preliminary End Date (3 months after start):
=== Discussion ===
{{Discussion}}
* It would be good to start it next week so that we can work out any problems. Would like to pilot it for a few weeks before vacations start on STB medicine.  First round of vacation starts June 15.  At least collector will learn the process before this date and be able implement before she goes. Julie is away last 3 weeks of July.[[User:TOstryzniuk|TOstryzniuk]] 15:54, 2 June 2009 (CDT)
**Tina, can I have a copy for my PDA and Julie and I can review? thanks.[[User:TOstryzniuk|TOstryzniuk]] 15:54, 2 June 2009 (CDT)
***Trish, I think this is a perfect opportunity to get you adding a project to temporary studies. Someone in addition to me needs to know how to do this. If you follow the guideline I set up [[#Data Structure Setup | below]] and add the data to the s_tmp on the PDA and in Access you'd be set. If you want to set up a meeting for me to come by and watch to make sure all goes right, please book me for an hour or so. [[User:Ttenbergen|Ttenbergen]] 10:48, 3 June 2009 (CDT)


=== Discussion ===
==[[:Category: Catheter09 Meeting Dates | Catheter09 Meeting Minutes]]==
{{Discussion}}
* [[Catheter09_Wednesday, October 28.09]]
* Will this study be impacted by running over the summer months? [[User:Ttenbergen|Ttenbergen]] 17:23, 1 June 2009 (CDT)
* [[Catheter09 Wednesday, November 25, 2009]]
**Summer is always a challenge. (between May and Aug).  I have 10 weeks of vacation between 3 people with no coverage at this time.  (3 wks in June, 4 wks in July & 3 wks in Aug).   If the program is willing to accept data that is not "immediately" available and up to date and that catch up work can be done in Medical records then it can be done over the summer. (Trish)   
**The vacation free period for STB-MED is Sept 4 to Nov 30.09. (Trish)


== Dates ==
===Testing Date===
*Testing period October 1-28, 2009
===Start Date===
*Real time start date: All patients who are "discharges" starting '''October 29, 2009'''
===Review Date===
*Review Date (~75 days after start): 15 Dec 2009
===Stop Date===
*'''January 31,2010 @ midnight''''''.--[[User:TOstryzniuk|TOstryzniuk]] 20:01, 27 January 2010 (CST)
*patients that were "admitted" prior to Jan 31.10 midnight, '''you will continue to follow until they are discharged or transferred to another ward from your ward'''.  Once this occurs, the catheter09 study is done for that patient.--[[User:TOstryzniuk|TOstryzniuk]] 17:27, 1 February 2010 (CST)
Last patient was discharged long ago, disabling this study in CCMDB. [[User:Ttenbergen|Ttenbergen]] 12:32, 25 February 2011 (CST)


== Collection Instructions ==
== Collection Instructions ==
Make a record in L_TmpV2 for every indwelling urinary catheter on your ward. It does not matter whether the patient arrived with it or was catheterized locally.  
Make a record in L_TmpV2 for every indwelling urinary catheter on your ward. It does not matter whether the patient arrived with it or was catheterized locally. '''This data needs to be completed as soon as possible for '''''all''''' patients, not only those who are being sent, since the data is sent for all patients every time data is sent. ''


We need more data than you can put on one line. We could have recorded a line for each data element, but to speed it up for you we combined them on 4 lines as follows:  
In the TMP file, every patient must have '''TWO lines''' of entries for '''every foley catheter''' incident.
# R-<option> = "Reason" from Item dropdown list; "Dr. order" on ''checkbox''; DT-Inserted = Insertion date/time
We need more data than you can put on one line. We could have recorded a line for each data element, but to speed it up for you we combined them on 2 lines as follows:
# W-<option> = "Where inserted" from Item dropdown box; "post-insert UTI" ''checkbox'';  DT-Removed = Removal date/time
Under '''Item''':  
# R-"Reason" from Item dropdown list; cath event #"1"; "Dr. order" on ''checkbox''; in date; in time.
# W-"Where inserted" from Item dropdown box; cath event #"1";  "UTI post" ''checkbox'';  out date; out time. (may not have a removal date if: died, moved to ICU or moved to another ward with same foley)


For example:  
*For example:  
* Project: Catheter09; Item: “R-Urinary incontinence”, Dr order: “yes”, “DT-Inserted”, Date: 12 May 09 10:00
'''*1. Project: Catheter09'''
* Project: Catheter09; Item: “W-HSC A4”, post-insert UTI: “no”, “DT-Removed”, Date: 14 May 09 14:00
*Item: “''R-Urinary incontinence''”  SEE: ([[Catheter09#Value_-_Actual_.28R.29_.22reason.22_for_insertion_options Go to drop down list options]])
*cath event # "''1''"
*Dr order: “''yes''”
*in date: "''12 May,09''"
*in time: "''10:00''"
 
'''*2. Project: Catheter09'''
*Item: “''  STB_ER''”  SEE: ([[Catheter09#Value_Actual_.28W.29_.22where.22_inserted_options Go to drop down list options]])
*cath event # "''1''"
*UTI post: “''no''”,  
*“out date”, "''14 May 0''9"
*out time, ''14:00''


If a patient was catheterized more than once, enter several sets of records. Make sure you finish entering one set of records before starting the next, as the record date/time will be used to group the records.  
If a patient was catheterized more than once, enter several sets of records. Make sure you finish entering one set of records before starting the next, as the record date/time will be used to group the records.  


===Discussion===
=== "Reason for insertion" data ===
 
Choose the '''first''' item starting with an''' “R-”''' listed under Catheter09’s item list that applies to this patient. The items are specifically ordered so that if you choose the first one that applies we will get the best results.
 
==== adding an incident coutner ====
{{Discussion}}
*To group the records per incidence clearly, I suggest we add a Catheter counter (1,2,3,and so on) under the INT_var field. So for the first incident, the counter will be 1 for the four records.[[User:JMojica|JMojica]] 10:59, 2 June 2009 (CDT)
*allows data collectors to sort and "group" incidents especially if there will be more than one. [[User:TOstryzniuk|TOstryzniuk]] 11:50, 2 June 2009 (CDT)
** If I understand the suggestion this would be the identifier that groups the 4 lines to one event. We can certainly add that, but it also adds one more thing that DCs have to tap into the PDA. It may be worth it, though. I am worried about calling it "counter" because someone will inevitably try to use it to just state how many catheterizations the patient has had. Do you think calling it just "event" would work? At least that is non-intuitive enough that DCs would look it up, and once they have looked it up it should make enough sense. [[User:Ttenbergen|Ttenbergen]] 10:48, 3 June 2009 (CDT)
***event sounds good.[[User:TOstryzniuk|TOstryzniuk]] 16:34, 3 June 2009 (CDT)


=== Reason data ===
===Catheter event data (int_var_label)===
Choose the '''first''' item starting with an “R-” listed under Catheter09’s item list that applies to this patient. The items are specifically ordered so that if you choose the first one that applies we will get the best results.
Catheter event number, i.e. "1" for the first catheterization, "2" for the second


=== Dr order ===
=== Dr order ===
Is there a doctor’s order to catheterize in the chart?
Check the checkbox if there is a doctor’s order to catheterize in the chart
*should be on the physicans order form.


 
=== in date, in time (insert) / out date, out time (remove)===
=== DT-inserted / DT-removed ===
Date and time the catheter was inserted or removed.  
Date and time the catheter was inserted or removed.  
* If you can’t find a time, use midnight.
* Make a reasonable effort to find the right time/date
** If the time is in fact midnight, record 23:59  
** If you can’t find a '''time''', use midnight
*** If the time is in fact midnight, record 23:59
** If you can't find a '''date''', use your best guess
** If you can't find a '''time or date''', enter your best approximation given the available data


=== "Where" Data ===
=== "Where" Data ===
Choose the place (elements starting with "W-") where the catheter was inserted.
Choose the place (elements starting with "W-") where the catheter was inserted.
===UTI (urinary track infection)===
Check the UTI check box for any patient who acquired a UTI while catheterized.
For the UTI to be considered catheter related, the positive (+ve) urine sample must be taken between '''>48 hrs after''' the catheter has been inserted and '''<=48 hrs after''' the catheter was removed.


== Data Structure Setup ==
== Data Structure Setup ==
The s_tmp lines driving this will be similar to the following table. These lines need to be added to the s_tmp table on [[ccmdb.mdb]] and on the PDA.
The s_tmp lines driving this will be similar to the following table. These lines need to be added to the s_tmp table on [[CCMDB.accdb]].
 
{| class="wikitable" border=1 <hiddentext> set to 0 for no borders</hiddentext>
{| class="wikitable" border=1 <hiddentext> set to 0 for no borders</hiddentext>
|- style="background-color:#C0C0C0;font-size:9pt" align="center" valign="bottom"
|- style="background-color:#FFFF99"
| width="53" height="37" | Project
| width="55" height="37" valign="bottom" | Project
| width="120" | Value
| width="140" align="center" valign="bottom" | Value
| width="146" | Instruction
| width="126" valign="bottom" | Instructions
| width="25" | int var label
| width="72"  valign="bottom" | int_var_label
| width="25" | float var label
| width="47"  valign="bottom" | float_var_label
| width="40" | bool var label
| width="50"  valign="bottom" | bool_var_label
| width="50" | date var label
| width="72"  valign="bottom" | date_var_label
| width="50" | time var label
| width="72"  valign="bottom" | time_var_label
| width="48" | complete send
| width="75"  valign="bottom" | complete_sent


|- style="font-size:9pt" valign="bottom"
|-  
| height="14" | Catheter09
| height="32" valign="bottom" | Catheter09
| R-<one line per [[#Actual "reason" options |reason]]>
| valign="bottom" | R-arrived with foley (one line per [[#Actual "reason" options |reason]]
  | catheterization reason, dr order
| valign="bottom" | see Wiki Catheter09
  | --
| valign="bottom" | cath event "#"
  | --
| valign="bottom" | ~~
  | Dr Order
| valign="bottom" | '''Dr order''' (checkbox marked = Yes)
  | --
| valign="bottom" | in date
  | --
| valign="bottom" | in time
  | True
| valign="bottom" | TRUE


|- style="font-size:9pt" valign="bottom"
|-  
| height="14" | Catheter09
| height="28" valign="bottom" | Catheter09
  | DT-Inserted
| valign="bottom" | W-(where inserted). One line per option
  | insertion date
| valign="bottom" | see Wiki Catheter09
  | --
| valign="bottom" | cath event "#"
  | --
| valign="bottom" | ~~
  | --
| valign="bottom" | '''UTI''' (checkbox marked = Yes)
  | Insert dt
| valign="bottom" | out date
| Insert tm
| valign="bottom" | out time
  | True
|  valign="bottom" | TRUE


|- style="font-size:9pt"  valign="bottom"
|}
| height="14" | Catheter09
| DT-Removed
| removal date
| --
| --
| --
| Remove dt
| Remove tm
| True


|- style="font-size:9pt"  valign="bottom"
| height="15" | Catheter09
| W-<one line per option>
| insert location; post-insertion UTI
| --
| --
| PI UTI
| --
| --
| True


|}
===Study (Project) "Catheter09===


=== Actual "reason" options ===
=== Value - Actual '''(R) "reason"''' for insertion options ===
''Note: Arrived with is at the top because it should be chosen for anyone arriving from off unit. Since the instructions say to use the first item on the list which applies, sorting it to the top will make it the option chosen for all who arrive catheterized.''
''Note: Arrived with is at the top because it should be chosen for anyone arriving from off unit. Since the instructions say to use the first item on the list which applies, sorting it to the top will make it the option chosen for all who arrive catheterized.''
*Arrived to the unit with catheter
*R-arrived with foley
*Urinary incontinence  
*R-routine foley change (Nov 9.09)--[[User:TOstryzniuk|TOstryzniuk]] 20:18, 9 November 2009 (CST)
*Acute/chronic retention  
*R-urinary incontinence  
*Accurate urinary output monitoring
*R-acute/chronic retention  
*Management of perianal/sacral wounds
*R-accurate urinary output  
*Palliative care
*R-Mgt decubitus ulcer  (perineal/sacral wounds)
*Hemostasis for active bleeding
*R-palliative care
*Ordered by Urologist
*R-hemostasis-active bleeding
*Ordered pre-procedure/surgery
*R-ordered by Urologist
*Monitoring of hematuria
*R-order pre OP/procedure
*Patient preference
*R-monitoring of hematuria
*R-patient preference
*R-unknown


=== Actual "where" options ===
===Catheter event (int_var_label)===
*SBGH ER Dept
*each foley catheter insertion has 2 lines of information in L_tmp. One for insertion the other for removal.
*SBGH ICU
*an identifier allow collector to group the 2 lines to one event. 
*This Ward
*For example for ONE patient:
*Other SBGH Unit (we don't just consider our units for that)
**Reason for insertion of initial catheter would have a cath event #1.  The remove of this catheter would also be marked with cath event #1.
*Other Facility
**If another foley is reinserted, then this would be marked as cath event #2.  When it is removed, it would also marked as event 2.
*feel free anyone to reword this example.[[User:TOstryzniuk|TOstryzniuk]] 17:38, 3 June 2009 (CDT)


=== Complete Files Only? ===
=== Value Actual '''(W) "where"''' inserted options ===
{{discussion}}
*W-STB ER
* Will we need this data only once a patient is sent, or as the recording proceeds? I suspect only as a patient is sent... [[User:Ttenbergen|Ttenbergen]] 17:23, 1 June 2009 (CDT)
*W-STB ICU
** Good question. Follow-up to this is 'Is there a time period the Investigator wanted the outputs to be summarized? Ex. how many catherization days occured for months of July and Aug. The time reference here is either the date inserted or the date removed.  If yes then the data is needed as recording proceeds.  But if the interest is data on a per patient level, then the data is needed once a patient is sent.  The time reference to be used if needed is the Discharge Date.  There will be a long wait for patients having a long stay.' [[User:JMojica|JMojica]] 11:18, 2 June 2009 (CDT)
*W-This Ward
*** I almost got the impression that Kim and co. will do their own analysis. This would be all the better for you, Julie, since it would save you time. It might be nice to pump it into an Access file for them, that way they can just pivot-table it any way they want - it's really quite slick. I am suggesting this based on the idea that Julie's time is at a premium here. If we use a tool that allows people to do their own investigation, then we don't need to decide ahead of time how to group. I may be underestimating the skill set required, but it sounds like this would be a good group to try with since they said they have some data analysis capability within their group. [[User:Ttenbergen|Ttenbergen]] 10:48, 3 June 2009 (CDT)
*W-Other STB ward
*W-Other Facility
*W-Not Applicable (do not use this option if admitted from ER).  If this item is used you must type reason in comment section.  (not rolled out yet)--[[User:TOstryzniuk|TOstryzniuk]] 09:36, 3 November 2009 (CST)


== Data Processing ==
== Data Processing ==
Our [[statistician]] will pull the data from the TmpV2_1.mdb file on the regional server. We will provide this data to the requester in the following format:  
Our [[statistician]] will pull the data from the TmpV2_1.mdb file on the regional server. We will provide this data to the requester in the following format:  
:Serial
:Serial
:Site (we don't need site since this is only for StB)
:Site (we don't need site since this is only for STB)
:Location
:Location
:Catheter Event
:Catheter Event
:Reason
:(R)Reason
:Dr.Order
:Dr.Order
:D-Inserted
:Date & time Inserted
:D-Removed
:Date & time Removed
:Total catheter days(calculated - if this comes in an Access file it can be generated internally right there)
:Number of catheter days per ward admission (calculated as difference between Date & Time Removed and Date & Time Inserted)
:Where
:(W)Where inserted
:Post Insertion (PI) UTI
:Post Insertion UTI (urinary tract infection)
*We will not provide patient identifiers at this time, but if necessary later we can resolve Serial, Site and location to patient identifiers.  
*We will not provide patient identifiers at this time, but if necessary later we can resolve Serial, Site and location to patient identifiers.  


*Summary statistics will be provided like frequencies for  Reasons and PI-UTI  and descriptive stats (N, mean,median, STD, min, max) for Catheter days. [[User:JMojica|JMojica]] 10:22, 2 June 2009 (CDT)
*Summary statistics will be provided: 1)Frequencies for  Reasons, PI-UTI, Dr Orders, Where Inserted and 2)descriptive stats (N, mean,median,sum, Std Dev, min, max) for 'Total Catheter Days per patient' defined as the sum of catheter days of all ward admissions of a given patient.  
** don't use that acronym here, it may mean different things to medical folks in a genitourinary setting ;-) [[User:Ttenbergen|Ttenbergen]] 10:48, 3 June 2009 (CDT)
 
** see above re. whether to analyze this data for them [[User:Ttenbergen|Ttenbergen]] 10:48, 3 June 2009 (CDT)
==Project Wrap up Comments==
*On behalf of the Medicine Program Nursing Leadership Council, thank you to you and your entire team for their assistance with this project.  The preliminary data was shared with the Council last week and this was the baseline data we required to now be able to move on to implementation of the clinical practice guidelines. I have spoken with Julie and she will provide a final report in February 2010.  I do not require a final meeting.  Again, thanks much. Regards,
*Kimberly Jabusch, RN MN BA
*Clinical Nurse Specialist
*St. Boniface General Hospital
*Medicine Program
 
{{Data Integrity Check List|}}
 


[[Category:Special Short Term Projects]]
[[Category:Catheter09]]
  }}

Latest revision as of 12:05, 5 January 2022

Projects
Active?: legacy
Program: Med
Requestor: Kimberly Jabusch
Collection start: 2009-10-29
Collection end: 2010-01-31
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The Nursing Leadership Counsel at St Boniface General Hospital is working on reducing the incidence and duration of urinary catheterizations without appropriate clinical indications for medicine patients at St Boniface General Hospital. We will collect some data for them as part of our temporary studies, initially for three months, but possibly longer pending the results at that time.

Catheter09 Meeting Minutes

Dates

Testing Date

  • Testing period October 1-28, 2009

Start Date

  • Real time start date: All patients who are "discharges" starting October 29, 2009

Review Date

  • Review Date (~75 days after start): 15 Dec 2009

Stop Date

  • January 31,2010 @ midnight'.--TOstryzniuk 20:01, 27 January 2010 (CST)
  • patients that were "admitted" prior to Jan 31.10 midnight, you will continue to follow until they are discharged or transferred to another ward from your ward. Once this occurs, the catheter09 study is done for that patient.--TOstryzniuk 17:27, 1 February 2010 (CST)

Last patient was discharged long ago, disabling this study in CCMDB. Ttenbergen 12:32, 25 February 2011 (CST)

Collection Instructions

Make a record in L_TmpV2 for every indwelling urinary catheter on your ward. It does not matter whether the patient arrived with it or was catheterized locally. 'This data needs to be completed as soon as possible for all patients, not only those who are being sent, since the data is sent for all patients every time data is sent.

In the TMP file, every patient must have TWO lines of entries for every foley catheter incident. We need more data than you can put on one line. We could have recorded a line for each data element, but to speed it up for you we combined them on 2 lines as follows: Under Item:

  1. R-"Reason" from Item dropdown list; cath event #"1"; "Dr. order" on checkbox; in date; in time.
  2. W-"Where inserted" from Item dropdown box; cath event #"1"; "UTI post" checkbox; out date; out time. (may not have a removal date if: died, moved to ICU or moved to another ward with same foley)
  • For example:

*1. Project: Catheter09

*2. Project: Catheter09

If a patient was catheterized more than once, enter several sets of records. Make sure you finish entering one set of records before starting the next, as the record date/time will be used to group the records.

"Reason for insertion" data

Choose the first item starting with an “R-” listed under Catheter09’s item list that applies to this patient. The items are specifically ordered so that if you choose the first one that applies we will get the best results.

Catheter event data (int_var_label)

Catheter event number, i.e. "1" for the first catheterization, "2" for the second

Dr order

Check the checkbox if there is a doctor’s order to catheterize in the chart

in date, in time (insert) / out date, out time (remove)

Date and time the catheter was inserted or removed.

  • Make a reasonable effort to find the right time/date
    • If you can’t find a time, use midnight
      • If the time is in fact midnight, record 23:59
    • If you can't find a date, use your best guess
    • If you can't find a time or date, enter your best approximation given the available data

"Where" Data

Choose the place (elements starting with "W-") where the catheter was inserted.

UTI (urinary track infection)

Check the UTI check box for any patient who acquired a UTI while catheterized.

For the UTI to be considered catheter related, the positive (+ve) urine sample must be taken between >48 hrs after the catheter has been inserted and <=48 hrs after the catheter was removed.

Data Structure Setup

The s_tmp lines driving this will be similar to the following table. These lines need to be added to the s_tmp table on CCMDB.accdb.

Project Value Instructions int_var_label float_var_label bool_var_label date_var_label time_var_label complete_sent
Catheter09 R-arrived with foley (one line per reason see Wiki Catheter09 cath event "#" ~~ Dr order (checkbox marked = Yes) in date in time TRUE
Catheter09 W-(where inserted). One line per option see Wiki Catheter09 cath event "#" ~~ UTI (checkbox marked = Yes) out date out time TRUE


Study (Project) "Catheter09

Value - Actual (R) "reason" for insertion options

Note: Arrived with is at the top because it should be chosen for anyone arriving from off unit. Since the instructions say to use the first item on the list which applies, sorting it to the top will make it the option chosen for all who arrive catheterized.

  • R-arrived with foley
  • R-routine foley change (Nov 9.09)--TOstryzniuk 20:18, 9 November 2009 (CST)
  • R-urinary incontinence
  • R-acute/chronic retention
  • R-accurate urinary output
  • R-Mgt decubitus ulcer (perineal/sacral wounds)
  • R-palliative care
  • R-hemostasis-active bleeding
  • R-ordered by Urologist
  • R-order pre OP/procedure
  • R-monitoring of hematuria
  • R-patient preference
  • R-unknown

Catheter event (int_var_label)

  • each foley catheter insertion has 2 lines of information in L_tmp. One for insertion the other for removal.
  • an identifier allow collector to group the 2 lines to one event.
  • For example for ONE patient:
    • Reason for insertion of initial catheter would have a cath event #1. The remove of this catheter would also be marked with cath event #1.
    • If another foley is reinserted, then this would be marked as cath event #2. When it is removed, it would also marked as event 2.
  • feel free anyone to reword this example.TOstryzniuk 17:38, 3 June 2009 (CDT)

Value Actual (W) "where" inserted options

  • W-STB ER
  • W-STB ICU
  • W-This Ward
  • W-Other STB ward
  • W-Other Facility
  • W-Not Applicable (do not use this option if admitted from ER). If this item is used you must type reason in comment section. (not rolled out yet)--TOstryzniuk 09:36, 3 November 2009 (CST)

Data Processing

Our statistician will pull the data from the TmpV2_1.mdb file on the regional server. We will provide this data to the requester in the following format:

Serial
Site (we don't need site since this is only for STB)
Location
Catheter Event
(R)Reason
Dr.Order
Date & time Inserted
Date & time Removed
Number of catheter days per ward admission (calculated as difference between Date & Time Removed and Date & Time Inserted)
(W)Where inserted
Post Insertion UTI (urinary tract infection)
  • We will not provide patient identifiers at this time, but if necessary later we can resolve Serial, Site and location to patient identifiers.
  • Summary statistics will be provided: 1)Frequencies for Reasons, PI-UTI, Dr Orders, Where Inserted and 2)descriptive stats (N, mean,median,sum, Std Dev, min, max) for 'Total Catheter Days per patient' defined as the sum of catheter days of all ward admissions of a given patient.

Project Wrap up Comments

  • On behalf of the Medicine Program Nursing Leadership Council, thank you to you and your entire team for their assistance with this project. The preliminary data was shared with the Council last week and this was the baseline data we required to now be able to move on to implementation of the clinical practice guidelines. I have spoken with Julie and she will provide a final report in February 2010. I do not require a final meeting. Again, thanks much. Regards,
  • Kimberly Jabusch, RN MN BA
  • Clinical Nurse Specialist
  • St. Boniface General Hospital
  • Medicine Program

Data Integrity Checks (automatic list)

none found 

 }}
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