DeviceUse Study

Project Name

DeviseUse Study (this is the spelling of the study in our program and on the wiki)

Purpose

Monitor resource allocation and monitor complication rates related to length of ICU medical device use. (VAP, Central Line Related Blood stream Infection (CLR-BSI), unplanned extubations) to improve patient quality of patient care in critical care.

Who

Information to be collected from charts daily by Regional Database Team - Critical Care areas.

• Monitoring being done by the Critical Care QI Team along with the cross Canada ICU collaborative project teams CCVSM. Members of the CCQI team will also provide ongoing support and feedback for issue related to collection of this data from chart.
• Laura Kolesar will be the lead data collector who will work with CCQI team, Statistician & Tina Tenbergen on matters related to this project.

Where

Data will be collected in all ICUs in the region.

Data will be stored de-identified in L TmpV2 in the output folder on the Regional Server.

How often data is sent

• Information sent each week with sending to L TmpV2 even though patient files is not complete.

Instructions for collecting

• The focus is to determine number of days with each device while in the unit
• For each of the following devices, enter an in and out record for each device present:
  • on "in" record, tick off "present on admission" instead of entering a date if the device is present on admission
  • on "out" record, tick off "present on discharge" instead of entering a date if the device is present on discharge
  • devices:

• • • Central line (first in and last out)
      • doesn't matter how many central lines a patient has at the same time (hint: if helps to keep track by writing in the note section which line it is for your own benefit.)
    • PICC line
    • ETT & vent in, use this option if both are simultaneous (if not use individual options which have a "Z" in front
    • ETT & vent out, use this option if both are simultaneous (if not use individual options which have a "Z" in front
    • ETT
      • If an unplanned extubation occurs enter a record for this in addition to documenting the ETT in and out records
      • if patient is re-intubated then the ETT out will not be completed at the same date and time because the ETT days will continue.
    • Trach
    • Vent
      • Out will be defined as OFF the ventilator for >=48 hrs
    • BIPAP/CPAP
      • DC BIPAP will be defined as OFF the ventilator for >=24 hrs
      • Home bipap or cpap is included in this study.
        • Template:DiscussionSorry, just read the off vent/bipap for 24 hours note. But this still is going to require a fair bit more work for IICU, especially with MICU already having a large census to manage.--Jpeterson 09:23, 7 October 2011 (CDT)
          • The times are different for BIPAP and VENT... Ttenbergen 09:26, 7 October 2011 (CDT)
• If the device is removed or stopped for a few days and then a new device is used, a new set of entries is required to get an accurate duration for the device.

Further instructions will follow as we start working with this tool. Anyone can start trialing this any time because Tina has put it on the laptops. This only applies to critical care collectors. Feedback is welcomed as you start collecting this information. The actual project will start Jan 1, 2011 but you are expected to work with it on a trial basis somewhat before that date so that you are familiar with it and all the glitches can be worked out.

Start Date

Testing

Anyone who wishes to test this is welcome to do so. Start of testing Oct 1.11. Document any difficulties encountered. Be sure to at least try this out prior to the start date to ensure familiarity.

Data collection

The actual start date of the project will be Jan 1, 2011.

Analysis

The Statistician will derived the intermediate variables:

• Invasive Mechanical Ventilator Days: The number of MV patients in the ICU at approximately the same time every day

• Non-Invasive MV days: The number of Non-invasive MV patients in the ICU at approximately the same time every day

• Total MV days: The number of MV (invasive and non-invasive ) patients in the ICU at approximately the same time every day

• Mechanical ventilation time: The duration of MV (both Non-invasive and invasive) per person

• CL days: The number of patients with a central line in the ICU at approximately the same time every day

• Number of Unplanned extubations

• Number of Re-intubations

The Statistician will perform the analysis of the following Quality Indicators:

• Ventilated Patient Flow (VPF) is a measurement of the proportion of ICU patients having been ventilated at any time during their ICU stay.

• Ventilator Utilization Ratio (VUR) is a measure of the proportion of ICU days being spent on mechanical ventilation.

• Ventilator Associated Pneumonia (VAP) reported as a rate of VAP per 1000 mechanical ventilation days. Also reported as the number of mechanical ventilator days in between VAP cases.

• Unplanned extubation is the unscheduled removal of an artificial airway (endotracheal or tracheostomy tube) due to accidental dislodgement or patient self extubation. The patient need not be ventilated at the time of the event (eg. tracheal collar).

• Failed extubation rate is the requirement for re-intubation within 48 hours of extubation during the same ICU admission. It is expressed as a rate per 1000 MV days.

• Failed extubation rate is the requirement for re-intubation within 48 hours of extubation during the same ICU admission. It is expressed as a percentage of all planned extubations.

• Time on mechanical ventilator is the median time on the ventilator for all ventilated patients. This is calculated monthly.

• Central line associated blood-stream infection is the number of CLA-BSI per 1000 central line days. This is also reported as the number of CL days in between CLA-BSI.

• Number of PICC being used in our units compared to central lines as approximately half of the CLA-BSI in 2010 were associated with PICC.