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==Purpose==
{{LegacyContent
To identify ALL patients who are treated with therapeutic hypothermia following a [[Witnessed Cardiac Arrest | Cardiac Arrest Witnessed 100-2]] or [[Unwitnessed Cardiac Arrest | Cardiac Arrest Unwitnessed 100-1]].  By identifying all patients that receive this therapy a further audit can be done to identify if therapy was appropriate or not.
|explanation=Will be included in ICD10
*reviewed with Kendiss Olafson and Dean Bell.--[[User:TOstryzniuk|TOstryzniuk]] 17:58, 26 August 2009 (CDT)
|successor=[[Targeted Temperature Management (TTM)]]
|content=


==Code used==
[[Task Team Meeting - Rolling Agenda and Minutes#ICU Database Task Group Meeting – November 8, 2018 | DB task meeting minutes Nov 8.18]]-- User:TOstryzniuk|Trish Ostryzniuk]] 13:41, 2018 December 24 (CST) -->
BRR is a [[ICU Var 2]] tag that we use in our database for ICU patients who have been placed on the '''Cardiac Arrest Cooling Protocol'''


*BRR - stands for "Brrrr" as in shivering or cold.
{{Project
| Project = {{PAGENAME}}
| ProjectActive = active
| ProjectProgram = CC
| ProjectRequestor = Dr. Dean Bell/Dr. Kendiss Olafson
}}


==Possible values==
{{TT | question =  
*'''BRR''' - mean cooling protocol applied for cardiac arrest (started August 2004).
* start and stop date should be in table? [[User:TOstryzniuk|Trish Ostryzniuk]] 13:56, 2018 December 24 (CST)
*'''XBR''' - means no cooling protocol applied for cardiac arrest (Added March 19.09)
** yes, it's somewhere on my list to change all the tmp project templates to have the dates built in. Tagged now so staying on the list. }}


==Cardiac Arrest Cooling Protocol==
'''BRR/XBR''' is an entry we use to identify whether patients are receiving therapeutic hypothermia [[Targeted Temperature Management (TTM)]] following a '''cardiac arrest''' according to the [[Cardiac Arrest Cooling Protocol]]. By identifying all patients that receive this therapy a further audit can be done to identify if therapy was appropriate or not.
*Target temp: '''32°C to 34°C''' for '''12 to 24 hours'''.
We do '''not track cooling for reasons other than cardiac arrest'''.


*Code is not to be applied when a cooling protocol is used to normalize temperature for non-arrested patients.
== Guidelines / Collection Instructions ==
For any ICU patient with one of the following diagnoses:
* [[Cardiac arrest]]


Taken from the Hypothermia Protocol:
or pre-ICD10:
*Cooling is indicated if '''all''' of the following are checked: 
* [[Witnessed Cardiac Arrest]]  
**[[Witnessed Cardiac Arrest |''' Cardiac Arrest Witnessed 100-2''']]
* [[Unwitnessed Cardiac Arrest]]
**Initial rhythm ventricular fibrillation/tachycardia(Dx code: 131-4, or 131-1)
**Time to ACLS <15 minutes
**Total ACLS time <60 minutes
**Persistent [[Glasgow Coma Scale]] < or = 9
**Systolic BP currently over 90 mmHg (pressors allowed)
**< 8 hours elapsed since Return of Spontaneous Circulation (ROSC)


==Data Integrity Rules==
Code in TMP follows:
If [[Witnessed Cardiac Arrest | Cardiac Arrest Witnessed 100-2]] or [[Unwitnessed Cardiac Arrest | Cardiac Arrest Unwitnessed 100-1]] in [[! Admit Diagnosis | '''admit''']] or [[! Acquired Diagnosis / Complication | '''complications''']] diagnosis field then '''both''' the following '''must''' also be marked:
* Project: Cooling
*[[ICU_Var 2 | ICU Var 2]] – “BRR” or “XBR”
*item
*[[TISS]] item [[TISS Neurological | T6-hypothermia/hyperthermia blanket]]
**'''BRR''' (BRR stands for "Brrrr" as in shivering or cold)
*changes made.--[[User:TOstryzniuk|TOstryzniuk]] 17:58, 26 August 2009 (CDT)
*** cooling protocol was applied at any point post arrest
**'''XBR''' - no cooling protocol applied


===Purpose of marking BRR or BRX===
'''Do not code BRR or XBR''' when a cooling protocol is used to normalize temperature for any type of '''non-cardiac arrest''' patients.
By marking BRR or BRX for all patients with the diagnosis of witnessed cardiac arrest (100-2) or unwitnessed cardiac arrest (100-1), collectors will have verified at the time of collection that they did not miss marking that a patient was placed on the cooling protocol.  This will eliminate the query that gets send back to collectors to double check this item.


== CCI ==
[[Task Team Meeting - Rolling Agenda and Minutes#ICU Database Task Group Meeting – October 3, 2018]] confirmed that we can stop collecting this when we start collecting CCI [[Targeted Temperature Management (TTM)]]. We may want to import the old entries as CCI codes? Ttenbergen 00:19, 2018 October 10 (CDT)


== Cross Checks ==
see [[Check BRR/XBR vs cardiac arrest dx]]


[[Category: ICU Variable Codes]]
== Background ==
[[Category: Data Integrity Rules]]
=== '''Start Dates''' ===
* '''2004 August'''
* XBR and [[CCMDB.accdb]] cross checks were added to detect occasions where entry was just forgotten/missed '''March 19.09'''
* reviewed with Kendiss Olafson and Dean Bell.--[[User:TOstryzniuk|TOstryzniuk]] 17:58, 26 August 2009 (CDT)
* cross-checks changed to include [[Unwitnessed Cardiac Arrest]] '''August 27.09'''
* moved from ICU Var 2 into TMP on Dec 18, 2014
 
=== '''Stop Date''' ===
'''2018 Dec 31'''
*Stop in TMP.  All patient still in unit after this date, code as: [[Targeted Temperature Management (TTM)]]
 
=== Why the code XBR? ===
The rationale for the code XBR is to identify those patients who had a cardiac arrest but '''were not cooled''' regardless if they met criteria for cooling or not. XBR was implemented after an audit of cardiac arrest was done and it was found that there were several cardiac arrests coded that were missing code BRR.  By leaving Variable 2 blank for a cardiac arrest, it is not clear to Kendiss or Julie whether a data collector missed tagging it or if indeed cooling was not applied.  Coding XBR indicates to both Kendiss and Julie that a collector verfied that the cooling protocol was not applied. 
 
=== removed 12 hr requirement ===
Discussed at task 2018-04-11: we are removing the 12 hr requirement because the use and application of the protocol has changed since inception and this restriction is no longer reasonable.
 
== Related articles ==
{{Related Articles}}
 
[[Category:Project ICU only]]
[[Category:Arrest]]
[[Category:Arrest]]
}}

Latest revision as of 16:07, 2020 May 5

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DB task meeting minutes Nov 8.18-- User:TOstryzniuk

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