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You can not enter 0 for APACHE physiological variables, and you can't leave them blank.
== When to collect, which value to use ==
See [[Selection and timing of APACHE components]]


== Patient lived ==
=== Exceptionally high or low values ===
If a specific physiological variable is '''not''' available during the first 24 hours when admitted to ICU then select a value closest to the time '''prior to''' admission to the unit, (max 24 hrs prior to admission). Make a note in your [[Notes field]] and record date time and location this variable was obtained from (e.g. ER or ward).  
[[CCMDB.accdb]] has error checks for values that are ''unlikely'' high or low to prevent errors. The ranges were determined by the [[statistician]] based on previous data(see abs min and abs max in [[APACHE_Scoring_table]]). To keep the checks meaningful the threshold values will not be changed for extreme outliers.


If no information is available, then assume it was not tested because it was normal.  Record the midpoint of the normal range for this value, which will generate a normal APACHE score for this item. The midpoint of each normal range can be found by double-clicking on the Apache score for the field in CCMDB.mdb.
For values outside the '''"warning" limit''', you must '''enter the reason''' for this into the [[Notes field]] so that we can validate that these were not errors. <!-- as of [[CCMDB.mdb_Change_Log_2011#ver_2011-05-04]] -->


=== Use of pre-admission ER LAB results ===
For values outside the '''"absolut" limit''', enter the '''closest value allowed''' and enter a comment into the [[Notes field]]. Also, '''email Pagasa the correct value'''.
{{discussion}}
'''The following refers to an ongoing discussion, not to a change in collection rules:'''
As discussed in the [[:Category:Critical Care Review Group|Critical Care Review Group]], the last 4 hours in the ER/OR/ward preceding admission to the ICU may be admissible data for APACHE values ''only if'' there is no data is available for the first 24 hours ''in'' ICU. Is this a rule we are using? [[User:Ttenbergen|Ttenbergen]] 13:12, 17 October 2008 (CDT)
* The above seems to be in conflict with the missing value rule below. Is it 4 or 24 hrs prior to admission? Is this really limited to values from the ER?[[User:Ttenbergen|Ttenbergen]] 15:38, 2 May 2011 (CDT)[[User:Ttenbergen|Ttenbergen]] 19:00, 2012 September 6 (CDT)
** anyone? Ttenbergen 14:12, 2014 September 19 (CDT)


== Patient DIED shortly after arriving in unit ==
== Guidelines for the Values to use for APACHE II Physiologic Variables ==
We don't want values of dead people.
=== Use the worst ===
For patients who died in the unit and have '''no''' data available to record for any one of the physiological variables during their stay on the unit:
*The general rule is to use the '''worst value as per APACHE II rules''' in the initial 24 hours of the ICU record (remember that ICU records begin when the patient begins being cared for by the ICU service, i.e. first [[Service tmp entry]] DtTm.


1. Select the value that is '''closest''' to the time "prior to" unit admission such as ER or ward.
=== When not available ===
The following info is relevant if no measurements were taken or in cases of [[Lost/missing chart]].
*You can not enter 0 for any of these, and you can't leave them blank.
*If for a given parameter there are '''no values''' during that initial 24 hours after the start of the profile, you can go back ''prior'' to the start of the ICU record, and use the value closest to the start time of the ICU record (but max 24 hrs prior to admission).
**If there are no values for that parameter either during the first 24 hours OR up to 24 hours prior to the start of the ICU record, APACHE assumes the value was normal -- so code the value that is the midpoint of the normal range per APACHE rules.


2. If the above is NOT an option then the following applies:
=== Values during Arrest ===
*'''DO NOT''' use vital signs from arrests.  Instead use the worst values from recordings '''OTHER THAN the code sheet'''.
*You can use labs drawn during arrests, but only do so if these are the ONLY labs available.
**For the lab data, you can use values both from the central laboratory and those done on a bloodgas machine.
*The rationale is that codes are specific, usually short interludes and if it occurs we don't miss it as there should be the ICD10 diagnosis listed for it ([[Cardiac arrest]]).


'''A.''' For the following vital signs elements-select the '''lowest limit value''' on the APACHE score table that will give you the highest score.
== Iatrogenically changed values ==
*This applies to the following fields:
*Keep in mind the diagnosis and try not to include iatrogenically modified values, e.g. BP severely high due to inotropes or decreased LOC due to sedation.
** [[HR]] - (Heart Rate)
*However, if a value is assessed as part of testing whether an intervention works, that value is not necessarily ineligible (e.g. see [[Arterial_blood_gas_(APACHE)#ABGs_as_part_of_apnea_tests]]).
** [[BP]] - (Blood Pressure)
** [[RR]] - (Respiratory Rate)
 
'''B.''' For other APACHE elements-record '''NORMAL values'''. Normal values are those items that give you a zero APACHE II point.
*This applied to the following fields:
**[[Temperature]]
**[[Serum CO2]] - use 25
**[[Na]] -(Sodium)
**[[K]] -(Potassium)
**[[CREAT]] -(Creatinine)
**[[HCT]] -(Hematocrit)
**[[WBC]] -(White Blood Count)


== Related articles ==
{{Related Articles}}


[[Category:APACHE II]]
[[Category:APACHE II]]
[[Category:End-of-life related data]]
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