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*See [[Septic Shock]] Guideline article
{{Project
|ProjectActive=legacy
|ProjectProgram=CC
|ProjectRequestor=Dr. Kendiss Olafson
|ProjectCollectionStartDate=2017-03-06
|ProjectCollectionStopDate=2017-06-30
|Project={{PAGENAME}}
}}


==Purpose==
{{LegacyContent
Kendiss Olafson & the QA team are monitoring performance and appropriate interventions for [[Septic Shock]] in the ICUs.
|explanation=Tmp project ended
|content=
see [[#Study Run Times]] for details.
 
Kendiss Olafson and the QA team are monitoring performance and appropriate interventions for [[Septic Shock]]/[[Shock, septic]] in the ICUs in the Winnipeg Region.


==Data Collection Method==
==Data Collection Method==
For the '''first episode''' of '''[[Septic Shock]]''' (admit or complication) of any ICU patient, the following two entries must be made in the L_TmpV2 file:  
For the '''first episode''' of '''[[Septic Shock]]/[[Shock, septic]]''' (admit or complication) of any ICU patient, the following two entries must be made in the TMP, [[L_TmpV2]] file.
=== BP Criteria === 
* Project: QASeptic
* Item: BP Criteria   
* Date and Time: that the '''blood pressure''' (BP) criteria is met for the '''first time''' as per [[Septic_Shock#.281.29_Blood_pressure_.28BP.29_criteria | Septic Shock Blood Pressure Guideline]] guideline
* '''Comment''': only in case of ''transfer from other ICU'', enter '''transferred from previous ICU with DX of shock already coded'''; in that case don't code date/time


* Project: [[QASeptic]]
==== BP prior to admission ====
* Item: First SBP<90
First low BP '''may be prior''' to ICU admission.
**'''Date and Time''' that the '''blood pressure''' (BP) criteria is met for the '''FIRST TIME''' as per [[Septic Shock]] guideline. Go [[Septic Shock | HERE]] to see '''BP''' criteria.
***('''may be prior to ICU admission''')


If a patient with existing septic shock is '''transferred''' from one ICU to another, for next ICU transferred ''into,'' code Item: First BP <90 with '''no date/time''' and enter ''transferred from previous ICU with DX of shock already coded'' as the '''COMMENT'''.


* Project: [[QASeptic]]
=== First '''NEW''' Antibiotic ===
* Item: First Antibiotic
The time of antibiotics is the date and time antibiotics are given '''for sepsis'''.  
**'''Date and Time''' that the first '''NEW antibiotic''' is used '''to treat septic shock'''
***('''may be prior to ICU admission''')
** If the patient '''does not receive Antibiotics''' (e.g. DC treatment) in the COMMENT section in TMP: type in a reason why antibiotic not given.


== Times ==
* Project: QASeptic
* Start date: likely Thu 2009 Oct 8  (after that week's send)
* Item: First Antibiotic
** '''Every''' qualifying patient sent after this date will need to have a temp entry, not only patients admitted after this date.
** includes all antimicrobials, not just antibiotics
* Review Date: (~75 days after start) - meeting booked with Kendiss and Trish for 2009 Dec 22
** if causative agent turns out insensitive to that antimicrobial, still enter it; this study is concerned with the delays in treatment, not the use of the correct drug
* Preliminary End Date: (6 months after start) - 2010 Apr 8 (set in ccmdb.mdb consistency checks)
* Date and Time: Date/Time of first antibiotic given to treat sepsis
* Comment:  
** note reason if an antibiotic was not given
** state if non-standard source of information was used


== Consistency Checks ==
==== Special Cases  ====
[[Tmp Checker]] will check for the following:
Use your '''judgment''' to determine the '''first''' antibiotic likely <u>administered</u> to '''treat septic shock'''.


=== Date or Comment ===
If a patient was on antibiotics '''prior to''' meeting the conditions for shock, then:
Every entry for project QA Septic must have either a date or a time.


=== Dx but no tmp ===
*if the antibiotic is '''not''' changed after going into shock, use the date/time of the last antibiotic <u>administered</u> '''prior to''' onset of shock;
L_Tmp entry is required if:  
*if the antibiotic '''is''' changed and <u>administered</u>'''&nbsp; shortly before '''or'''&nbsp; after''' going into shock then use your judgment to determine the following:  
* a DX of Septic shock exists
**if the antibiotic change was likely '''related''' to the imminent septic shock, record the date/time that '''new''' antibiotic was <u>administered</u> as the start dt/tm; you can state your reason in the comments field.
* program is "CC"
**if the antibiotic change was likely '''unrelated''' to septic shock, code the date and time of the first <u>administered</u> antibiotic change AFTER or the most recent change BEFORE&nbsp; (again, use your judgment)


(implemented by s_tmp_QASeptic_Dx_no_tmp)
<br> If you are using '''non-standard data sources''' such as the in/out sheet, note so in the comment field.
{{Discussion}}


If the patient '''does not receive Antibiotics''' (e.g. DC treatment) don't enter a date but provide a reason in the comment section of the "First Antibiotic" entry.


=== Tmp but no dx ===
== Study Run Times ==
A diagnosis must exist if:  
===Third wave - Start Date: March 6, 2017 00:01 / End Date: June 30, 2017 23:59 ===
* a "QASeptic" entry is present in [[L_Tmp]]  
Any patient who is discharged between the above dates and has a DX of septic shock needs to have a QASeptic Tmp entry.
* program must be "CC"
*Tmp entry is not required for those patients admited during the study time but discharged after June 30 23:59 (confirmed with Julie)[[User:GHall|GHall]] 10:34, 2017 July 6 (CDT)
*The ICU QI team has requested an updated review.


(implemented by s_tmp_QASeptic_tmp_no_dx)
===Second wave - Start Date: April 1, 2012 / End Date: June 30, 2012 ===
Three month data collection for the Septic Shock Study.  A review of the current data has been completed by the [[p:Julie Mojica |statistician]] and the ICU QI on June 12.12. 
*RE: '''stop date''': Patients '''ADMITTED up to midnight June 30th''' will '''continue to be entered and followed''' for QASeptic Study '''until they are discharged''' from the ICU.
*Any new patients ADMITTED on July 1st 0001 hrs will not be entered into the QASeptic Study.--[[User:TOstryzniuk|Trish Ostryzniuk]] 16:05, 2012 June 13 (CDT).


== Send mode ==
=== First wave - Start Date: October 8, 2009 / End Date: July 1, 2011 ===
Data for '''all''' patients meeting requirements for this study, including patients you are not sending this batch, will be sent every time complete patients are sent.
Every qualifying patient sent after this date will need to have a temp entry, not only patients admitted after this date.
*Review Date - done Feb 2,2010
**Data is showing some good trends for ICU's in the Region.  Dr. Kendiss Olafson from the ICU QI team will present at the data collection team meeting in April 2010.--[[User:TOstryzniuk|TOstryzniuk]] 16:30, 2 February 2010 (CST)--[[User:TOstryzniuk|TOstryzniuk]] 16:30, 2 February 2010 (CST)
**see: [[QA_Septic_Shock#Update:_Feb_2.2010_Review_Meeting Feb 2.2010 |Review Meeting]]
*Stop for '''all''' patient, that include those already in unit prior to July 1 who develop septic shock after July 1
*we will attempt to resume in fall time "after" Education blitz completed by ICU QA team.--[[User:TOstryzniuk|TOstryzniuk]] 14:42, 27 June 2011 (CDT)


=== Date or Comment ===
Every entry for project QA Septic must have either a date or a time.


{{Data Integrity Check List|}}


== Send mode ==
Data for '''all''' patients meeting requirements for this study, including patients you are not sending this batch, will be sent every time complete patients are sent.


'''Discussion:'''
== Related articles ==
* I just entered my first pt into this study, and ran into a bit of a snag.  The pt had been transfered to us from another ICU.  I was able to find the first low BP, but had to take the first AB from the in and out record.  I don't have any copies of MAR or any of the ER charting....so I took the first antibiotic given after the low BP. Had it not been recorded on the I&O record, I wouldn't have had anything else to get info from.  So, my question is...is this good enough?  Does it actually provide the info that you are looking for? [[User:BDeVlaming|BDeVlaming]] 12:10, 7 October 2009 (CDT)
* [[Septic Shock]]
**Yes this is good enough.  Please put a note in your "COMMENT" section in TMP for First antibitic start.  "''Date and time of antibitic obtained from I & O sheet.  No medication record from other center''".--[[User:TOstryzniuk|TOstryzniuk]] 11:55, 20 October 2009 (CDT)
 
{{Discussion}}
===Discussion===
** Another issue:  There are instances where the patient may already be on antibiotics for an infection and then later develops septic shock anyway. Sometimes a new antibiotic is started and in this case the new antibiotic is the one to use in our tmp file.  Occasionally, though,  a new antibiotic may not be started.  We need to know what to do in these cases. Putting a start date of an antibiotic that is likely not the right one would not help. I have one patient like this right now. The patient was on two antibiotics for pneumonia, copd exac.  Developed septic shock 2 days later.  No new antibiotics started yet.  I will keep watching to see if new antibiotics are started as this patient likely has a bug that is not covered by the antibiotics he is on.  --[[User:LKolesar|LKolesar]] 15:20, 7 October 2009 (CDT)
***if the patient had new antibiotics started for THIS infection, put that date and time of the antibiotic start.  In another words antibiotic start may be PRIOR to the onset of shock. 
***If they where aready on an antibotic and they develop new sepsis/infection, the antibiotic date should be left blank and in the COMMENT section state patient already on antibitic and there were no antibiotic changes made.[[User:TOstryzniuk|TOstryzniuk]] 11:33, 20 October 2009 (CDT)
 
***Here is another scenario for you:  A patient develops septic shock in a community hospital and is coded by the data collector, then a few days later the patient is transferred to a tertiary ICU for continued care.  The data collector in the second hospital needs to code septic shock because it is still ongoing.  Should she use the same times of low BP and antibiotic start as the first presentation of septic shock at the first hospital?  We cannot always derive this information from the bits of chart that the sending hospital copies for us.  The only way to be sure of getting the same times would be to email the first data collector and obtain the times from her.  Is this the correct process to follow?? --[[User:LKolesar|LKolesar]] 11:08, 16 October 2009 (CDT)


***The data collector in the second hospital needs to code in the Admit Diagnosis septic shock because it is still ongoing however, if a patient comes from an ICU with a previous onset of septic shock and the data has already captured in the previous ICU admission TMP file, there is no need to enter the same start date of onset of shock in the next ICU admission TMP file. We don't want to double count same episode of septic shock.
== Legacy ==
****'''INSTRUCTION''': for next ICU transfered into, in the TMP file select ITEM: First BP <90, don't put a date however in the '''COMMENT''' section type in the following: '''transfered from previous ICU with DX of shock already coded'''.
In [[CCMDB.mdb_Change_Log_2012#ver_2012-09-06]] "First SBP<90" was changed to "BP Criteria". [[User:Ttenbergen|Ttenbergen]] 11:08, 2012 September 12 (CDT)


}}


[[Category: Special_Short_Term_Projects]]
[[Category:Sepsis]]
[[Category: L_TmpV2 Data]]
[[Category:Shock]]
[[Category: All Projects]]
[[Category:L_TmpV2 Data]]
[[Category: QA]]
[[Category:QA]]
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