Minutes Team Meeting June 14, 2018

Minutes June 14, 2018

Review use of REPLY ALL vs REPLY in email

• important to be mindful of who needs to be replied to. If main office is planning shift, Pagasa & Trish do this together therefore just replying to one person, this does not aid in the coordination of this task. Thanks guys!!
  • if you have an "attachment" in an email and you want to reply with attachment still in place, you have to use FORWARD to reply to the email however, you will have to select who you are forwarding to.

Discussion Tagging on Wiki

• Discussion & Question Instructions
  • make sure when you ask question on Wiki to place a discussion tag where you question is.
  • doing this pulls the question into a Questions Category and compiles the list in one place. This allows better opportunity to review.
  • collectors are encouraged, if you know the answer, address it in the article by updating the instructions and most important, removed the discussion tag.
  • some of the questions that need more medical input and then added to another category called Allan Garlands list.
    • using tag DiscussAllan, put it on a list for his input. See: Allan's links for what this is about and how to do it.
    • there are weekly meeting with Dr. Allan Garland to try and address these.

ICD10 diagnosis article reconciliation on Wiki & double coding

• staff have all been required to contribute to reconciling old diagnosis codes to the new ICD10 DX codes on the Wiki. The purpose of requiring all staff to participation is to facilitate the learning, understanding and the necessary documentation of the new DX coding schema and how to use it.
  • It is important for staff to do this work and also to practice using the new codes. Double coding at least 2-3 or more patient per week using both coding systems (old and new)

ICD10/CCI roll out feedback - round table comments:

• takes much longer because it is new.
  • ICD10 is becoming more familiar and easier to use.
  • WIKI- "old to new" links are very helpful
• CCI is still confusing and time consuming to use.
  • adds to workload, to find info and dates for procedures
  • uses terminology for a procedures that is not written in a chart, so takes much longer to enter
  • daily counts of the common and frequent test from EPR labs such as: ABG,VBG, CXR is time consuming to count and enter daily.
  • inconsistent between collectors because option can be many. (Dr. Garland had mentioned that we know this and it is okay. Administrative data, and previous DX coding was also applied inconsistently.)
  • there are: 71 CCI items, 235 CCI-1 items, 36 CCI-2 items
• Categories have still been confusing.
  • Noted that they were imported to Wiki incorrectly and this is being worked as with the changes collectors are making and also feedback they are providing.
• Good to be able search by categories in CCMDB.
  • Suggestions and feedback from collectors for Tina, to ease searching in CCMDB.
  • Need more tips and tricks.
  • Use the ICD10_Diagnosis_List on Wiki to see what is on it: Tina pointed out: use the small triangles that is beside the column label which is at the top of the list. Click on it, and it will sort alphabetically. You can sort any column on this list.
  • check Wiki article for a specific DX for more information including inclusion/exclusion criteria.
  • check link from old codes to new codes.
• Suggestion to color code past history of, chronic history off (comorbid) - everything is past hx, so can be confusing on CCMDB list, because all grouped together.

Use of expandable list in Wiki articles

• on many of the NEW DX's articles, there are expandable lists. For one example, look at this article: Intracranial hemorrhage, injury/trauma. One the page, you will see BLUE work Expand.
• Contains content of subcategories. Related articles that link to other related articles on Wiki
• a way to compress longer list in an article on a Wiki page.

Setting Wiki preferences

• if have added a question to an article and want to set that article up onto your watch list (get notification of an changes sent to your email by Wiki), you can set up watch list.
  • at the very top right of your screen in blue, after you have logged into Wiki, you will see your name, talks, preference, watch list, contributions
  • click on: watchlist then user profile and check list.
  • you are welcome to check it out and try.
  • if you set up TOO many pages to watch list you will get inundated with emails from the Wik. Use judgement. This is good if there is specific article you want to be notified about.
  • talk to Tina if you want more info.

Regional Critical Care Quality Symposium held June 8 at Canad Inn - Pembina Hwy

• Database Program - Poster - Nurses use Data too!
  • purpose - outreach and information
  • data is used not only by managers and Director. Examples of how nurse have used, or can use our database for patient care quality improvement projects
  • Laura and Julie presented
• Vic hospital request copy of poster to put up. Would need approval from site manager if can post.
• outreach - pyramids that contain general info and contact info were provided to staff to asked their manager at their sites if they can place at nursing stations in unit.
• Database Request forms - are available. The most up to date request for is on the Regional Server.
  • there is also copy of Wiki, but it is not the updated copy, as Julie had changed it.
    • Template:Discussion need to find link and then update the request form on Wiki.
  • there are 2 types: one for ICU and 1 for medicine.
  • instruction on the form how to fill out and who to submit to. Main office can advise if needed.
  • all requests are review by Director. Dan Roberts for Medicine. Jodi for ICU nursing and Boyan P for ICU.
  • may be a fee charged. This is determined by Director at approval level.

Suggestions for outreach

• Put article in the "Wave" news
• any change to the Wiki Main page? Currently the page link to various article that audiences outside the actual database program, could quickly look at.

VAP Criteria

• CDC changed criteria as not enough report (feel many are missed)
  • RE: item 3 lack of CXR's done to confirm DX
  • previous direction to code HAP then.
  • unclear how to proceed when lack of CXR to confirm?
  • judgement call, over reporting is better than under reporting.
  • mixed bugs - VAP possible
  • more bugs included ie candida, but must be in both sputum and blood culture
  • Why are we not including PVAP (Presumed-VAP) like they do in the USA?

BRR

• target body temp management to 36 C.
• no longer requires 12 hrs criteria
• applied to cardiac arrests only.

Staff Cross training between ICU and Med and other sites in Region

• on going and number of staff have been crossed trained and are working in both ICU and medicine within own units and other units in the city.
• this training will continue
• generally staff given orientation with buddy and then work location is swapped for extended period of time so that there is opportunity to apply what is learned into new area.
• most staff have required minimal orientation, as they know the process, they must take the time to learn the area/program
• be open to challenge to work in other area in your center or in another center in Region, as we are Regional Program.
• commendations to those that have completed this and are working in a number of units and sites.

Project Borrow arrive

• not discuss.
• Please review from project borrow arrive link above for changes coming.
• use of bed or service & standardization of this collection process

record and documentation of these minutes

• p:Pamela Piche
• p:Trish Ostryzniuk