BRR: Difference between revisions
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==Purpose== | ==Purpose== | ||
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. | 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. | ||
== | =={{G | Guidelines}}== | ||
For any ICU patient with a witnessed or unwitnessed cardiac arrest, code the [[Var2]] variable as follows: | |||
*BRR - stands for "Brrrr" as in shivering or cold | *'''BRR''' - cooling protocol was applied (BRR stands for "Brrrr" as in shivering or cold) | ||
** Note: Do '''not''' code BRR when a cooling protocol is used to normalize temperature for non-arrested patients! | |||
*'''XBR''' - means no cooling protocol candidate patient | |||
** by coding XBR rather than leaving the variable empty we can automatically cross check that this was not just missed | |||
== | ==Context: Cardiac Arrest Cooling Protocol== | ||
*Target temp: '''32°C to 34°C''' for '''12 to 24 hours'''. | *Target temp: '''32°C to 34°C''' for '''12 to 24 hours'''. | ||
Taken from the Hypothermia Protocol: | Taken from the Hypothermia Protocol: | ||
*Cooling is indicated if '''all''' of the following are checked: | *Cooling is indicated if '''all''' of the following are checked: | ||
** | **Cardiac Arrest | ||
**Initial rhythm ventricular fibrillation/tachycardia(Dx code: 131-4, or 131-1) | **Initial rhythm ventricular fibrillation/tachycardia(Dx code: 131-4, or 131-1) | ||
**Time to ACLS <15 minutes | **Time to ACLS <15 minutes | ||
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=== Discussion === | === Discussion === | ||
{{discussion}} | {{discussion}} | ||
* Is the cooling protocol given as a coding aid, i.e. is BRR only supposed to be coded if all of the above are met? Or else, is BRR to be coded if cooling was done post-arrest, even if one of the indications is missing? I suspect the former. If so, this should be clarified in here. This could be done by moving the protocol into a "context" section at the bottom of the article. [[User:Ttenbergen|Ttenbergen]] 10:40, 27 August 2009 (CDT) | * Is the cooling protocol given as a coding aid, i.e. is BRR only supposed to be coded if all of the above are met? Or else, is BRR to be coded if cooling was done post-arrest, even if one of the indications is missing? I suspect the former. If so, this should be clarified in here. This could be done by moving the protocol into a "context" section at the bottom of the article. [[User:Ttenbergen|Ttenbergen]] 10:40, 27 August 2009 (CDT) | ||
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*changes made.--[[User:TOstryzniuk|TOstryzniuk]] 17:58, 26 August 2009 (CDT) | *changes made.--[[User:TOstryzniuk|TOstryzniuk]] 17:58, 26 August 2009 (CDT) | ||
=== | === Historical Info === | ||
* 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) | |||
* 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) | |||
Revision as of 13:01, 2009 August 27
Purpose
To identify ALL patients who are treated with therapeutic hypothermia following a Cardiac Arrest Witnessed 100-2 or 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.
Guidelines
For any ICU patient with a witnessed or unwitnessed cardiac arrest, code the Var2 variable as follows:
- BRR - cooling protocol was applied (BRR stands for "Brrrr" as in shivering or cold)
- Note: Do not code BRR when a cooling protocol is used to normalize temperature for non-arrested patients!
- XBR - means no cooling protocol candidate patient
- by coding XBR rather than leaving the variable empty we can automatically cross check that this was not just missed
Context: Cardiac Arrest Cooling Protocol
- Target temp: 32°C to 34°C for 12 to 24 hours.
Taken from the Hypothermia Protocol:
- Cooling is indicated if all of the following are checked:
- 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)
Discussion
- Is the cooling protocol given as a coding aid, i.e. is BRR only supposed to be coded if all of the above are met? Or else, is BRR to be coded if cooling was done post-arrest, even if one of the indications is missing? I suspect the former. If so, this should be clarified in here. This could be done by moving the protocol into a "context" section at the bottom of the article. Ttenbergen 10:40, 27 August 2009 (CDT)
Data Integrity Rules
If Cardiac Arrest Witnessed 100-2 or Cardiac Arrest Unwitnessed 100-1 in admit or complications diagnosis field then both the following must also be marked:
- ICU Var 2 – “BRR” or “XBR”
- TISS item T6-hypothermia/hyperthermia blanket
- changes made.--TOstryzniuk 17:58, 26 August 2009 (CDT)
Historical Info
- 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)
- reviewed with Kendiss Olafson and Dean Bell.--TOstryzniuk 17:58, 26 August 2009 (CDT)
- cross-checks changed to include Unwitnessed Cardiac Arrest (August 27.09)