QA Septic Shock: Difference between revisions

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==Purpose==
{{Project
Kendiss Olafson & the QA team are monitoring performance and appropriate interventions for [[Septic Shock]] in the ICUs.
|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==
==Data Collection Method==
If an ICU patient has an '''admit''' or '''complication''' diagnosis of '''[[Septic Shock]]''', 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
 
==== 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 ''transferred from previous ICU with DX of shock already coded'' as the '''COMMENT'''.
 
=== First '''NEW''' Antibiotic ===
The time of antibiotics is the date and time antibiotics are given '''for sepsis'''.


* Project: QASeptic
* Project: QASeptic
* Item: First SBP<90
* Item: First Antibiotic
* Date and Time
** 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:
** note reason if an antibiotic was not given
** state if non-standard source of information was used
 
==== Special Cases  ====
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 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.


* Project: QASeptic
== Study Run Times ==
* Item: First Antibiotic
===Third wave - Start Date: March 6, 2017 00:01 / End Date: June 30, 2017 23:59 ===
* Date and Time
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.
 
===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).


=== Discussion ===
=== First wave - Start Date: October 8, 2009 / End Date: July 1, 2011 ===
{{Discussion}}
Every qualifying patient sent after this date will need to have a temp entry, not only patients admitted after this date.
*The time of first hypotension should be clarified.  Is this during their specific icu stay or the first hypotension at presentation to the health care system ie. emergency, community hospitals, nursing homes, wards, etc.
*Review Date - done Feb 2,2010
?Hypotension can sometimes go on for days prior to actual diagnosis of septic shock and transfer to ICU.  Also it needs to be clear that the antibiotic start time must be related to the specific presentation of septic shock.  
**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)
Sometimes the patient is on antibiotics prior to onset of shock. I think I know what Dr.Kumar wants here as I have done some chart reviews for him in the past, but this must be made clear to all the data collectors so that it is
**see: [[QA_Septic_Shock#Update:_Feb_2.2010_Review_Meeting Feb 2.2010 |Review Meeting]]
consistent.      Also, be aware that finding the initial hypotension and
*Stop for '''all''' patient, that include those already in unit prior to July 1 who develop septic shock after July 1
antibiotic start times can sometimes require quite an extensive chart search in some cases if the patient has been moved around between hospitals or wards.
*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)
** waiting for clarification from Kendiss Olafson [[User:Ttenbergen|Ttenbergen]] 15:30, 29 September 2009 (CDT)


== Consistency Checks ==
=== Date or Comment ===
[[Tmp Checker]] will check for the following:
Every entry for project QA Septic must have either a date or a time.
=== Dx but no tmp ===
L_Tmp entry is required if:
* a DX of Septic shock exists
* program is "CC"


=== Tmp but no dx ===
{{Data Integrity Check List|}}
A diagnosis must exist if:
* a "QASeptic" entry is present in [[L_Tmp]]
* program must be "CC"


== Send mode ==
== 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.
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.


== Related articles ==
* [[Septic Shock]]
== Legacy ==
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: Shock]]
[[Category: L_TmpV2 Data]]
[[Category: L_TmpV2 Data]]
[[Category: QA]]

Latest revision as of 20:22, 17 February 2022

Projects
Active?: legacy
Program: CC
Requestor: Dr. Kendiss Olafson
Collection start: 2017-03-06
Collection end: 2017-06-30

Legacy Content

This page contains Legacy Content.
  • Explanation: Tmp project ended
  • Successor: No successor was entered

Click Expand to show legacy 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/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 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

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 transferred from previous ICU with DX of shock already coded as the COMMENT.

First NEW Antibiotic

The time of antibiotics is the date and time antibiotics are given for sepsis.

  • 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:
    • note reason if an antibiotic was not given
    • state if non-standard source of information was used

Special Cases

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 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

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

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)GHall 10:34, 2017 July 6 (CDT)
  • The ICU QI team has requested an updated review.

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 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.--Trish Ostryzniuk 16:05, 2012 June 13 (CDT).

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

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.--TOstryzniuk 16:30, 2 February 2010 (CST)--TOstryzniuk 16:30, 2 February 2010 (CST)
    • see: 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.--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 Checks (automatic list)

 AppStatus
Query s tmp QASeptic tmp no dxCCMDB.accdbimplemented
Query s tmp QASeptic Dx no tmp ICD10CCMDB.accdbimplemented

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.

Related articles

Legacy

In CCMDB.mdb_Change_Log_2012#ver_2012-09-06 "First SBP<90" was changed to "BP Criteria". Ttenbergen 11:08, 2012 September 12 (CDT)

Retrieved from "https://ccmdb.kuality.ca/index.php?title=QA_Septic_Shock&oldid=154817"