List of Factor affecting data quality: Difference between revisions

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Please feel free to add other thoughts and ideas

~~{{Discussion}}~~

# One example identified at a meeting today by [[User: CMarks| CMarks]] was if there is no MOST, because a patient was in palliative care, and only vital signs available is from 1 week prior to acceptance to medicine service then what do you put in as a BP, HR, WBC? The guidelines state if there are no values assume normal. But what are the normal values that should be recorded?

~~#*Solution: Tina suggested putting '''not available''' and when data sent to Server, values will be output as a preset standard normals.~~

# Another example ID'd by [[User: LBilesky | LBilesky]] was for APACHE - the exact physiological item is not recorded because APACHE score is based on selecting a value within a RANGE for points. If the points are the same why fuss about which value to select? There were never any guidelines instructing a collector which value to choose within a range.

~~#*Solution: Update guidelines for APACHE II collection rules.~~

~~# [[User: PStein | PStein]] - ID'd that she sometimes find 2 or more sources of DATE and TIME first accepted to the Medicine Service. She uses the first date and time she finds on the chart?~~

~~#*Solution: Update guidelines so that FIRST date and time found on a chart or [[EPR]] at STB is recorded.~~

# [[User: FLindell | FLindell]] - if actual med ward arrival time is obtained the data collector from the ward log book, then a auditor of a chart would not have assess to the log book, hence the ward arrival date and time is not easily reproduced. --[[User:TOstryzniuk|TOstryzniuk]] 17:24, 30 September 2010 (CDT)

~~#*Solutions: ?~~

~~=Discussion=~~

*Some collectors take the time of acceptance by Medicine from the doctors orders in the chart and compare it to the Admission/Separation sheet admit time,then compare to take the earliest time.For arrival time on the ward they look at the nurses notes to see if it is''' clearly documented''' and in that case they will take that time. If the arrival time is not clearly charted they look at the log book for a time.They also look at notes of the sending location to see if there is a departure time and compare it to the arrival time to see if it makes sense.

== APACHE improvements ==

* One example identified at a meeting today by [[User: CMarks| CMarks]] was if there is no MOST, because a patient was in palliative care, and only vital signs available is from 1 week prior to acceptance to medicine service then what do you put in as a BP, HR, WBC? The guidelines state if there are no values assume normal. But what are the normal values that should be recorded?

**Use the value shown when you click on the "AP" behind the field.

* Another example ID'd by [[p:Lois Bilesky-retire Jan 10, 2019 | Lois Bilesky]] was for APACHE - the exact physiological item is not recorded because APACHE score is based on selecting a value within a RANGE for points. If the points are the same why fuss about which value to select? There were never any guidelines instructing a collector which value to choose within a range.

**Solution: Update guidelines for APACHE II collection rules.

*** We certainly have more guidelines now than we did in 2011... is this still a concern? If they are still relevant pls start a new discussion about them.

*I have been thinking about ways in which apache scores could be done more consistently. If a mean BP calculator was put into access so that entering the systolic and diastolic numbers will result in a mean BP every time, this would be very helpful. Another thought that I had was that every value have a permanent display of the median (normal) number. For example the median for Potassium is 4.4, for WBC it is 9, etc. If the median number is permanently displayed on the screen then it is easier to ascertain the number furthest from that number either higher or lower. I think this is easier than having the range display. It would also be more accurate I think. --[[User:LKolesar|LKolesar]] 07:44, 10 January 2011 (CST)

**This display of median number of the normal scale would also apply to vital signs. --[[User:LKolesar|LKolesar]] 07:25, 11 January 2011 (CST)

* These points about improving APACHE were made a long time ago. Since then we added a listing for default values and ranges, and the [[BP Helper button]], and the reference values and ranges on the [[Patient Viewer Tab APACHE]]. Would you say that these issues are addressed or is this still a problem? If they are still relevant pls start a new discussion about them.

== Related articles ==

[[Category:Peer Audit]]

[[Category:QA]]

[[Category: Peer Audit]]

[[Category: QA]]

@@ Line 4: / Line 4: @@
 Please feel free to add other thoughts and ideas
-{{Discussion}}
-# One example identified at a meeting today by [[User: CMarks| CMarks]] was if there is no MOST, because a patient was in palliative care, and only vital signs available is from 1 week prior to acceptance to medicine service then what do you put in as a BP, HR, WBC?  The guidelines state if there are no values assume normal.  But what are the normal values that should be recorded?
-#*Solution: Tina suggested putting '''not available''' and when data sent to Server, values will be output as a preset standard normals.
-# Another example ID'd by [[User: LBilesky | LBilesky]] was for APACHE - the exact physiological item is not recorded because APACHE score is based on selecting a value within a RANGE for points. If the points are the same why fuss about which value to select?   There were never any guidelines instructing a collector which value to choose within a range.
-#*Solution: Update guidelines for APACHE II collection rules.
-# [[User: PStein | PStein]] - ID'd that she sometimes find 2 or more sources of DATE and TIME first accepted to the Medicine Service.  She uses the first date and time she finds on the chart?
-#*Solution: Update guidelines so that FIRST date and time found on a chart or [[EPR]] at STB is recorded.
-# [[User: FLindell | FLindell]] - if actual med ward arrival time is obtained the data collector from the ward log book, then a auditor of a chart would not have assess to the log book, hence the ward arrival date and time is not easily reproduced.  --[[User:TOstryzniuk|TOstryzniuk]] 17:24, 30 September 2010 (CDT)
-#*Solutions: ?
-=Discussion=
-*Some collectors take the time of acceptance by Medicine from the doctors orders in the chart and compare it to the Admission/Separation sheet admit time,then compare to take the earliest time.For arrival time on the ward they look at the nurses notes to see if it is''' clearly documented''' and in that case they will take that time. If the arrival time is not clearly charted they look at the log book for a time.They also look at notes of the sending location to see if there is a departure time and compare it to the arrival time to see if it makes sense.
+== APACHE improvements ==
+* One example identified at a meeting today by [[User: CMarks| CMarks]] was if there is no MOST, because a patient was in palliative care, and only vital signs available is from 1 week prior to acceptance to medicine service then what do you put in as a BP, HR, WBC?  The guidelines state if there are no values assume normal.  But what are the normal values that should be recorded?
+**Use the value shown when you click on the "AP" behind the field.
+* Another example ID'd by [[p:Lois Bilesky-retire Jan 10, 2019 | Lois Bilesky]] was for APACHE - the exact physiological item is not recorded because APACHE score is based on selecting a value within a RANGE for points. If the points are the same why fuss about which value to select?   There were never any guidelines instructing a collector which value to choose within a range.
+**Solution: Update guidelines for APACHE II collection rules.
+*** We certainly have more guidelines now than we did in 2011... is this still a concern? If they are still relevant pls start a new discussion about them.
+*I have been thinking about ways in which apache scores could be done more consistently.  If a mean BP calculator was put into access so that entering the systolic and diastolic numbers will result in a mean BP every time, this would be very helpful.   Another thought that I had was that every value have a permanent display of the median (normal) number.  For example the median for Potassium is 4.4, for WBC it is 9, etc.    If the median number is permanently displayed on the screen then it is easier to ascertain the number furthest from that number either higher or lower.    I think this is easier than having the range display.     It would also be more accurate I think.  --[[User:LKolesar|LKolesar]] 07:44, 10 January 2011 (CST)
+**This display of median number of the normal scale would also apply to vital signs.   --[[User:LKolesar|LKolesar]] 07:25, 11 January 2011 (CST)
+* These points about improving APACHE were made a long time ago. Since then we added a listing for default values and ranges, and the [[BP Helper button]], and the reference values and ranges on the [[Patient Viewer Tab APACHE]]. Would you say that these issues are addressed or is this still a problem? If they are still relevant pls start a new discussion about them.
+== Related articles ==
+{{Related Articles}}
+[[Category:Peer Audit]]
+[[Category:QA]]
-[[Category: Peer Audit]]
-[[Category: QA]]