Overstay Predictor Project Collection Instructions: Difference between revisions

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This article explains how to collect data in the [[CCMDB.mdb]] for the [[Overstay Predictor Project]].
{{LegacyContent
|explanation=we stopped [[Overstay]]
|successor=
|content=
This article documents what data collectors need to do to collect information for the [[Overstay Predictor Project]].  


For every '''medicine''' patient admitted to a ward participating in the project, '''as soon as possible''', but definitely '''within 48 business hrs of admission''' the data collector will need to enter the data in the [[Media:Nursing_Discharge_Screening_Tool Nursing_Discharge_Screening_Tool.pdf|Nursing Discharge Screening Tool form]] into the [[CCMDB.mdb]], enter a certain amount of regular data early to generate a colour, put a sticker of that colour onto the chart, and in case of certain colours notify the transition coordinator.
'''This project was one of the Vacation and staff shortage collection priorities!'''


== The Nursing Discharge Screening Tool ==
== In addition to [[Minimal Data Set]] ==
Find the white [[Media:Nursing_Discharge_Screening_Tool Nursing_Discharge_Screening_Tool.pdf|Nursing Discharge Screening Tool]]  
The following items need to be entered '''before the generation of the chart colour in the next step''' because the algorithm uses this data:
with the admission documentation on the patient chart and check if there is either a yes or no for all the first 6 questions. Also collect the patients living arrangements from the form. (Home, Nursing home, Assisted Living).
* [[Date of Birth]]
The form is to be completed within 24 hours of all new admissions to hospital and patients transferred to the unit without a previously completed Nursing Discharge Screening Tool. If it is not possible at time of admission, the admitting nurse will pass the responsibility for completion to the next duty nurse.
* [[Province]]
* "Accept DtTm" if used, else "Arrive DtTm"
* [[Pre-admit Inpatient Institution]]
* [[ADL]]
* [[Glasgow Coma Scale]]
* '''important:''' [[List of diagnoses affecting Overstay Project]]


The nurse can update the form within the first 24 hours after admission if, for example they receive information from the patients family that contradicts the patients answers. It is possible that depending on when you review that document these changes are not captured. This a known risk that we are accepting.
== Generate colour ==
Once the required information has been entered click the "Overstay" button on the patient viewer screen next to the [[Notes field]] and it will turn a colour based on an [[Overstay Predictor Project Algorithm | algorithm]].  


=== ensuring completeness within 24 hrs ===
The program will ask you if this is the final colour you will submit. If so, it will be stored and sent. The colour will also be automatically added to the beginning of the Notes field, since most collectors were manually putting it there anyways.  
The bedside nurses have 24 hours from the time of [http://ccmdb.kuality.ca/index.php/Admit,_Transfer_and_Discharge_date_and_time#Definition_for_Medicine| admission to the unit] to fill out the Nurse Discharge Assessment Tool. This time frame allows for the nurse to clarify unanswered questions with the patient or caregivers during the day.  


'''If you can't find the form or an answer is still missing 24 hrs after admission:''':
* '''Red''' - significant risk for discharge delays
* enter the project "Overstay" "form data missing" entry into the tmp table
** email to notify unit manager - see [[#Notifying_the_Unit_Manager]]
** If the nurse form is incomplete the patient will be evaluated as if the nurse form had identified a problem, i.e. the patient will become yellow or red; the program will give a message that data had been missing.
**put red stick on chart - see [[#Red Chart Stickers]]
* check with the bedside nurse and remind them to complete it; enter the remaining data into CCMDB.mdb if it now becomes available.
* '''Yellow''' - anyone who is not red
**no email to manager
**no sticker on chart
* '''Gray''' -  there are no gray stickers, gray is just a colour the laptop will give when it gets bad data for the algorithm.one of two scenarios:
** data needed to generate the colour is missing; you will not be able to generate a colour; there will be a specific error, please act on it
** the patient is transferred from a ward where the colour should have been generated already.


=== entering the data ===
== Red Chart Stickers ==
For the first 6 questions on the form, create a record for each in tmp entries and check the check box if the answer is Yes.  
If the colour is '''red''' place a 3/4" red round sticker on the spine of the patient chart. Ward clerks will need to order these. Collectors will tell ward clerks when supplies are getting low.  


*If any answer is no include a tmp entry indicating where the patient lives. This information can be found on the form as answer number 1 under the '''General Information''' ''Living Arrangements?''. The purpose is to exclude patients currently living in a personal care home from being assigned a transition coordinator since these patients infrequently overstay.
=== Other coloured dots on charts ===
** {{discussion}} further down it said: "For each patient, add a "From..." entry into the Tmp table, e.g. "From Personal Care Home" or "From Home". Patients admitted from a personal care home can not become "red", but at most "yellow"." Is this required only for the patients flagged positive by the nurse tool? I'd have thought we wanted it anyway to be able to evaluate if excluding these people from discharge coordination is valid. [[User:Ttenbergen|Ttenbergen]] 13:46, 2012 September 13 (CDT). My understanding is that if a patient answers yes to the six questions they would not be coming from an alternative care arrangement. We currently instruct the nurses not to complete any more of the form if the top six questions are answered '''yes''', mainly to save time. This process does not assume the patients could be misleading enough to have the nurse check ''yes'' to the six questions even though the patient is in an alternative care arrangement. I will verify with the nursing members on the committee if we should be collecting living arrangement for all cases. Please remove this comment once reviewed. Please remove comment once reviewed I will update the process if it changes.[[User:LHathout|LHathout]]
There is currently a small red dot used to indicate long term chart. These are not ours and users of the chart who use these ought to be aware of them.  


Question 4 consists of several sub-questions re. the patient's inability to manage daily activities. If even one of the activities raises a concern then summary answer for the question needs to be "'''no'''".
== Notifying the Unit Manager ==
If a patient is identified as red, [[CCMDB.accdb]] will populate an email subject line with the name of the patient and that they have been identified as overstay colour red. The collector must send the email to the unit manager (see [[List of Unit Managers]]). It should not be necessary to add additional information to the body, this way all info is visible when the manager sees the email arrive, and they don't have to open it.  


Take answers to questions directly from the form, no interpretation, even if you disagree after reading the chart. We will be testing the answers provided by the nurses to determine if they are a better predictor of transition support needs or can be used in conjunction with existing admission data to improve the effectiveness of the prediction tool. If the data were interpreted by the collector it would introduce another factor and make this test less valid.
If we find that additional info is required, let's talk about it and add it to the program, rather than add anything manually, so we know this is done consistently.


If the patient is transferred from one medical unit to another within the facility  the current intention is that the patient will continue to be monitored by a Transition Coordinator till the time of discharge, so only one Discharge Screening Tool is required. We have also discussed handing the patient over from one transition coordinator to another. In this case there still would not need to be a a second screening form completed since the patient is already identified as needing assistance.  
== Possible Scenarios ==
=== Possible Scenario - Patient transferred from other ward - admit ward was participating ward ===
If the patient was admitted from a another '''medicine''' ward at the same location that also participates in the Overstay project, then the original Yellow/Red designation is retained.
It will be the responsibility of the manager of the originating ward to notify the manager of the receiving ward of any red patients.  


==== how to enter if nurse form data missing ====
==== Previous ward's collector ====
On the form if any of the 6 questions are not answered, enter a "form missing" record for each, like:
When you find out that your patient has been discharged to another ward where we collect please notify that collector. There seem to be different informal methods used by different collectors for this right now. We will test if that is good enough, and only formalize it if there are problems.  
*Overstay  1. Alert and  
*Overstay  form missing
*Overstay  3. Mobilze
*Overstay    form missing
*Overstay  5. Pt. supports 
*Overstay  6. smoke
(i.e. you can then tell that questions #2 & 4 are missing)


==== how to enter if admitted-from data missing ====
==== New ward's collector ====
If the admitted-from information is not recorded on the form enter a "form missing" record instead.
Ensure that these charts have the appropriate colour dot on them as communicated to you.  


== Changes to regular data entry required for the Overstay Project ==
Enter the patient as normal and click the overstay button. It will give you a message ''"Patient comes from participating ward, use their overstay colour on charts. CCMDB will list gray."''. We will match the data to the original ward behind the scenes.
A number of items in addition to the regular [[Minimal Data Set]] needs to be entered '''before the generation of the chart colour in the next step''' because the algorithm uses this data:
*DOB
*Admit Date
** Enter admit date as before; we are aware that this can be different from the time of admission to the unit and the algorithm takes that into account
* ADL
* any '''[[Overstay Predictor Diagnosis Code Used]] (note exclusion of most comorbids and all acquireds/complications)'''
** if a dx is entered as a working diagnosis but not yet confirmed, '''do''' enter that diagnosis
** only dxs as listed in [[Overstay Predictor Diagnosis Code Used]] need to be entered early, i.e. the rest can be entered as they were before


*The following data needs to be entered at admission time (i.e. like minimal data set) for the coloring algorithm.
=== Possible Scenario - Patient transferred from other ward - admit ward was '''NON'''-participating ward ===
** province
If the patient is transferred either '''from''' or '''via''' any unit not participating in the Overstay project (e.g. an ICU) generate a colour.
** whether the patient is admitted from a nursing home (into overstay tmp data)
** admit diagnosis of "Palliative Care"


== Chart Stickers ==
=== Possible Scenario - colour change due to data entry error ===
Once the required information has been entered click the new “Overstay” button on the patient viewer form next to the notes field and it will turn a colour based on an [[Media:Two_Stage_Predictive_Model_of_Patients_in_Need_of_a_Transition_Coordinator.pdf | underlying algorithm]].
'''The only case where the colour should be changed is if the data-collector made a error on data entry. We don't want you to change colour because data becomes available after the initial assessment window.'''
* GREEN - low/no risk for discharge issues
* YELLOW - some risk for discharge issues
* RED - significant risk for discharge issues assign a transition coordinator.
* GRAY - if some needed data is missing you will not be able to generate a colour in the ccmdb database; there will be a specific error
Based on the color displayed put that colored sticker on the spine of the patient chart. The sticker 3/4 inch stickers will be located adjacent to the transition coordinator binder at the unit clerk desk.


The color on the button is not stored in ccmdb.mdb, so it will not be visible next time you open the patient. This is by design as you should only need to use the colour once.
If you realize you made a data entry error and you have fixed it, you can click the Overstay button again. It will ask you again if this is final, and if you click yes the original entry will be '''overwritten''' and the new colour be added to the beginning of the Notes field. This means you may have multiple colours in notes, the first one being the current one.


Note: There is currently a small red dot used to indicate long term chart. There is also a small yellow dot used to indicate VRE.
It is '''not necessary to document''' when a colour changes. Just change the colour.


=== colour if data is missing ===
=== Possible Scenario - Patient died/discharged before data collection ===
See the dialog boxes in the program for information on color coding if data is missing.
Enter anyway and generate colour. Do not contact Unit Manager.  


=== no need to document sticker colour changes ===
=== Possible Scenario - EMIP patient that never made it to the ward ===
It will not be necessary to '''document''' when a sticker colour changes. Just change the colour.
Enter anyway and generate colour. Do not contact Unit Manager.  


After 24 hours all information required to make the assessment as to if the patient is at risk should be available (or not known to the nurse within the first 24 hours and thus considered a risk). The only case where the colour should be changed is if the data-collector knew they had made an error on data entry in which case there is no need to record the previous colour. If the change results in the patient no longer needing a transition coordinator, then the data coordinator needs to notify the transition coordinator to ensure they are ware of the change.
=== Possible Scenario - Off ward patients ===
Almost all of these will be [[#Possible Scenario - Patient transferred from other ward - admit ward was participating ward]], so use those collection instructions. It will be the responsibility of that manager to notify the next manager.  


== Notifying the Transition Coordinator ==
For the rare patient admitted to an off-ward location without hitting one of our regular wards first, generate a colour and put it on the chart, but don't worry about contacting a manager. This was discussed as a special case not worth following up on. It Is OK.
If the patient has been designated as "red" for purposes of overstay prediction, the data collector will notify a Transition Coordinator by placing the patients name on the Transition Coordinator Assignment Sheet.  The rotation of Coordinators is made up of Home Care, Social Work, Physio, And OTs. After assignment, that service is responsible for following that patient throughout their hospital stay. The Transition Coordinators are responsible for ballancing their workload in the case that any individual is overburdened.


== Questions ==
== Start/Stop/Site participation ==
see [[Overstay Project Start Stop dates]]


# If it is my responsibility to keep the N5 project binder up to date & well stocked with all the necessary forms then I’d like a supply of  the Discharge screening tool, Coordinator case notes, Coordinator assignment forms in the Data office. I don’t have access to a copier that makes double sided copies so sending me a master copy by email makes doesn’t work.''You are not responsible for keeping or making copies -  thanks for offering. I will discuss this with the transition coordinators at our meeting on the 15th.''--[[User:LHathout|LHathout]] 13:50, 2012 August 31 (CDT)
{{Data Integrity Check List}}
# At present it is often taking the nurses 24 hours or longer to complete the screening tool. I have to then either ask the nurses to complete it (which I really don’t think is my job nor do I feel comfortable doing) or leave the form with the Clinical Manager Helen for her to follow up on. This is a problem because I can’t do my job in the project efficiently within the 48 hrs or effectively which is to identify whether the patient is “at risk” and then assign them a Coordinator. This is very time consuming and frustrating for me to have to keep track of which patients forms are complete and which ones are not and then where the forms are actually located and then having to check and then recheck the charts for the forms. During the education sessions I think we should not only include the nurses from the wards but also the Resource Team nurses (they cover sick calls and vacations etc.) From now on I think it should be stressed to the nurses that the discharge screening tool should preferably be completed during the admission process and the exception being within 24 hours maximum, not the rule. ''I will ask Helen to explain if there is a legitimate reason why the 24 hour time frame is not enough to complete the discharge screening tool. If there is no reason then it is her responsibility to police this. If you are missing forms please bring the issue to the clinic managers attention. All Grace nurses with be trained in the next month as they are hoping to roles this out to all unit in September.''--[[User:LHathout|LHathout]] 13:50, 2012 August 31 (CDT)
# Because of the above mentioned delay, there are some N5 patients who will not have the Overstay data entered because the form is blank eg. Short stay< 24hrs either pt. died or transferred. The Short stay patients are obviously not the ones that overstay, therefore they are of no real concern. If there is no Nurse Discharge Screening Tool and therefore no classification for these patients there is no impact on the process other than we will have a discrepancy in the statistics i.e. 20 patients discharged from 5N of which 8 were green, 10 were yellow, 1 was red and 1 has no color. If were pressed to explain this we will had the admission and transfer discharge dates and be able to note the early discharge. I was told these short stays are rare.
# If a patient is transferred between wards are we to complete a D/C screening tool? I thought that until all medical wards were included in the project we were to complete the form on all admissions to N5.There was one pt. who was transferred between wards who had already been paneled and awaiting placement in a nursing home. In this circumstance the screening tool wasn’t done (Helen decided it was not necessary). ''The Screening tool only has to be completed once. In September all patients will have the screening tool done upon admission so there should be no patients transferred onto the ward without one. In the interim if a patient is transferred on to the unit without one the screening tool needs to be completed''--[[User:LHathout|LHathout]] 13:50, 2012 August 31 (CDT)


= Clarification of difference to previous process=
The following documentation is relevant to pre-empt questions only until the transition to the new process is complete.


== even at STB ==
For a while STB medicine collectors stopped putting red dots on the charts. They will now be required to put dots on the charts again. We discussed only notifying the manager by email with the requestor of the project, but they really want the dots. One thing we considered was the possibility of putting something equivalent to the red dot onto [[Medworxx]]. I am looking into that.


== DPST form - STOP July 31.17 ==
Collectors will '''no longer''':
*collect any information from the DPST forms or be responsible for them  (tmp file for the questions will be gone)
*post information in the Transition Coordinator binders or
*notify and assign allied Health.   


Collectors can ignore the form and just collect the minimal data set outlined above to generate a colour.
*wards may continue to fill out the DPST form at admission ''For their own purposes.'' 


== Transition Coordinator Binder - Stop July 31.17 ==
Collectors will '''no longer''':
*post any kind of information in the Transition Coordinator binder 
*notify and assign reds to allied Health team 


[[Category: OverstayProject]]
= Instructions admissions before Jul 30 2017 =
see [[Pre-2017-07-30 Overstay Predictor Project Collection Instructions]]
* All reds generated prior to July 31st are already in our data, just leave them as they were.
}}
 
[[Category: OverstayProject| *]]

Latest revision as of 13:16, 2022 April 19

Legacy Content

This page contains Legacy Content.
  • Explanation: we stopped Overstay
  • Successor:

Click Expand to show legacy content.

This article documents what data collectors need to do to collect information for the Overstay Predictor Project.

This project was one of the Vacation and staff shortage collection priorities!

In addition to Minimal Data Set

The following items need to be entered before the generation of the chart colour in the next step because the algorithm uses this data:

Generate colour

Once the required information has been entered click the "Overstay" button on the patient viewer screen next to the Notes field and it will turn a colour based on an algorithm.

The program will ask you if this is the final colour you will submit. If so, it will be stored and sent. The colour will also be automatically added to the beginning of the Notes field, since most collectors were manually putting it there anyways.

  • Red - significant risk for discharge delays
  • Yellow - anyone who is not red
    • no email to manager
    • no sticker on chart
  • Gray - there are no gray stickers, gray is just a colour the laptop will give when it gets bad data for the algorithm.one of two scenarios:
    • data needed to generate the colour is missing; you will not be able to generate a colour; there will be a specific error, please act on it
    • the patient is transferred from a ward where the colour should have been generated already.

Red Chart Stickers

If the colour is red place a 3/4" red round sticker on the spine of the patient chart. Ward clerks will need to order these. Collectors will tell ward clerks when supplies are getting low.

Other coloured dots on charts

There is currently a small red dot used to indicate long term chart. These are not ours and users of the chart who use these ought to be aware of them.

Notifying the Unit Manager

If a patient is identified as red, CCMDB.accdb will populate an email subject line with the name of the patient and that they have been identified as overstay colour red. The collector must send the email to the unit manager (see List of Unit Managers). It should not be necessary to add additional information to the body, this way all info is visible when the manager sees the email arrive, and they don't have to open it.

If we find that additional info is required, let's talk about it and add it to the program, rather than add anything manually, so we know this is done consistently.

Possible Scenarios

Possible Scenario - Patient transferred from other ward - admit ward was participating ward

If the patient was admitted from a another medicine ward at the same location that also participates in the Overstay project, then the original Yellow/Red designation is retained. It will be the responsibility of the manager of the originating ward to notify the manager of the receiving ward of any red patients.

Previous ward's collector

When you find out that your patient has been discharged to another ward where we collect please notify that collector. There seem to be different informal methods used by different collectors for this right now. We will test if that is good enough, and only formalize it if there are problems.

New ward's collector

Ensure that these charts have the appropriate colour dot on them as communicated to you.

Enter the patient as normal and click the overstay button. It will give you a message "Patient comes from participating ward, use their overstay colour on charts. CCMDB will list gray.". We will match the data to the original ward behind the scenes.

Possible Scenario - Patient transferred from other ward - admit ward was NON-participating ward

If the patient is transferred either from or via any unit not participating in the Overstay project (e.g. an ICU) generate a colour.

Possible Scenario - colour change due to data entry error

The only case where the colour should be changed is if the data-collector made a error on data entry. We don't want you to change colour because data becomes available after the initial assessment window.

If you realize you made a data entry error and you have fixed it, you can click the Overstay button again. It will ask you again if this is final, and if you click yes the original entry will be overwritten and the new colour be added to the beginning of the Notes field. This means you may have multiple colours in notes, the first one being the current one.

It is not necessary to document when a colour changes. Just change the colour.

Possible Scenario - Patient died/discharged before data collection

Enter anyway and generate colour. Do not contact Unit Manager.

Possible Scenario - EMIP patient that never made it to the ward

Enter anyway and generate colour. Do not contact Unit Manager.

Possible Scenario - Off ward patients

Almost all of these will be #Possible Scenario - Patient transferred from other ward - admit ward was participating ward, so use those collection instructions. It will be the responsibility of that manager to notify the next manager.

For the rare patient admitted to an off-ward location without hitting one of our regular wards first, generate a colour and put it on the chart, but don't worry about contacting a manager. This was discussed as a special case not worth following up on. It Is OK.

Start/Stop/Site participation

see Overstay Project Start Stop dates

Data Integrity Checks (automatic list)

 AppStatus
Query check tmp generate allowedCCMDB.accdbimplemented
Query check overstay no colourCCMDB.accdbretired
Query check overstay pt from our medCCMDB.accdbretired
Query check overstay not enteredCCMDB.accdbretired

Clarification of difference to previous process

The following documentation is relevant to pre-empt questions only until the transition to the new process is complete.

even at STB

For a while STB medicine collectors stopped putting red dots on the charts. They will now be required to put dots on the charts again. We discussed only notifying the manager by email with the requestor of the project, but they really want the dots. One thing we considered was the possibility of putting something equivalent to the red dot onto Medworxx. I am looking into that.

DPST form - STOP July 31.17

Collectors will no longer:

  • collect any information from the DPST forms or be responsible for them (tmp file for the questions will be gone)
  • post information in the Transition Coordinator binders or
  • notify and assign allied Health.

Collectors can ignore the form and just collect the minimal data set outlined above to generate a colour.

  • wards may continue to fill out the DPST form at admission For their own purposes.

Transition Coordinator Binder - Stop July 31.17

Collectors will no longer:

  • post any kind of information in the Transition Coordinator binder
  • notify and assign reds to allied Health team

Instructions admissions before Jul 30 2017

see Pre-2017-07-30 Overstay Predictor Project Collection Instructions

  • All reds generated prior to July 31st are already in our data, just leave them as they were.
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