QA Septic Shock: Difference between revisions

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Kendiss Olafson & 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==
==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
* 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
* 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.
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 ===
=== First '''NEW''' Antibiotic ===
Line 19: Line 33:


* Project: QASeptic
* Project: QASeptic
* Item: First Antibiotic
* 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
* Date and Time: Date/Time of first antibiotic given to treat sepsis
* Comment:  
* Comment:  
Line 25: Line 41:
** state if non-standard source of information was used
** state if non-standard source of information was used


==== Special Cases ====
==== Special Cases ====
Antibiotic may be given prior to the development of shock or after. 
Use your '''judgment''' to determine the '''first''' antibiotic likely <u>administered</u> to '''treat septic shock'''.  
 
If the person then goes into septic shock and the antibiotics '''are not changed''' the time is that of '''original''' antibiotic coverage.


If the antibiotics '''are changed''' in response to the new shock state then the time of Antibiotics is the date/time that the '''new''' antibiotics were given.
If a patient was on antibiotics '''prior to''' meeting the conditions for shock, then:


If the patient '''does not receive Antibiotics''' (e.g. DC treatment) provide a reason in the comment section of the "First Antibiotic" entry.
*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)


Use your best judgment in entering this. If you are using non-standard sources such as the in/out sheet, note so in the comment field.
<br> If you are using '''non-standard data sources''' such as the in/out sheet, note so in the comment field.  


If the patient was already on a likely unrelated antibiotic and they develop new sepsis/infection, the antibiotic date should be left blank and in the comment section state patient already on antibiotic and there were no antibiotic changes made.
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 ==
== 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 ===
=== Date or Comment ===
Every entry for project QA Septic must have either a date or a time.
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 ==
== 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.


==Discussion==
== Related articles ==
{{Discussion}}
* [[Septic Shock]]
 
*Another issue:  There are instances where the patient may already be on antibiotics for an infection and then later develops septic shock anyway. Sometimes a new antibiotic is started and in this case the new antibiotic is the one to use in our tmp file.  Occasionally, though,  a new antibiotic may not be started.  We need to know what to do in these cases. Putting a start date of an antibiotic that is likely not the right one would not help. I have one patient like this right now. The patient was on two antibiotics for pneumonia, copd exac.  Developed septic shock 2 days later.  No new antibiotics started yet.  I will keep watching to see if new antibiotics are started as this patient likely has a bug that is not covered by the antibiotics he is on.  --[[User:LKolesar|LKolesar]] 15:20, 7 October 2009 (CDT)
**if the patient had new antibiotics started for THIS infection, put that date and time of the antibiotic start.  In another words antibiotic start may be PRIOR to the onset of shock. 
**If they where aready on an antibotic and they develop new sepsis/infection, the antibiotic date should be left blank and in the COMMENT section state patient already on antibitic and there were no antibiotic changes made.[[User:TOstryzniuk|TOstryzniuk]] 11:33, 20 October 2009 (CDT)
 
*Here is another scenario for you:  A patient develops septic shock in a community hospital and is coded by the data collector, then a few days later the patient is transferred to a tertiary ICU for continued care.  The data collector in the second hospital needs to code septic shock because it is still ongoing.  Should she use the same times of low BP and antibiotic start as the first presentation of septic shock at the first hospital?  We cannot always derive this information from the bits of chart that the sending hospital copies for us.  The only way to be sure of getting the same times would be to email the first data collector and obtain the times from her.  Is this the correct process to follow?? --[[User:LKolesar|LKolesar]] 11:08, 16 October 2009 (CDT)
**The data collector in the second hospital needs to code in the Admit Diagnosis septic shock because it is still ongoing however, if a patient comes from an ICU with a previous onset of septic shock and the data has already captured in the previous ICU admission TMP file, there is no need to enter the same start date of onset of shock in the next ICU admission TMP file.  We don't want to double count same episode of septic shock. 
***'''INSTRUCTION''': for next ICU transfered into, in the TMP file select ITEM: First BP <90, don't put a date however in the '''COMMENT''' section type in the following: '''transfered from previous ICU with DX of shock already coded'''.


=== Update: Feb 2.2010 Review Meeting ===
== Legacy ==
Collection guide has been updated under Instruction above in regards to collecting antibiotics.--[[User:TOstryzniuk|TOstryzniuk]] 14:44, 4 February 2010 (CST)
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)
*Brenda Kline and Kendiss Olafson have audited at a few septic shock charts.  They found a couple charts that they disagreed with in regards to the date/time of antibiotics.  Below are their findings and suggestion for clarifying data collection guidelines:
'''*Most of the errors are due to the following situation'''.
**Someone is on antibiotics (could be for days….) Their clinical situation deteriorates and in response '''NEW antibiotics''' are ordered (this may be prior to shock onset or just before).  If new antibiotics are not ordered immediately after septic shock onset then We want the time the antibiotics were last changed….
*We found that if antibiotics were not changed after septic shock that the data collectors are reporting when the person was FIRST started on antibiotics rather then the '''last time prior to shock''' that '''NEW antibiotics''' were initiated.I hope that makes sense. Dr. Kendiss Olafson.


== Related articles ==
}}
* [[Septic Shock]]


[[Category: Special_Short_Term_Projects]]
[[Category:Sepsis]]
[[Category: Shock]]
[[Category: L_TmpV2 Data]]
[[Category: L_TmpV2 Data]]
[[Category: All Projects]]
[[Category: QA]]
[[Category: QA]]

Latest revision as of 20:22, 2022 February 17

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"