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ACP Status Collection in ICU: Difference between revisions

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This article is about collecting the "ACP Status" temp entry.
{{Project
|ProjectActive=legacy
|ProjectProgram=CC
|ProjectRequestor=Critical Care QI Team
|ProjectCollectionStartDate=2015-08-10
|ProjectCollectionStopDate=2016-12-31
|Project=ACP Status Collection in ICU
}}
{{LegacyContent
|explanation=Collection for this project stopped 2016-12-31
|successor=See [[ACP Status Collection over time]] for related collection projects.
|content=
 
This article is about collecting the "ACP Status" (Advanced Care Planning) temp entry.
 
== Start and stop date ==
* First ACP Collection Start Date: 2015-08-10
* Date with complete data across all sites: 2015-09-01
* Date that ACP status documented in chart closest to ICU ADMIT and ICU END.  Start to collect dates on: 2016-04-8
* Revised ACP Collection Start Date: 2016-05-01
* '''Stop Date: 2016-12-31'''
**For patients who have been admitted before or on Dec 31, 2016 and are still in the unit by Jan 2017 and have ACP status data, just email Pagasa the ACP status, ACP source and dates - she will add it in the TMPV2 table of the master database.


== Purpose ==
== Purpose ==
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== Collection Instructions ==
== Collection Instructions ==
We want this entered for each ICU patient, for the last documentation prior to ICU admission, and for each piece of ACP documentation until ICU discharge.  
For each ICU patient, use the last documented ACP status in the chart ''prior to ICU'' admission date. After ICU admission, collect any ACP status changes and source of this documentation until the patient is discharged from the ICU.
An initial "ACP Status" and "ACP Source" entry will be automatically added. Add additional pairs of entries for each additional ACP documentation since the beginning of this hospitalization.
If there are no changes during ICU admission from initial ACP status and source you have recorded then no need to enter more. Only use ACP forms made during '''same hospitalization''' (e.g. ACP status documented by ER, or ward or in prior ICU for transferred patients); ACP forms from prior hospitalizations are not to be collected (not included) in this project.
An initial '''ACP Status''' and '''ACP Source''' entry will be automatically added.  
Add additional pairs of entries for each additional ACP documentation since the beginning of this hospitalization.
 
* for '''each''' ACP documentation, change
* for '''each''' ACP documentation, change
** Project '''ACP Status'''
** Project '''ACP Status'''
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**** '''ACP M+''' - all medical care given except cardiac resuscitation; intubation either happened or allowed
**** '''ACP M+''' - all medical care given except cardiac resuscitation; intubation either happened or allowed
**** '''ACP M-''' - all medical care given except cardiac resuscitation and intubation; also if ACP M is written without +/-
**** '''ACP M-''' - all medical care given except cardiac resuscitation and intubation; also if ACP M is written without +/-
**** '''[[ACP C]]''' - comfort care
**** '''[[ACP-C]]''' - comfort care
** Project '''ACP Source''' [''for'' Location of ACP documentation]
**** '''not documented''' - should be paired with same in ACP Status
*** Item one of the following
** Project '''ACP Source'''
*** Item one of the following:
**** '''Form '''
**** '''Orders '''
**** '''Form and Orders '''  
**** '''Form and Orders '''  
*****choose this item if the ACP status and Date are the '''same''' on both the ACP Form and the ICU Admitting Orders (see below for sample forms). Otherwise, enter a new ACP documentation with different ACP status or date.
*****choose this item if the ACP status and Date are the '''same''' on both the ACP Form and the ICU Admitting Orders (see below for sample forms). Otherwise, enter a new ACP documentation with different ACP status or date.
**** '''Form '''
**** '''Other''' - with this option only, put in tmp comment what other place you obtain ACP status and date
**** '''Orders '''
**** '''not documented''' - should be paired with same in ACP Source
**** '''Other''' - with this option only, put in tmp comment what other place you obtain ACP status date from is none of the above.
** for both Source and Status:  
** for both Source and Status:  
*** Date: '''date filled out''', or '''check checkbox''' if '''no''' date
*** Date: '''Same date''' filled out for both Project '''ACP''' and '''ACP Source'''
**** '''Same date''' filled out for both Project '''ACP''' and '''ACP Source'''
**** '''No Date''': check the checkbox for source and status if there is no date
**** Date is used as the identifier for each ACP documentation.
*** '''Integer (column "N"): used to ''pair'' status and source entries; put a number; use the same number for the status and source entry for the same form. e.g. put a "1" for the status and source for the first tmp entry pair, then put a "2" for each of the second. This allows us to pair up entries even if there are more than one for the same date.
**** Date prior to ICU admission must be during the '''same hospitalization''' (e.g. ACP status documented by ER, or ward or in prior ICU for transferred patients).
 
**** Date and ACP status for prior hospitalizations are not to be collected (not included) in this project.
===Question - Source Others ===
*** '''Integer (column "N")''': put '''a number'''; use the same number for the status and source entry for the same form. e.g. put a "1" for the status and source for the first tmp entry pair, then put a "2" for each of the second. This allows us to pair up entries even if there are more than one for a date.
* if no ACP decisions are documented at all then:
** Project '''ACP Status''' - '''delete this line'''
** Project '''ACP Source'''
*** Item '''not documented'''


=== Mandatory after 2016-05-01 ===
=== Examples ===
Entries for this will be mandatory for records with admit dates after 2016-May-01.  
Some EXAMPLES of pairing ACP status and Source in CCMDB_TMP: [[Media:ACP status collection examples status and source.pdf|CLICK HERE]] to see table of examples.


=== If care has been discontinued ===
=== If care has been discontinued ===
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=== If ACP-M is documented without +/- ===
=== If ACP-M is documented without +/- ===
If ACP M is just written with no qualifiers then one would classify as ACP M-.
If ACP M is just written with no qualifiers then one would classify as ACP M-.
===ACP from EPR (STB only at this time)===
*To collect the ACP status go to EPR orders.  Under "transfers and care directives" there should be an order that states, "advanced care planning goals of care"  with the ACP status listed (this also displays in the top of the EPR individual patient demographic information).  If you double click on the order, the ACP electronic form displays (it is exactly the same as the paper form which was previously used). 
*When the physician writes the order, the form automatically is populated with the doctor name and the ACP status also.  However, if there are special conditions or comments, the doctor may fill out parts of the form itself separately from the displayed order. 
*When putting in the source of ACP, if the order for ACP is written and the form has no additonal information (other than status and dr name) just put source as "order".  If the electronic form is filled out with additional information then put "order and form".  --[[User:LKolesar|LKolesar]] 11:37, 2016 May 26 (CDT)


== WRHA guidelines / forms ==
== WRHA guidelines / forms ==
*[http://www.wrha.mb.ca/acp/files/Workbook.pdf WRHA ACP Guidelines/workbook]
*[[Media:WRHA ACP form Nov 2013.pdf | Example of WRHA ACP FORM]]
*[http://home.wrha.mb.ca/corp/policy/files/110.000.200.pdf  WRHA Advance Care Policy]
*[[Media:AdmittingOrdersforICU.pdf | Example of Admitting Orders for ICU]]
*[[Media:WRHA ACP form Nov 2013.pdf |Example of WRHA ACP FORM]]
*[[Media:AdmittingOrdersforICU.pdf |Example of Admitting Orders for ICU]]
 
== Start and stop date ==
* First ACP Collection Start Date: 2015-AUG-10
* Date with complete data across all sites: 2015-SEP-1
* Date that ACP status documented in chart closest to ICU ADMIT and ICU END.  Start to collect dates on: 2016-APR-8
* Revised ACP Collection Start Date: 2016-May-01
* Stop Date: none
 
== {{CCMDB Data Integrity Checks}} ==
=== Checks at sending time ===
If a patient exists who
* pt is ICU pt
* RecordStatus is complete
* one of the following is true
** there is not at least one entry in tmp with project = "ACP Source"
** project = "ACP Source" or "ACP Status" and item = "enter"
then won't be able to send anyone.
In normal operation such a patient should not be possible to set to "complete", this is a double-check.
Implemented as query ''s_tmp_ACP'' in [[CCMDB.mdb_Change_Log_2016#2016-May-04]]
 
{{Discussion}}
 
I'm confused. Why does '''ACP end''' come up automatically in the temp file when you can send a file with just 1.ACP status and source. The question is if the ACP status doesn't change from admission to discharge is one entry of both status and source good enough?
 
=== pairs of records ===
will need to make a check that looks for matching pairs of integers Ttenbergen 15:34, 2016 May 9 (CDT)


=== Check at Complete-time ===
== Cross Checks ==
Can't check patient complete if the Item for an entry for this project is "enter" or "".
* [[Query s tmp ACP]]
Implemented in VBA in [[CCMDB.mdb_Change_Log_2016#2016-May-04]]


== Data use / Reporting and Analysis ==
== Data use / Reporting and Analysis ==
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** Level of care at the time of discharge for survived patients
** Level of care at the time of discharge for survived patients


* the data are saved in table L_TmpV2 under project "ACP at admit / ACP at end" of the centralized_data.mdb
* the data are saved in table L_TmpV2 under projects "ACP at admit / ACP at end / ACP Status / ACP Source" of the centralized_data.mdb
* the SAS program that reads the data can be found in X:\Julie\SAS_CFE\CFE_macros\CFE_CC_ACP.sas
* the SAS program that reads the data can be found in {{S:\MED\MED_CCMED}}Julie\SAS_CFE\CFE_macros\CFE_CC_ACP.sas


== Legacy ==
== Legacy ==
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''see [[Comfort Care]] for collection of similar info in Medicine''
''see [[Comfort Care]] for collection of similar info in Medicine''


[[Category: Critical Care Element]]
}}
[[Category: All Projects ICU only]]
[[Category:End-of-life related data]]
[[Category: End-of-life related data]]
[[Category:ACP]]
Retrieved from "https://ccmdb.kuality.ca/index.php?title=ACP_Status_Collection_in_ICU"