Overstay Predictor Project Collection Instructions: Difference between revisions

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This article explains how to collect data in the [[CCMDB.mdb]] for the [[Overstay Predictor Project]].
{{LegacyContent
|explanation=we stopped [[Overstay]]
|successor=
|content=
This article documents what data collectors need to do to collect information for the [[Overstay Predictor Project]].  


For every '''medicine''' patient admitted to a ward participating in the project, '''as soon as possible''', but definitely '''within 48 business hrs of admission''' the data collector will need to enter the data in the [[Media:!Nursing_Discharge_Screening_Tool_Sept_18.pdf|Nursing Discharge Screening Tool]] into the [[CCMDB.mdb]], enter a certain amount of regular data early to generate a colour, put a sticker of that colour onto the chart, and in case of certain colours notify the transition coordinator.
'''This project was one of the Vacation and staff shortage collection priorities!'''


Additional information on roles and responsibilities for all participants in this initiative can be found at [[Overstay roles and responsibilities]].
== In addition to [[Minimal Data Set]] ==
The following items need to be entered '''before the generation of the chart colour in the next step''' because the algorithm uses this data:
* [[Date of Birth]]
* [[Province]]
* "Accept DtTm" if used, else "Arrive DtTm"
* [[Pre-admit Inpatient Institution]]
* [[ADL]]
* [[Glasgow Coma Scale]]
* '''important:''' [[List of diagnoses affecting Overstay Project]]


== The Nursing Discharge Screening Tool ==
== Generate colour ==
Find the white [[Media:!Nursing_Discharge_Screening_Tool_Sept_18.pdf|Nursing Discharge Screening Tool]]
Once the required information has been entered click the "Overstay" button on the patient viewer screen next to the [[Notes field]] and it will turn a colour based on an [[Overstay Predictor Project Algorithm | algorithm]].  
with the admission documentation on the patient chart and check if there is either a yes or no for all the first 6 questions. Also collect the patients living arrangements from the form. (Home, Nursing home, Assisted Living).
The form is to be completed within 24 hours of all new admissions to hospital and patients transferred to the unit without a previously completed ''Nursing Discharge Screening Tool''. If it is not possible at time of admission, the admitting nurse will pass the responsibility for completion to the next duty nurse.  


If the patient was discharged before a colour could be assigned write "not assessed" and write the discharge date on the Nurse Discharge Screening Tool, take a copy and put it in the Transition Coordinator Binder.
The program will ask you if this is the final colour you will submit. If so, it will be stored and sent. The colour will also be automatically added to the beginning of the Notes field, since most collectors were manually putting it there anyways.  


The nurse can update the form within the first 24 hours after admission if, for example they receive information from the patients family that contradicts the patients answers. It is possible that depending on when you review that document these changes are not captured. This a known risk that we are accepting.
* '''Red''' - significant risk for discharge delays
** email to notify unit manager - see [[#Notifying_the_Unit_Manager]]
**put red stick on chart - see [[#Red Chart Stickers]]
* '''Yellow''' - anyone who is not red
**no email to manager
**no sticker on chart
* '''Gray''' -  there are no gray stickers, gray is just a colour the laptop will give when it gets bad data for the algorithm.one of two scenarios:
** data needed to generate the colour is missing; you will not be able to generate a colour; there will be a specific error, please act on it
** the patient is transferred from a ward where the colour should have been generated already.


=== ensuring completeness within 24 hrs ===
== Red Chart Stickers ==
The bedside nurses have 24 hours from the time of [http://ccmdb.kuality.ca/index.php/Admit,_Transfer_and_Discharge_date_and_time#Definition_for_Medicine| admission to the unit] to fill out the ''Nurse Discharge Screening Tool''. This time frame allows for the nurse to clarify unanswered questions with the patient or caregivers during the day.  
If the colour is '''red''' place a 3/4" red round sticker on the spine of the patient chart. Ward clerks will need to order these. Collectors will tell ward clerks when supplies are getting low.  


'''If you can't find the form or an answer is still missing 24 hrs after admission:''':
=== Other coloured dots on charts ===
* enter the project "Overstay" "form data missing" entry into the tmp table
There is currently a small red dot used to indicate long term chart. These are not ours and users of the chart who use these ought to be aware of them.  
** If the nurse form is incomplete the patient will be evaluated as if the nurse form had identified a problem, i.e. the patient will become yellow or red; the program will give a message that data had been missing.
* check with the bedside nurse and remind them to complete it; enter the remaining data into CCMDB.mdb if it now becomes available.


If a patient was admitted and discharged within the 24 hours and no "Nurse Discharge Screening Tool" was completed do not enter anything in the Temp files.
== Notifying the Unit Manager ==
If a patient is identified as red, [[CCMDB.accdb]] will populate an email subject line with the name of the patient and that they have been identified as overstay colour red. The collector must send the email to the unit manager (see [[List of Unit Managers]]). It should not be necessary to add additional information to the body, this way all info is visible when the manager sees the email arrive, and they don't have to open it.  


=== entering the data ===
If we find that additional info is required, let's talk about it and add it to the program, rather than add anything manually, so we know this is done consistently.
Within two business days after the bedside nurse has completed the ''Nurse Discharge Screening Tool'' the rest of the Predictor data must be collected. For the first 6 questions and the question about their living arrangements, create a record in tmp entries and check the check box if the answer is '''Yes''' and indicate where they live.  


Question 4 consists of several sub-questions re. the patient's inability to manage daily activities. If even one of the activities raises a concern then the summary answer for the question needs to be '''no'''.
== Possible Scenarios ==
=== Possible Scenario - Patient transferred from other ward - admit ward was participating ward ===
If the patient was admitted from a another '''medicine''' ward at the same location that also participates in the Overstay project, then the original Yellow/Red designation is retained.
It will be the responsibility of the manager of the originating ward to notify the manager of the receiving ward of any red patients.  


Take answers to questions directly from the form, no interpretation, even if you disagree after reading the chart. We will be testing the answers provided by the nurses to determine if they are a better predictor of transition support needs or can be used in conjunction with existing admission data to improve the effectiveness of the prediction tool. If the data were interpreted by the collector it would introduce another factor and make this test less valid. If you identify a discrepancy please note it in the Temp Comments field also known as column Q.
==== Previous ward's collector ====
When you find out that your patient has been discharged to another ward where we collect please notify that collector. There seem to be different informal methods used by different collectors for this right now. We will test if that is good enough, and only formalize it if there are problems.  


If the patient is transferred from one medical unit to another within the facility only the one ''Nurse Discharge Screening Tool'' is required and the original Green/Yellow/Red designation is retained. You do not need to collect the information from the ''Nurse Discharge Screening Tool'', but to be allowed to send your data you need to enter an entry Project "Overstay", Item "Transferred form"  into the Tmp table. The designated colour should be written on the form, so ensure that the chart has a dot of the right colour. The Patient does need to be assigned to a Transition Coordinator so add the patients name to the Assignment Sheet.
==== New ward's collector ====
Ensure that these charts have the appropriate colour dot on them as communicated to you.  


==== how to enter if nurse form data missing ====
Enter the patient as normal and click the overstay button. It will give you a message ''"Patient comes from participating ward, use their overstay colour on charts. CCMDB will list gray."''. We will match the data to the original ward behind the scenes.
On the form if any of the 6 questions are not answered, enter a "form missing" record for each, like:
*Overstay  1. Alert and
*Overstay  form missing
*Overstay  3. Mobilze
*Overstay    form missing
*Overstay  5. Pt. supports 
*Overstay  6. smoke
(i.e. you can then tell that questions #2 & 4 are missing)


==== admitted from ====
=== Possible Scenario - Patient transferred from other ward - admit ward was '''NON'''-participating ward ===
For each patient also enter where they are admitted from;
If the patient is transferred either '''from''' or '''via''' any unit not participating in the Overstay project (e.g. an ICU) generate a colour.
* Project Overstay
* Item: one of
** From House
** From Apartment
** From Assisted Living
** From Supportive Housing
** From Personal Care Home
If the admitted-from information is not recorded on the form enter a "form missing" record instead.


{{Discussion}}
=== Possible Scenario - colour change due to data entry error ===
[[User: JMojica | Julie Mojica]] as of his week, is getting PCH arrival date from MHSC along with regular cross checks done with MHSC.--[[User:TOstryzniuk|Trish Ostryzniuk]] 20:55, 2012 November 1 (EDT)
'''The only case where the colour should be changed is if the data-collector made a error on data entry. We don't want you to change colour because data becomes available after the initial assessment window.'''
* that only gets us part of this info, and we already have several weeks of this. Let's keep it for now. The fact that we get additional data now means that [[Crosschecking data with Manitoba Health]] needs to be updated. Ttenbergen 22:24, 2012 November 1 (EDT)


== Changes to regular data entry required for the Overstay Project ==
If you realize you made a data entry error and you have fixed it, you can click the Overstay button again. It will ask you again if this is final, and if you click yes the original entry will be '''overwritten''' and the new colour be added to the beginning of the Notes field. This means you may have multiple colours in notes, the first one being the current one.
A number of items in addition to the regular [[Minimal Data Set]] needs to be entered '''before the generation of the chart colour in the next step''' because the algorithm uses this data:
*DOB
*Admit Date
** Enter admit date as before; we are aware that this can be different from the time of admission to the unit and the algorithm takes that into account
* ADL
* any '''[[Overstay Predictor Diagnosis Code Used]] (note exclusion of most comorbids and all acquireds/complications)'''
** if a dx is entered as a working diagnosis but not yet confirmed, '''do''' enter that diagnosis
** only dxs as listed in [[Overstay Predictor Diagnosis Code Used]] need to be entered early, i.e. the rest can be entered as they were before


*The following data needs to be entered at admission time (i.e. like minimal data set) for the coloring algorithm.
It is '''not necessary to document''' when a colour changes. Just change the colour.
** province
** whether the patient is admitted from a nursing home (into overstay tmp data)
** admit diagnosis of "Palliative Care"


== Chart Stickers ==
=== Possible Scenario - Patient died/discharged before data collection ===
Once the required information has been entered click the new “Overstay” button on the patient viewer form next to the notes field and it will turn a colour based on an [[Media:Two_Stage_Predictive_Model_of_Patients_in_Need_of_a_Transition_Coordinator.pdf | underlying algorithm]].  
Enter anyway and generate colour. Do not contact Unit Manager.  
* GREEN - low/no risk for discharge issues
* YELLOW - some risk for discharge issues
* RED - significant risk for discharge issues assign a transition coordinator.
* GRAY - if some needed data is missing you will not be able to generate a colour in the ccmdb database; there will be a specific error
Based on the color displayed circle the colour on the Discharge Screening tool. Also place a colored sticker on the spine of the patient chart. The sticker 3/4 inch stickers will be located in the transition coordinator binder at the unit clerk desk. 
Take a copy of all discharge screening tools and leave the copy on the Transition Coordinator binder. We will be collecting these forms for the time being to evaluate the form.


The color on the button is not stored in ccmdb.mdb, so it will not be visible next time you open the patient. This is by design as you should only need to use the colour once.
=== Possible Scenario - EMIP patient that never made it to the ward ===
Enter anyway and generate colour. Do not contact Unit Manager.  


Note: There is currently a small red dot used to indicate long term chart. There is also a small yellow dot used to indicate VRE.
=== Possible Scenario - Off ward patients ===
Almost all of these will be [[#Possible Scenario - Patient transferred from other ward - admit ward was participating ward]], so use those collection instructions. It will be the responsibility of that manager to notify the next manager.  


=== colour if data is missing ===
For the rare patient admitted to an off-ward location without hitting one of our regular wards first, generate a colour and put it on the chart, but don't worry about contacting a manager. This was discussed as a special case not worth following up on. It Is OK.
See the dialog boxes in the program for information on color coding if data is missing.


=== no need to document sticker colour changes ===
== Start/Stop/Site participation ==
It will not be necessary to '''document''' when a sticker colour changes. Just change the colour.
see [[Overstay Project Start Stop dates]]


After 24 hours all information required to make the assessment as to if the patient is at risk should be available (or not known to the nurse within the first 24 hours and thus considered a risk). The only case where the colour should be changed is if the data-collector knew they had made an error on data entry in which case there is no need to record the previous colour. If the change results in the patient no longer needing a transition coordinator, then the data coordinator needs to notify the transition coordinator to ensure they are ware of the change.
{{Data Integrity Check List}}


== Notifying the Transition Coordinator ==
= Clarification of difference to previous process=
If the patient has been designated as "red" for purposes of overstay prediction, the data collector will notify a Transition Coordinator by placing the patients name on the ''Transition Coordinator Assignment Sheet''. If a patient is transferred to the unit with a chart that already has a Red designation the data collector is to add the patient name to the ''Transition Coordinator Assignment Sheet''.
The following documentation is relevant to pre-empt questions only until the transition to the new process is complete.  
The rotation of Coordinators is made up of Home Care, Social Work, Physio, And OTs.  After assignment, that service is responsible for following that patient throughout their hospital stay. The Transition Coordinators are responsible for balancing their workload in the case that any individual is overburdened. They will also reassign patients if any Transition Coordinator is expecting to be a away for more than three business days.


== even at STB ==
For a while STB medicine collectors stopped putting red dots on the charts. They will now be required to put dots on the charts again. We discussed only notifying the manager by email with the requestor of the project, but they really want the dots. One thing we considered was the possibility of putting something equivalent to the red dot onto [[Medworxx]]. I am looking into that.


===Comment===
== DPST form - STOP July 31.17 ==
At your next meeting could you please ask the Nurse managers to remind the unit clerks upon discharge to remove the old stickers from the charts. I'm finding some and this could be confusing. Thanks, [[User: SDowson2 | Sheila Dowson]]-Thursday, October 11, 2012 11:56 AM
Collectors will '''no longer''':
*collect any information from the DPST forms or be responsible for them  (tmp file for the questions will be gone)
*post information in the Transition Coordinator binders or
*notify and assign allied Health.  


Collectors can ignore the form and just collect the minimal data set outlined above to generate a colour.
*wards may continue to fill out the DPST form at admission ''For their own purposes.'' 


== Transition Coordinator Binder - Stop July 31.17 ==
Collectors will '''no longer''':
*post any kind of information in the Transition Coordinator binder 
*notify and assign reds to allied Health team 


= Instructions admissions before Jul 30 2017 =
see [[Pre-2017-07-30 Overstay Predictor Project Collection Instructions]]
* All reds generated prior to July 31st are already in our data, just leave them as they were.
}}


 
[[Category: OverstayProject| *]]
[[Category: OverstayProject]]

Latest revision as of 13:16, 2022 April 19

Legacy Content

This page contains Legacy Content.
  • Explanation: we stopped Overstay
  • Successor:

Click Expand to show legacy content.

This article documents what data collectors need to do to collect information for the Overstay Predictor Project.

This project was one of the Vacation and staff shortage collection priorities!

In addition to Minimal Data Set

The following items need to be entered before the generation of the chart colour in the next step because the algorithm uses this data:

Generate colour

Once the required information has been entered click the "Overstay" button on the patient viewer screen next to the Notes field and it will turn a colour based on an algorithm.

The program will ask you if this is the final colour you will submit. If so, it will be stored and sent. The colour will also be automatically added to the beginning of the Notes field, since most collectors were manually putting it there anyways.

  • Red - significant risk for discharge delays
  • Yellow - anyone who is not red
    • no email to manager
    • no sticker on chart
  • Gray - there are no gray stickers, gray is just a colour the laptop will give when it gets bad data for the algorithm.one of two scenarios:
    • data needed to generate the colour is missing; you will not be able to generate a colour; there will be a specific error, please act on it
    • the patient is transferred from a ward where the colour should have been generated already.

Red Chart Stickers

If the colour is red place a 3/4" red round sticker on the spine of the patient chart. Ward clerks will need to order these. Collectors will tell ward clerks when supplies are getting low.

Other coloured dots on charts

There is currently a small red dot used to indicate long term chart. These are not ours and users of the chart who use these ought to be aware of them.

Notifying the Unit Manager

If a patient is identified as red, CCMDB.accdb will populate an email subject line with the name of the patient and that they have been identified as overstay colour red. The collector must send the email to the unit manager (see List of Unit Managers). It should not be necessary to add additional information to the body, this way all info is visible when the manager sees the email arrive, and they don't have to open it.

If we find that additional info is required, let's talk about it and add it to the program, rather than add anything manually, so we know this is done consistently.

Possible Scenarios

Possible Scenario - Patient transferred from other ward - admit ward was participating ward

If the patient was admitted from a another medicine ward at the same location that also participates in the Overstay project, then the original Yellow/Red designation is retained. It will be the responsibility of the manager of the originating ward to notify the manager of the receiving ward of any red patients.

Previous ward's collector

When you find out that your patient has been discharged to another ward where we collect please notify that collector. There seem to be different informal methods used by different collectors for this right now. We will test if that is good enough, and only formalize it if there are problems.

New ward's collector

Ensure that these charts have the appropriate colour dot on them as communicated to you.

Enter the patient as normal and click the overstay button. It will give you a message "Patient comes from participating ward, use their overstay colour on charts. CCMDB will list gray.". We will match the data to the original ward behind the scenes.

Possible Scenario - Patient transferred from other ward - admit ward was NON-participating ward

If the patient is transferred either from or via any unit not participating in the Overstay project (e.g. an ICU) generate a colour.

Possible Scenario - colour change due to data entry error

The only case where the colour should be changed is if the data-collector made a error on data entry. We don't want you to change colour because data becomes available after the initial assessment window.

If you realize you made a data entry error and you have fixed it, you can click the Overstay button again. It will ask you again if this is final, and if you click yes the original entry will be overwritten and the new colour be added to the beginning of the Notes field. This means you may have multiple colours in notes, the first one being the current one.

It is not necessary to document when a colour changes. Just change the colour.

Possible Scenario - Patient died/discharged before data collection

Enter anyway and generate colour. Do not contact Unit Manager.

Possible Scenario - EMIP patient that never made it to the ward

Enter anyway and generate colour. Do not contact Unit Manager.

Possible Scenario - Off ward patients

Almost all of these will be #Possible Scenario - Patient transferred from other ward - admit ward was participating ward, so use those collection instructions. It will be the responsibility of that manager to notify the next manager.

For the rare patient admitted to an off-ward location without hitting one of our regular wards first, generate a colour and put it on the chart, but don't worry about contacting a manager. This was discussed as a special case not worth following up on. It Is OK.

Start/Stop/Site participation

see Overstay Project Start Stop dates

Data Integrity Checks (automatic list)

 AppStatus
Query check tmp generate allowedCCMDB.accdbimplemented
Query check overstay no colourCCMDB.accdbretired
Query check overstay pt from our medCCMDB.accdbretired
Query check overstay not enteredCCMDB.accdbretired

Clarification of difference to previous process

The following documentation is relevant to pre-empt questions only until the transition to the new process is complete.

even at STB

For a while STB medicine collectors stopped putting red dots on the charts. They will now be required to put dots on the charts again. We discussed only notifying the manager by email with the requestor of the project, but they really want the dots. One thing we considered was the possibility of putting something equivalent to the red dot onto Medworxx. I am looking into that.

DPST form - STOP July 31.17

Collectors will no longer:

  • collect any information from the DPST forms or be responsible for them (tmp file for the questions will be gone)
  • post information in the Transition Coordinator binders or
  • notify and assign allied Health.

Collectors can ignore the form and just collect the minimal data set outlined above to generate a colour.

  • wards may continue to fill out the DPST form at admission For their own purposes.

Transition Coordinator Binder - Stop July 31.17

Collectors will no longer:

  • post any kind of information in the Transition Coordinator binder
  • notify and assign reds to allied Health team

Instructions admissions before Jul 30 2017

see Pre-2017-07-30 Overstay Predictor Project Collection Instructions

  • All reds generated prior to July 31st are already in our data, just leave them as they were.
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