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| '''Location''': HSC, 4th floor of the John Buhler building, room 405 | | '''Location''': HSC, 4th floor of the John Buhler building, room 405 |
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| | ==[[Minutes Team Meeting 12 June 2008]]== |
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| Please make every effort to attend this meeting if at all possible. | | Please make every effort to attend this meeting if at all possible. |
| Medicine data collectors please bring examples of where you are getting your information to complete the Katz ADL from. | | Medicine data collectors please bring examples of where you are getting your information to complete the ADL. |
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| == Agenda == | | == Agenda == |
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| * Questions and Answers - Everyone | | * Questions and Answers - Everyone |
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| [[Tina Tenbergen|Tina]] will be updating the Wiki with the answers to your questions. | | [[p:Tina Tenbergen|Tina]] & [[p:Trish Ostryzniuk|Trish]] will be updating the Wiki with the answers to your questions. |
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| If you have any other questions or concerns please send them to [[Linda Hathout|Linda]] ahead of time so we can ensure questions get addressed. | | If you have any other questions or concerns please send them to [[Linda Hathout|Linda]] ahead of time so we can ensure questions get addressed. |
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| ===Questions/Concerns Submitted so far===
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| # Clarify definition for Hypotension NYD- it says not due to shock or post-op in the code book we don't know when to use this. Why can't we just have hypotension NYD for a code? In other words if patients don't meet the specific criteria for septic shock or hypovolemic shock or cardiogenic shock it would be NYD.
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| # Clarify definition [[Septic Shock]]
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| # Clarify definition [[Cardiogenic Shock]]
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| # Clarify definition [[Cardiac Arrest]]s-It's impossible to see how many occur right before admission to Medicine as some patients are admitted to medicine bypassing ICU
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| # Clarify definition [[Violent behavior]] code - supposed to be 2nd to dementia but is used for anyone who is violent
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| # Clarify definition [[Panelling or Discharge Planning]] why does it say in the code book primary reason for admission to ward bed?
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| # Clarify definition
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| #* [[Muscle deconditioning]]
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| #* [[Pain Control - non post op]]
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| #* [[Pain Control - post op]] - we feel it is highly overused
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| # Clarify definition [[Palliative Care]] - need criteria to follow
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| # [[Acute coronary insufficiency]] and [[Unstable angina]] (151, 152) - description in code book should be reversed
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| # There currently is no codes for: hematuria- we have lots of people who are getting CBI for hematuria NYD
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| #* either add to [[:Category:Diagnoses we are not coding]] or make [[Hematuria NYD]]
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| # Regarding the KATZ [[Activities of Daily Living|ADL]]
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| ## assessment for feeding; when a person arrives to the unit within the first 24 hours NPO either for a test or for GI Bleed does this qualify as Dependant? The KATZ says 'Dependant is assistance to eat; does not eat (I interpret this to include NPO); must be fed; fed partly or completely by NG or IV.
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| ## Continence for assessment; does the use of a foley from home or within the first 24 hours qualify as Dependant. The KATZ states "Dependant as assistance; incontinent or cathether used (as with the use of a foley).
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| # Will a position be created to focus on quality control through chart audits to ensure our data is consistent? It would be nice to have some feed back.
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| # The Diagnostic coding book would benefit from a thorough "overhaul" to itemize specific criteria for coding definitions. As a group each month we could perform audits in each dx category with the goal of talking about codes etc in order to all understand when and where to use them. The Wiki may be the best way to do this.
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| # Possible impacts of the new Code Blue policy at HSC
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| ==Meeting Notes==
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| Dr. Roberts:
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| Discussed the MOST score. The MOST score is a risk stratification toll that generates a probability of an adverse outcome for a patient. The equation is derived from the Charlson Comorbid index, the Glascow Coma Score, the ADL, systolic BP, heart rate, respiratory rate, white blood cell count the sex of the patient and their age. With these variable the equation can predict the likelihood of the patient having an adverse outcome such as death, a cardiac arrest and readmission or admission to an ICU. This equation was validated based on data collected at HSC, SBGH, the Grace and Victoria hospital on over 11,000 patients admitted to medical units in 2004/2005. There is no existing tool that can make such prediction for non ICU patients. This makes this equation and the research conducted by Dr. Roberts and Julie extremely valuable and powerful.
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| Because the MOST score can be used to predict negative outcomes the intention is to try and use it to prevent the. This required that the ongoing integrity of the data is consistent. This is why there was some concern when the 2008 data indicated a significant change in the MOST score values at HSC and SBGH. This promoted the need to review the data collection standards.
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| Trish:
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| Discussed how the MOST score elements were to be collected as of December 2007 at which time some of the old vital sign data fields were removed and clear guidelines were provided for the collection of the ADL and the other MOST score elements. This information can be found by clicking on this link.
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| Trish clarified that it is not supposed to be the worst assessment values observed prior to a patient being admitted to a ward rather the value closed to the decision to admit. If there were no pre admissions scores documented then it should be the closed score post admission. If no assessment value was recored withing 48 hours pre admission or 48 hours post than the data collector should assume normal.
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| Dr. Roberts:
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| | [[Category: 2008 Data Collection Team Meetings]] |
A team meeting has been scheduled.
Time: 12 June 2008, 11:00 - 13:00
Location: HSC, 4th floor of the John Buhler building, room 405
Please make every effort to attend this meeting if at all possible.
Medicine data collectors please bring examples of where you are getting your information to complete the ADL.
Agenda
- Discuss how the MOST Score is being collected - Trish or Linda
- What the MOST Score is used for - Dr. Roberts
- Discuss discharges to ER – Julie
- Review Vital Signs project – Julie
- Review the Wiki application – Tina
- Questions and Answers - Everyone
Tina & Trish will be updating the Wiki with the answers to your questions.
If you have any other questions or concerns please send them to Linda ahead of time so we can ensure questions get addressed.