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 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.

Template:Discussion

• I now have admitted pts to overflow areas-are these to be included? They would be followed by different allied health personnel and the nurses are not oriented to the forms
• is there a response to this???-Trish Ostryzniuk 20:46, 2013 February 12 (EST)

Additional information on roles and responsibilities for all participants in this initiative can be found at Overstay roles and responsibilities.

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.

If the patient was discharged/died before a colour could be assigned write "not assessed" and write the discharge date on the Nurse Discharge Screening Tool, take a copy and put it in the Transition Coordinator Binder. Enter "Form Data Missing" in the temp field. Template:Discussion who is responsible for collecting the forms that have been placed in the binder? I have forms from December and the binder is full to bursting

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 Screening 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.

If a patient was admitted and discharged within the 24 hours and no "Nurse Discharge Screening Tool" was completed enter "Form data missing".

entering the data

Within two business days after the bedside nurse has completed the Nurse Discharge Screening Tool the rest of the Predictor data must be collected. For the first 6 questions and the question about their living arrangements, create a record in tmp entries and check the check box if the answer is Yes and indicate where they live.

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 the 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 you identify a discrepancy please note it in the Temp Comments field also known as column Q.

If the patient is transferred from one medical unit to another within the facility only the one Nurse Discharge Screening Tool is required and the original Green/Yellow/Red designation is retained. You do not need to collect the information from the Nurse Discharge Screening Tool, but to be allowed to send your data you need to enter an entry Project "Overstay", Item "Transferred form" into the Tmp table. The designated colour should be written on the form, so ensure that the new chart has a dot of the right colour. If the patient is designated a Red they still need to be assigned to a Transition Coordinator so add the patients name to the Assignment Sheet.

What you See in TMP for overstay - 6 rows

See: Overstay Tmp what you see

What you ENTER in TMP for overstay - list of choices

See: Overstay TMP What to ENTER

How to enter data into TMP from the bedside nurse Overstay form including an example if a question on form is not filled in

There are 7 rows of items for overstay in TMP. 6 questions and 1 item asking specifically where patient lives prior to hospital admission. If any item are not answered, enter a "form missing" record for each in TMP. (Example: showing questions #2 below is missing data on form & how to fill in)

• Overstay 1. Alert and Oriented
  • Column B in TMP - check if A&O or leave blank if not A&O.
• Overstay 2. form missing
  • Not fallen in 6 mths not marked on form
  • Column B in TMP - BLANK
• Overstay 3. Ambulates
  • Column B in TMP - check if ambulating, leave blank if not ambulating
• Overstay 4. managing independently
  • Column B in TMP - check if managing independent, leave blank if not managing independently
• Overstay 5. living situation
  • Column B in TMP - Template:Discussion If check in column B, what exactly does this mean in regards to living situation? That there is a problems with living situation?
• Overstay 6. home smoke
  • Template:Discussion What is "home smoke"? Is this just smoker of tobacco? Why not just Smoker? Does it make a diff if smokes in the house or goes outside behind the garage?
  • Column B in TMP - check if patient is a smoker, leave blank is not a smoker.

admitted from

For each patient also enter where they are admitted from;

• Project Overstay
• Item: one of
  • From House
  • From Apartment
  • From Assisted Living
  • From House
  • From Other (e.g. homeless, inmate...)
  • From Personal Care Home
  • From location missing - enter if the admitted-from information is not recorded on the form

• For the living arrangement question, are the nurses or data collectors able to utilize the patient's address to assist with the answer if it is not obtained by questioning the patient? For example, it is easy to see if any address in an apartment VS a house by the address. --LKolesar 15:28, 2012 November 30 (EST)
  • I will say "yes, if it is obvious" for now, Linda can correct if she disagrees. Ttenbergen 18:56, 2013 February 8 (EST)

checking Overstay PCH status against MH

Template:Potential Change Julie Mojica as of his week, is getting PCH arrival date from MHSC along with regular cross checks done with MHSC.--Trish Ostryzniuk 20:55, 2012 November 1 (EDT)

• that only gets us part of this info, and we already have several weeks of this. Let's keep it for now. The fact that we get additional data now means that Crosschecking data with Manitoba Health needs to be updated. Ttenbergen 22:24, 2012 November 1 (EDT)

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:

• "from" and "questions" tmp entries, "transferred" entry if applicable
• DOB
• province
• 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
• admit-from
• ADL
• Glasgow Coma Scale
• Charlson Comorbids
  • still working on list for the wiki; in the meantime, please just code all comorbids for the patient
• admit diagnoses if applicable:
  • Dementia or Violent 2nd to dementia
  • 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 circle the colour on the Discharge Screening tool. Also place a colored sticker on the spine of the patient chart. The sticker 3/4 inch stickers will be located in the transition coordinator binder at the unit clerk desk. Take a copy of all discharge screening tools and leave the copy on the Transition Coordinator binder. We will be collecting these forms for the time being to evaluate the form.

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 on the Transition Coordinator Assignment Sheet. If a patient is transferred to the unit with a chart that already has a Red designation the data collector is to add the patient name to the Transition Coordinator Assignment Sheet. 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. The Transition Coordinators are responsible for balancing their workload in the case that any individual is overburdened. They will also reassign patients if any Transition Coordinator is expecting to be a away for more than three business days.

Question(s)

1. Will Allied Health follow these patients on their own incentive until I start enteries Nov. 19/12.

Allied health will practice their normal discharge planning for all patients. It is only once the patients get designated as Red will they "up their game" and pay closer attention to discharge planning for that special subset of patients for whom more complex allied health coordination is required. LHathout

1. If these patients are followed by the same co-ordinator, will you inform the E5 and E6 managers to orientate their staff to include sending the chart spine colour sticker to the receiving ward, as the chart covers Do Not travel between wards,(5B no supplies), or do I "do nothing" until Nov.19/12.

I think the answer is provided in the text above please correct it if it was not clear. The Discharge Planning Screening Tool, once complete, will travel with the chart so when you review a new admissions to the unit you will see that Tool has already been filled out and a colour has been assigned. Place the colored sticker on the new binder insert. You are only expected to start doing this come Nov.19/12 on 5B.LHathout

1. Also, during vacation periods, there is a very good possibility that information will not be entered and colours will not be generated on the teaching units. When/if these patients are transfered to non-teaching, will the nurses on 5B be filling out the screening tool within 24hr. of transfer to ward? I can not find the answers to these questions on self learning collection instructions on Wiki. Please advise.ENagy 17:30, 2012 November 8 (EST)

I am not sure if you are referring to nurses on vacation or data collectors. I will leave it to Trish to managed the data collector coverage model and the unit managers to manage nursing coverage. We will be monitoring form adherence to the process on an ongoing bases.LHathout

Bug with This week version of ccmdb in OVERSTAY

ISSUE: Collectors seeing RED & other things!

• STB-inappropriate REDS being generated. ID by Debbie this week. Unble to connect with Tina on Feb 11 & 12th.
• STB-I found a patient that was flagged red that should not be. The ADL's were all unassisted. The admit diagnosis & ccm were not any of the flagged diagnosis. The living arrangment was house. For questions 1-6, only question 2 (falls) was a no. The patient was flagged red. This is very inappropriate. The transition coordinators will not be happy if we are now going to start coming up with inappropriate reds for them. DPageNewton 14:44, 2013 February 12 (EST)
• VIC: overstay showing a extra line of code, so there are seven rows for overstay instead of six. Location From is seventh one. Shirley was able to delete the extra row from serial 8345 and enter data.
• VIC serial 8345 -RED flagged when admit from is Personal Care Home. Though if from Personal Care home then should not be RED.--Shirely Kiesman.-Trish Ostryzniuk 16:51, 2013 February 12 (EST)
• collection instruction: there is no where on wiki that clearly explains how to collect overstay in tmp properly. For example, the B column, it is not clear how this functions or relates to some projects or items. Looking and the TMP is not intuitive on how & when items relate to Column B, (check mark or leave blank). Visual folks find it hard to follow unless shown. Tmp column labels, as mentioned before, are not intutitive.
  • Trish has made attempt to update collection instructions. Have uploaded 2 JPG's for those who are visual, but pics is bit large so only linked to them rather than paste into page. Not sure now to make smaller. thanks --Shirely Kiesman.Trish Ostryzniuk 16:51, 2013 February 12 (EST)
• STB I have come across another (second) patient that I think is inappropriately assigned a red color. As of this moment I will NOT be entering these names in the transition coordinator binder, until such time as this issue is sorted out. As data collectors we are told we must adhere to strict guidelines as to time frame for work done. It is more than a little frustrating that these issues are not addressed and attended to in the same strict time frame guidelines. This delay in addressing issues in turn will affect the time frame for our assigning opp colors. Serial #'s for the two patients I think are inappropriately assigned red are SBGH E5 #'s 9683 & 9684. DPageNewton 19:00, 2013 February 12 (EST)
• I too have the extra line of code here at SBGH. DPageNewton 19:09, 2013 February 12 (EST)
• Overstay dropdown list, last item on LIST: Transferred form. What is this? _Trish Ostryzniuk 20:37, 2013 February 12 (EST)
• Reminder to all staff.........please email Tina or post issue on Wiki rather phone calls. If phone call is getting you voice message than email her & CC Fred and Linda. Thank you for your cooperation with this.Trish Ostryzniuk 18:47, 2013 February 12 (EST)