Overstay Predictor Project Collection Instructions

This article explains how to collect data in the CCMDB.mdb for the Overstay Predictor Project.

For every medicine patient admitted to a ward participating in the project, as soon as possible, but definitely within 48 business hrs of admission the data collector will need to enter the data in the Nursing Discharge Screening Tool form into the CCMDB.mdb, enter a certain amount of regular data early to generate a colour, put a sticker of that colour onto the chart, and in case of certain colours notify the transition coordinator.

The Nursing Discharge Screening Tool

Find the white Nursing Discharge Screening Tool with the admission documentation on the patient chart and check if there is either a yes or no for all the first 6 questions. Also collect the patients living arrangements from the form. (Home, Nursing home, Assisted Living). The form is to be completed within 24 hours of all new admissions to hospital and patients transferred to the unit without a previously completed Nursing Discharge Screening Tool. If it is not possible at time of admission, the admitting nurse will pass the responsibility for completion to the next duty nurse.

The nurse can update the form within the first 24 hours after admission if, for example they receive information from the patients family that contradicts the patients answers. It is possible that depending on when you review that document these changes are not captured. This a known risk that we are accepting.

ensuring completeness within 24 hrs

The bedside nurses have 24 hours from the time of admission to the unit to fill out the Nurse Discharge Assessment Tool. This time frame allows for the nurse to clarify unanswered questions with the patient or caregivers during the day.

If you can't find the form or an answer is still missing 24 hrs after admission::

• enter the project "Overstay" "form data missing" entry into the tmp table
  • If the nurse form is incomplete the patient will be evaluated as if the nurse form had identified a problem, i.e. the patient will become yellow or red; the program will give a message that data had been missing.
• check with the bedside nurse and remind them to complete it; enter the remaining data into CCMDB.mdb if it now becomes available.

entering the data

For the first 6 questions on the form, create a record for each in tmp entries and check the check box if the answer is Yes.

• If any answer is no include a tmp entry indicating where the patient lives. This information can be found on the form as answer number 1 under the General Information Living Arrangements?. The purpose is to exclude patients currently living in a personal care home from being assigned a transition coordinator since these patients infrequently overstay.
  • Template:Discussion further down it said: "For each patient, add a "From..." entry into the Tmp table, e.g. "From Personal Care Home" or "From Home". Patients admitted from a personal care home can not become "red", but at most "yellow"." Is this required only for the patients flagged positive by the nurse tool? I'd have thought we wanted it anyway to be able to evaluate if excluding these people from discharge coordination is valid. Ttenbergen 13:46, 2012 September 13 (CDT). My understanding is that if a patient answers yes to the six questions they would not be coming from an alternative care arrangement. We currently instruct the nurses not to complete any more of the form if the top six questions are answered yes, mainly to save time. This process does not assume the patients could be misleading enough to have the nurse check yes to the six questions even though the patient is in an alternative care arrangement. I will verify with the nursing members on the committee if we should be collecting living arrangement for all cases. Please remove this comment once reviewed. Please remove comment once reviewed I will update the process if it changes.LHathout

Question 4 consists of several sub-questions re. the patient's inability to manage daily activities. If even one of the activities raises a concern then summary answer for the question needs to be "no".

Take answers to questions directly from the form, no interpretation, even if you disagree after reading the chart. We will be testing the answers provided by the nurses to determine if they are a better predictor of transition support needs or can be used in conjunction with existing admission data to improve the effectiveness of the prediction tool. If the data were interpreted by the collector it would introduce another factor and make this test less valid.

If the patient is transferred from one medical unit to another within the facility the current intention is that the patient will continue to be monitored by a Transition Coordinator till the time of discharge, so only one Discharge Screening Tool is required. We have also discussed handing the patient over from one transition coordinator to another. In this case there still would not need to be a a second screening form completed since the patient is already identified as needing assistance.

how to enter if nurse form data missing

On the form if any of the 6 questions are not answered, enter a "form missing" record for each, like:

• Overstay 1. Alert and
• Overstay form missing
• Overstay 3. Mobilze
• Overstay form missing
• Overstay 5. Pt. supports
• Overstay 6. smoke

(i.e. you can then tell that questions #2 & 4 are missing)

how to enter if admitted-from data missing

If the admitted-from information is not recorded on the form enter a "form missing" record instead.

Changes to regular data entry required for the Overstay Project

A number of items in addition to the regular Minimal Data Set needs to be entered before the generation of the chart colour in the next step because the algorithm uses this data:

• DOB
• Admit Date
  • Enter admit date as before; we are aware that this can be different from the time of admission to the unit and the algorithm takes that into account
• ADL
• any Overstay Predictor Diagnosis Code Used (note exclusion of most comorbids and all acquireds/complications)
  • if a dx is entered as a working diagnosis but not yet confirmed, do enter that diagnosis
  • only dxs as listed in Overstay Predictor Diagnosis Code Used need to be entered early, i.e. the rest can be entered as they were before

• The following data needs to be entered at admission time (i.e. like minimal data set) for the coloring algorithm.
  • province
  • whether the patient is admitted from a nursing home (into overstay tmp data)
  • admit diagnosis of "Palliative Care"

Chart Stickers

Once the required information has been entered click the new “Overstay” button on the patient viewer form next to the notes field and it will turn a colour based on an underlying algorithm.

• GREEN - low/no risk for discharge issues
• YELLOW - some risk for discharge issues
• RED - significant risk for discharge issues assign a transition coordinator.
• GRAY - if some needed data is missing you will not be able to generate a colour in the ccmdb database; there will be a specific error

Based on the color displayed put that colored sticker on the spine of the patient chart. The sticker 3/4 inch stickers will be located adjacent to the transition coordinator binder at the unit clerk desk.

The color on the button is not stored in ccmdb.mdb, so it will not be visible next time you open the patient. This is by design as you should only need to use the colour once.

Note: There is currently a small red dot used to indicate long term chart. There is also a small yellow dot used to indicate VRE.

colour if data is missing

See the dialog boxes in the program for information on color coding if data is missing.

no need to document sticker colour changes

It will not be necessary to document when a sticker colour changes. Just change the colour.

After 24 hours all information required to make the assessment as to if the patient is at risk should be available (or not known to the nurse within the first 24 hours and thus considered a risk). The only case where the colour should be changed is if the data-collector knew they had made an error on data entry in which case there is no need to record the previous colour. If the change results in the patient no longer needing a transition coordinator, then the data coordinator needs to notify the transition coordinator to ensure they are ware of the change.

Notifying the Transition Coordinator

If the patient has been designated as "red" for purposes of overstay prediction, the data collector will notify a Transition Coordinator by placing the patients name beside the transition coordinator on call for the time period of the patient's admission. The transition coordinators will be assigned to cover between Friday to Monday, the next shift will go to Wednesday, the last will be Wednesday to Friday. If the designation is made after 1500 on the day of entry, the assignment will be deferred to the next day's coordinator. The rotation of Coordinators is made up of Home Care, Social Work, Physio, And OTs. After assignment, that service is responsible for following that patient throughout their hospital stay.

Questions

1. If it is my responsibility to keep the N5 project binder up to date & well stocked with all the necessary forms then I’d like a supply of the Discharge screening tool, Coordinator case notes, Coordinator assignment forms in the Data office. I don’t have access to a copier that makes double sided copies so sending me a master copy by email makes doesn’t work.You are not responsible for keeping or making copies - thanks for offering. I will discuss this with the transition coordinators at our meeting on the 15th.--LHathout 13:50, 2012 August 31 (CDT)
2. At present it is often taking the nurses 24 hours or longer to complete the screening tool. I have to then either ask the nurses to complete it (which I really don’t think is my job nor do I feel comfortable doing) or leave the form with the Clinical Manager Helen for her to follow up on. This is a problem because I can’t do my job in the project efficiently within the 48 hrs or effectively which is to identify whether the patient is “at risk” and then assign them a Coordinator. This is very time consuming and frustrating for me to have to keep track of which patients forms are complete and which ones are not and then where the forms are actually located and then having to check and then recheck the charts for the forms. During the education sessions I think we should not only include the nurses from the wards but also the Resource Team nurses (they cover sick calls and vacations etc.) From now on I think it should be stressed to the nurses that the discharge screening tool should preferably be completed during the admission process and the exception being within 24 hours maximum, not the rule. I will ask Helen to explain if there is a legitimate reason why the 24 hour time frame is not enough to complete the discharge screening tool. If there is no reason then it is her responsibility to police this. If you are missing forms please bring the issue to the clinic managers attention. All Grace nurses with be trained in the next month as they are hoping to roles this out to all unit in September.--LHathout 13:50, 2012 August 31 (CDT)
3. Because of the above mentioned delay, there are some N5 patients who will not have the Overstay data entered because the form is blank eg. Short stay< 24hrs either pt. died or transferred. The Short stay patients are obviously not the ones that overstay, therefore they are of no real concern. If there is no Nurse Discharge Screening Tool and therefore no classification for these patients there is no impact on the process other than we will have a discrepancy in the statistics i.e. 20 patients discharged from 5N of which 8 were green, 10 were yellow, 1 was red and 1 has no color. If were pressed to explain this we will had the admission and transfer discharge dates and be able to note the early discharge. I was told these short stays are rare.
4. If a patient is transferred between wards are we to complete a D/C screening tool? I thought that until all medical wards were included in the project we were to complete the form on all admissions to N5.There was one pt. who was transferred between wards who had already been paneled and awaiting placement in a nursing home. In this circumstance the screening tool wasn’t done (Helen decided it was not necessary). The Screening tool only has to be completed once. In September all patients will have the screening tool done upon admission so there should be no patients transferred onto the ward without one. In the interim if a patient is transferred on to the unit without one the screening tool needs to be completed--LHathout 13:50, 2012 August 31 (CDT)