QA Septic Shock: Difference between revisions

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Kendiss Olafson and the QA team are monitoring performance and appropriate interventions for [[Septic Shock]] in the ICUs in the Winnipeg Region.

{{Project

|ProjectActive=legacy

|ProjectProgram=CC

|ProjectRequestor=Dr. Kendiss Olafson

|ProjectCollectionStartDate=2017-03-06

|ProjectCollectionStopDate=2017-06-30

|Project={{PAGENAME}}

}}

{{LegacyContent

|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==

For the '''first episode''' of '''[[Septic Shock]]''' (admit or complication) of any ICU patient, the following two entries must be made in the TMP, [[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.

=== ~~First SBP<90~~ ===

=== BP Criteria ===

* Project: QASeptic

* Item: ~~First SBP<90~~

* 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 '''~~transfered~~ from previous ICU with DX of shock already coded'''; in that case don't code date/time

* '''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

==== ~~Special Cases~~ ====

==== BP prior to admission ====

First low BP '''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 ''~~transfered~~ from previous ICU with DX of shock already coded'' as the ~~comment~~.

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'''.

=== First '''NEW''' Antibiotic ===

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Line 33:

* Project: QASeptic

* Item: First Antibiotic

** includes all antimicrobials, not just antibiotics

** 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

* Date and Time: Date/Time of first antibiotic given to treat sepsis

* Comment:

Line 25:

Line 41:

** state if non-standard source of information was used

==== Special Cases ====

Use your '''judgment''' to determine the '''first''' antibiotic likely ~~given~~ '''to treat shock'''.

Use your '''judgment''' to determine the '''first''' antibiotic likely administered to '''treat septic shock'''.

If a patient was on antibiotics '''prior''' to meeting the conditions for shock, then

If a patient was on antibiotics '''prior to''' meeting the conditions for shock, then:

* if the antibiotic is '''not''' changed after going into shock, use the dt/tm of the last antibiotic change or treatment start prior to onset of shock;

* if the antibiotic is changed '''after or shortly before''' going into shock then use your judgment to determine the following:

** if the change/prescription was likely related to the imminent shock, code that change as the antibiotic start date; you can state your reason in the comments field

** if the change/prescription was likely unrelated, code the first change after, or the most recent change before (again, use your judgment)

If you are using '''non-standard data sources''' such as the in/out sheet, note so in the comment field.

*if the antibiotic is '''not''' changed after going into shock, use the date/time of the last antibiotic administered '''prior to''' onset of shock;

*if the antibiotic '''is''' changed and administered'''  shortly before '''or'''  after''' going into shock then use your judgment to determine the following:

**if the antibiotic change was likely '''related''' to the imminent septic shock, record the date/time that '''new''' antibiotic was administered as the start dt/tm; you can state your reason in the comments field.

**if the antibiotic change was likely '''unrelated''' to septic shock, code the date and time of the first administered antibiotic change AFTER or the most recent change BEFORE  (again, use your judgment)

If you are using '''non-standard data sources''' such as the in/out sheet, note so in the comment field.

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.

== Study Run Times ==

=== Start ~~date~~: ~~October 8~~, ~~2009~~ ===

===Third wave - Start Date: March 6, 2017 00:01 / End Date: June 30, 2017 23:59 ===

~~'''Every''' qualifying~~ patient ~~sent after this date will need~~ to have a ~~temp~~ entry, not ~~only~~ patients ~~admitted~~ after ~~this date~~.

Any patient who is discharged between the above dates and has a DX of septic shock needs to have a QASeptic Tmp entry.

*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.

=== ~~Review~~ Date ===

===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).

==== Feb 2,2010~~'''====~~

=== First wave - Start Date: October 8, 2009 / End Date: July 1, 2011 ===

*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)

Every qualifying patient sent after this date will need to have a temp entry, not only patients admitted after this date.

**see: [~~http://ltc.umanitoba.ca/wikis/ccmdb/index.php/~~QA_Septic_Shock#Update:_Feb_2.2010_Review_Meeting Feb 2.2010 Review Meeting]

*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)

~~==== May 4 ,2010 from 1100-1200 hrs ====~~

**see: [[QA_Septic_Shock#Update:_Feb_2.2010_Review_Meeting Feb 2.2010 |Review Meeting]]

*meeting request sent out Feb 2.10 by [[User:TOstryzniuk|TOstryzniuk]] ~~22:21, 2 February 2010 (CST)~~

*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)

~~=== End Date ===~~

*~~Preliminary End Date:~~ '''~~December 31.2010~~'''---[[User:TOstryzniuk|TOstryzniuk]] 17:04, ~~8 February 2010 (CST)~~(~~extended from April 8.10~~)

**'''(set in ccmdb.mdb consistency checks)'''See: [http://ltc.umanitoba.ca/wikis/ccmdb/index.php/CCMDB.mdb_Change_Log_2010#V1.993_Changes | See:change request log]

~~== Consistency Checks ==~~

~~[[Tmp Checker]] will check for the following:~~

=== Date or Comment ===

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

~~=== Dx but no tmp ===~~

~~[[L_TmpV2]] entry is required if:~~

* a DX of Septic shock exists

* program is "CC"

~~(implemented by [[s_tmp_QASeptic_Dx_no_tmp]])~~

~~=== Tmp but no dx ===~~

~~A diagnosis must exist if:~~

* a "QASeptic" entry is present in [[L_TmpV2]]

* program must be "CC"

**implemented by: [[S tmp QASeptic Dx no tmp]]

== Send mode ==

Line 79:

Line 85:

* [[Septic Shock]]

[[Category: ~~Special_Short_Term_Projects~~]]

== Legacy ==

[[Category: ~~L_TmpV2 Data~~]]

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: ~~All Projects~~]]

[[Category: QA]]

}}

[[Category:Sepsis]]

[[Category:Shock]]

[[Category:L_TmpV2 Data]]

[[Category:QA]]

@@ Line 1: / Line 1: @@
-Kendiss Olafson and the QA team are monitoring performance and appropriate interventions for [[Septic Shock]] in the ICUs in the Winnipeg Region.
+{{Project
+|ProjectActive=legacy
+|ProjectProgram=CC
+|ProjectRequestor=Dr. Kendiss Olafson
+|ProjectCollectionStartDate=2017-03-06
+|ProjectCollectionStopDate=2017-06-30
+|Project={{PAGENAME}}
+}}
+{{LegacyContent
+|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==
-For the '''first episode''' of '''[[Septic Shock]]''' (admit or complication) of any ICU patient, the following two entries must be made in the TMP, [[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.
-=== First SBP<90 ===
+=== BP Criteria ===
 * Project: QASeptic
-* Item: First SBP<90
+* 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 '''transfered from previous ICU with DX of shock already coded'''; in that case don't code date/time
+* '''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
-==== Special Cases ====
+==== BP prior to admission ====
 First low BP '''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 ''transfered from previous ICU with DX of shock already coded'' as the comment.
+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'''.
 === First '''NEW''' Antibiotic ===
@@ Line 19: / Line 33: @@
 * Project: QASeptic
 * Item: First Antibiotic
+** includes all antimicrobials, not just antibiotics
+** 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
 * Date and Time: Date/Time of first antibiotic given to treat sepsis
 * Comment:
@@ Line 25: / Line 41: @@
 ** state if non-standard source of information was used
-==== Special Cases ====
+==== Special Cases  ====
-Use your '''judgment''' to determine the '''first''' antibiotic likely given '''to treat shock'''.
+Use your '''judgment''' to determine the '''first''' antibiotic likely <u>administered</u> to '''treat septic shock'''.
-If a patient was on antibiotics '''prior''' to meeting the conditions for shock, then
+If a patient was on antibiotics '''prior to''' meeting the conditions for shock, then:
-* if the antibiotic is '''not''' changed after going into shock, use the dt/tm of the last antibiotic change or treatment start prior to onset of shock;
-* if the antibiotic is changed '''after or shortly before''' going into shock then use your judgment to determine the following:
-** if the change/prescription was likely related to the imminent shock, code that change as the antibiotic start date; you can state your reason in the comments field
-** if the change/prescription was likely unrelated, code the first change after, or the most recent change before (again, use your judgment)
-If you are using '''non-standard data sources''' such as the in/out sheet, note so in the comment field.
+*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;
+*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:
+**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.
+**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)
+<br> If you are using '''non-standard data sources''' such as the in/out sheet, note so in the comment field.
 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.
 == Study Run Times ==
-=== Start date: October 8, 2009 ===
+===Third wave - Start Date: March 6, 2017 00:01 / End Date: June 30, 2017 23:59 ===
-'''Every''' qualifying patient sent after this date will need to have a temp entry, not only patients admitted after this date.
+Any patient who is discharged between the above dates and has a DX of septic shock needs to have a QASeptic Tmp entry.
+*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.
-=== Review Date ===
+===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).
-==== Feb 2,2010'''====
+=== First wave - Start Date: October 8, 2009 / End Date: July 1, 2011 ===
-*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)
+Every qualifying patient sent after this date will need to have a temp entry, not only patients admitted after this date.
-**see: [http://ltc.umanitoba.ca/wikis/ccmdb/index.php/QA_Septic_Shock#Update:_Feb_2.2010_Review_Meeting Feb 2.2010 Review Meeting]
+*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)
-==== May 4 ,2010 from 1100-1200 hrs ====
+**see: [[QA_Septic_Shock#Update:_Feb_2.2010_Review_Meeting Feb 2.2010 |Review Meeting]]
-*meeting request sent out Feb 2.10 by [[User:TOstryzniuk|TOstryzniuk]] 22:21, 2 February 2010 (CST)
+*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)
-=== End Date ===
-*Preliminary End Date: '''December 31.2010'''---[[User:TOstryzniuk|TOstryzniuk]] 17:04, 8 February 2010 (CST)(extended from April 8.10)
-**'''(set in ccmdb.mdb consistency checks)'''See: [http://ltc.umanitoba.ca/wikis/ccmdb/index.php/CCMDB.mdb_Change_Log_2010#V1.993_Changes | See:change request log]
-== Consistency Checks ==
-[[Tmp Checker]] will check for the following:
 === Date or Comment ===
 Every entry for project QA Septic must have either a date or a time.
-=== Dx but no tmp ===
+{{Data Integrity Check List|}}
-[[L_TmpV2]] entry is required if:
-* a DX of Septic shock exists
-* program is "CC"
-(implemented by [[s_tmp_QASeptic_Dx_no_tmp]])
-=== Tmp but no dx ===
-A diagnosis must exist if:
-* a "QASeptic" entry is present in [[L_TmpV2]]
-* program must be "CC"
-**implemented by: [[S tmp QASeptic Dx no tmp]]
 == Send mode ==
@@ Line 79: / Line 85: @@
 * [[Septic Shock]]
-[[Category: Special_Short_Term_Projects]]
+== Legacy ==
-[[Category: L_TmpV2 Data]]
+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: All Projects]]
-[[Category: QA]]
+}}
+[[Category:Sepsis]]
+[[Category:Shock]]
+[[Category:L_TmpV2 Data]]
+[[Category:QA]]