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HSC Medicine Collection Guide: Difference between revisions

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==Information relevant to patients admitted to D4==
==Information relevant to patients admitted to D4==
*D4 is a ward that accepts both medical and surgical patients.
*D4 is a teaching medical ward which in close proximity to the renal clinic,and specializes in renal patients.It is the designated ward for the renal transplant patients which includes post operative care.
Area specific data collection practices exist that will be written in the near future by Fran Lindell
'''Data Collection for Renal Transplant Patient'''
*D4 admits Renal Transplants and Renal Donors. These pts are marked surgical. Renal Tx's are usually admitted from home.The admit time is that registered on the admission sheet.
*patient type is Surgical
They're admit Dx is pre-op optimization. Their first comp is Renal Tx ( choose living or cadaveric) If the pt was on HD dialysis, they may or maynot have have a HD prior to surgery. Mark task, no HD or chronic HD, as it applies. If they require HD after their renal Tx, this becomes acute HD task. Because chronic task & acute task cannot be marked at the same time, it is more important to capture the acute HD task. Peritoneal dialysis pt's always have dialsate instilled night before and drained prior to Sx. Same rule applies, capture chronic PD task, unless pt required acute PD post renal Tx.
*usually patients are admitted from their home.If the recipient patient is not living in Winnipeg and is receiving a cadaveric donor kidney they may be instructed to go to their nearest hospital and arrangements will be made to transport them to HSC.
N.B. Since CRF is in co-morb, ARF will not be accepted in comp Dx when file is completed and sent. The complication is either ATN or Renal Tx problem (ie in case of delayed graft function)
*The living donor recipients are scheduled by the renal clinic.The clinic will forward this information the week prior to surgery with the names of both the donor and recipient,Living renal transplants are performed on Thursdays and the patients are admitted Wednesday afternoon.
Renal donors are admitted from HSC Recovery.Admit Dx is Nephrectomy - donor. Sometimes surgeon chooses to do renal Bx at same time. Initial VS are taken from last entry on PACU record.
*Renal transplants patients are captured with the admit code diagnosis of Pre-Operative optimization.
The tasks for both pts are how independent they were prior to hospitalization.--[[User:FLindell|FLindell]] 16:16, 17 December 2010 (CST)
*Once the transplant is performed the code living donor or cadaveric donor is entered as a complication.
*Usually these patients have a co-morbidity of chronic renal failure. These patients are treated with hemodialysis or peritoneal dialysis.Occasionally the patient may receive a transplant before needing dialysis,in that case code chronic renal insufficiency mild or moderate depending on their creatinine.
*Once the patient has received a successful renal transplant and is discharged from the hospital,chronic renal failure will not be captured as a co-morbidity unless the transplanted kidney becomes diseased.
*Immune compromised renal transplants very occasionally become CMV+ or EBV+. This occurs when the donor is positive for CMV or EBV and the recipient was negative.The blood test is done by the Cadham Lab.The nephologist will document his in the history or progress notes.The transplant recipient will be started on anti-viral medications approximately one week post-op and will continue these medications for six months and in conjunction their immune suppression drug dosage will be titrated lower.
*N.B Chronic renal failure patients who receive a transplant that is not successful,cannot have acute renal failure as an acquired diagnosis for our medical collection data program.This might be captured as delayed graft function/renal transplant problems other,or sometimes it is related to acute tubular necrosis and can be proven by renal biopsy. Other problems will be documented by the Nephrologists.  
'''Renal Donor Patient'''
*Patient type is surgical
*They are admitted from recovery room.
*Initial vital signs are taken from the last recorded in recovery.
*The admission diagnosis will be Nephrectomy-renal donor
*ADL's are to reflect the patient's level of independence prior to surgery (home).


==Information relevant to patients admitted to B3==
==Information relevant to patients admitted to B3==
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