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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
|successor=[[Targeted Temperature Management (TTM)]]
|content=


=={{G | Guidelines}}==
[[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) -->
For any ICU patient with a witnessed or unwitnessed cardiac arrest, code the [[ICU Var 2 - BRR]] variable as follows:  


*'''BRR''' - cooling protocol was applied (BRR stands for "Brrrr" as in shivering or cold)
{{Project
** Note: Do '''not''' code BRR when a cooling protocol is used to normalize temperature for non-arrested patients!
| Project = {{PAGENAME}}
***BRR '''start date: August, 2004'''
| ProjectActive = active
*'''XBR''' - means no cooling protocol applied for cardiac arrest patient for whom cooling could have been indicated as described below
| ProjectProgram = CC
** by coding XBR rather than leaving the variable empty we can automatically cross check that this was not just missed
| ProjectRequestor = Dr. Dean Bell/Dr. Kendiss Olafson
***XBR '''start date: March 19.2009'''
}}


As per Dr. KendissOlafson. Sept 15.10:  
{{TT | question =
"I think we want to capture all patients who are cooled post cardiac arrest whether they meet criteria or not.  A significant portion of patients following cardiac arrest do not meet ALL the criteria however based on the available evidence it is reasonable to consider cooling them.
* start and stop date should be in table? [[User:TOstryzniuk|Trish Ostryzniuk]] 13:56, 2018 December 24 (CST)
I believe, the rationale for the code XBR is to identify those patients who meet all our criteria for coding so that we can examine how often patients who meet all criteria to initiate cooling but are not cooled."
** 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. }}


==Context: 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'''.


Taken from the Hypothermia Protocol:
== Guidelines / Collection Instructions ==
*Cooling is indicated if '''all''' of the following are checked:
For any ICU patient with one of the following diagnoses:  
**Cardiac Arrest
* [[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)


See also [http://en.wikipedia.org/wiki/Therapeutic_hypothermia Therapeutic hypothermia] on wikipedia.
or pre-ICD10:
* [[Witnessed Cardiac Arrest]]
* [[Unwitnessed Cardiac Arrest]]


==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 - BRR]] – “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


=== Start Dates and other historical information ===
'''Do not code BRR or XBR''' when a cooling protocol is used to normalize temperature for any type of '''non-cardiac arrest''' patients.
* collection was started '''August 2004'''
 
* XBR and [[CCMDB.mdb]] cross checks were added to detect occasions where entry was just forgotten/missed '''March 19.09'''
== 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]]
 
== Background ==
=== '''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)
* 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'''  
* 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: ICU Variable Codes]]
[[Category:Project ICU only]]
[[Category: Data Integrity Rules]]
[[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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