Overstay Predictor Project Collection Instructions

This article documents what data collectors need to do with the Discharge Planning Screening Tool (DPST)

ensuring completeness within 24 hrs

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

DPST FORM completely missing

If the data collector can not find the Discharge Planning Screening Tool (DPST) form or if answers to any or all the questions are still missing 24 hrs after admission:

• in TMP enter the project "Overstay" "form data missing" entry into the TMP table for all 7 items.
  • If the bedside nurse's Discharge Planning Screening Tool (DPST) form is incomplete the patient will be evaluated as if they 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 or notify the medicine ward unit manager; enter the remaining data into CCMDB.mdb if it now becomes available.
    • IMPORTANT NOTE: Even if the form is missing you still need to generate a colour for the patient.
      • entry instruction in TMP when DPST form is completely missing:

1. Project Overstay
   • Item: FROM LOCATION
     • If available, record, if unknown, choose FROM LOCATION MISSING
2. ProjectOverstay
   • Items: 1-6 choose: form data missing for each item
     • press button to generate a color (collector would be able to see the color if follows steps above.Trish Ostryzniuk 18:27, 2013 July 31 (CDT)

If a patient was admitted and discharged within the 24 hours, see #Special Case - Patient died/discharged before assessment.

The nurse can update the DPST 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.

Special cases

See

• #Special Case - Patient transferred from other participating ward
• #Special Case - Patient died/discharged before assessment
• #Special Case - EMIP patient that never made it to the ward
• #Special Case - HSC overflows to RR5 & RR6

entering the data in TMP

Within two business days after the bedside nurse has completed the "" DPST"" the rest of the Predictor data must be collected & entered into laptop by data collector. Under temp files, in the drop down list indicate where the pt lives by choosing an option from the drop down list. For the first 6 questions,create a record in tmp entries (by choosing the corresponding question from the drop down list) and then check the box under the COLUMN labeled B if the answer is Yes. Leave the box blank to indicate no.

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 DPST 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.

What you See in TMP for overstay - 6 rows

Overstay Tmp what you see

What you ENTER in TMP for overstay - list of choices

Overstay TMP What to ENTER

How to enter data into TMP from the DPST form including an example if a question is not filled in

For a look at the actual form go to DPST

• 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 is not answered on DPST form, enter a "form missing" record for that item in the TMP. (Example: showing questions #2 below is missing data on form & how to fill in)

General Questions

1. Overstay 1. Alert and Oriented
   • Column B in TMP - check if A&O or leave blank if not A&O.
2. Overstay 2. form data missing
   • Not fallen in 6 mths not marked on form
     • Column B in TMP - BLANK
3. Overstay 3. Ambulates
   • Column B in TMP - check if ambulating, leave blank if not ambulating
4. Overstay 4. managing independently
   • Column B in TMP - check if managing independent, leave blank if not managing independently
5. Overstay 5. living situation
   • Column B in TMP - Check if the patients and family/support are confident that the patient can be discharged to their current living situation
6. Overstay 6. home smoke
   • Column B in TMP - check if answers appropriately to “You wake up in the middle of the night and smell smoke in your home, what do you do?” Blank if response is not normal.

"From" Question

1. Enter (admitted) from - for each patient also enter where they are admitted from. Nurses or data collectors can 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.

• Project: Overstay
• Item: one of
  • From House
  • From Apartment *** use apartment if a patient comes from a condo as per Tina/Shirley discussion
  • From Assisted Living
  • From Supportive Housing
  • From Other (e.g. homeless, inmate, group home...)
  • From Personal Care Home
  • From location missing - enter if the admitted-from information is not recorded on the form

transferred FROM

see #Special Case - Patient transferred from other participating ward

Changes to regular minimal data collection and 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, or else "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
  • will be here: List of diagnoses affecting Overstay Project
• admit diagnoses important to code if applicable:
  • Dementia or Violent 2nd to dementia

Colored Chart Stickers

Once the required information has been entered click the new “Overstay” button on the patient viewer screen 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 Planning Screening Tool (DPST). 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 DPST forms 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. Template:Discussion

• Everytime collector presses the Color generating button, the color generated is show and is stored. If they keep pressing button every time they add data, and press the button again, this event is stored. If they exit profile and go back later the last color they generated is not visible to collect, only when pressed button again then they can see the color. So if they press 3 times, then it is stored 3 times. Color can be generated numerous times when staff update data, or are waiting for data that they are following up or generate color just to check if changes to color after when they added data even after posting sticker on chart. These mulitple color generation show up in TMPV2.mdb every time data is sent in. Because of this, it is a challenge to anylyse because it is not alway clear what the final color was posted on a chart. This is epecially the case when a new color is generate each day after admission. Trish Ostryzniuk 19:00, 2013 July 23 (CDT)

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.

• • Are you talking about the small dots that the ward staff use on the addressograghs?--CMarks 12:56, 2013 July 30 (CDT)

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

see also #Special Case - Patient transferred from other participating ward 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.

Special Case - HSC overflows to RR5 & RR6

As of May 13, 2013 HSC medicine data collection will follow all OVERFLOW patient that are going to RR5 & RR. These are patient that are under a medicine attending service while on RR5 or RR6. They are sent there from medicine wards we are collecting on at HSC. They are also admitted there under Internal medicine service attending physicians from the ER department.Trish Ostryzniuk 16:20, 2013 June 14 (EDT)

Medical records will auto print patient list for RR5 & RR6 direclty to the printer in GF216. HSC collector should now have access to ADT (Admit/Transfer/Discharge) for patient wards list via KEA/ Reflections also. If not, please contact Denise Felbel (she is in global address in your email).

Special Case - Patient transferred from other participating ward

If the patient was admitted from a another medicine ward at the same location, and if that ward also participates in the Overstay project, then no DPST form needs to be filled out and and the original Green/Yellow/Red designation is retained. The completed form, with colour written on it, should arrive on the new unit with the patient. The designated colour should be written on the form. If the patient is transferred either from or via any other unit, the form needs to be filled out; if it is not, enter it as a missing form. Template:Discussion I have had several pts readmitted to my ward after a stay in ICU, but whose original Screening Tools were never completed; should this still be recorded as a "transferred form" or should we attempt to have a form filled out to generate a colour this admission?

• I have forwarded this question to Linda Hathout and Mary Anne Lynch.-Trish Ostryzniuk 12:26, 2013 July 5 (CDT)
  • The form should of been completed on admission.

I would bring this to the attention of the manager and ensure the form gets completed as it is part of the admission process- so if it was missed on admission and patient stayed on unit we would get them to complete it. Is this 3N by chance? --Mary Ann Lynch. July 5.13.

entry instructions

• erase the 6 questions
• enter an entry Project "Overstay", Item "Transferred form"
• ensure that the new chart has a dot of the right colour
• if red add the patients name to the assignment sheet

Special Case - Patient died/discharged before assessment

If the patient was discharged/died before a colour could be assigned write "not assessed" and write the discharge date on the Discharge Planning Screening Tool, take a copy and put it in the Transition Coordinator Binder.

entry instructions

• erase the 6 questions
• enter an entry Project "Overstay", Item "Form Data Missing"; put "early death" or "early discharge" into the notes field

Special Case - EMIP patient that never made it to the ward

If a pt was an EMIP and never got as far as the ward, then enter "Form Data Missing" in the temp field. We will know from the patient data why this patient does not have any Overstay information.

entry instructions

• erase the 6 questions
• enter an entry Project "Overstay", Item "Form Data Missing"; put "EMIP" into the notes field

Special Collection Instructions - Colour Generation during collection staff shortages

Staff have the option to pick up posted vacation shift as before. Also staff will also have some of their shifts assigned to the area were there is the highest project priority during vacation time. Overstay Project is currently the priority project and HSC, STB, GRA and VIC.

specific SBGH medicine

SBGH has now gone to paperless charting or EPR. This means that we can now review almost the entire chart on the computer. The exceptions to this are:

1. the Discharge Planning Screening Tool (DPST) form. The information found on this form is one part of the information we need for the overstay predictor project (opp).
2. the medicine apache score. These elements are usually found in the ER nurses notes, or the MICU flowsheet (for those patients transferred to medicine from MICU). Both of these forms are still paper.

The priority for medicine data collection at this point in time is this:

1. minimal data entry and assignment of serial #'s to all admissions.
2. overstay predictor project with color assignment, i.e. keeping current and up to date with same. For instructions on what to do with entering reds into the transition coordinator binder, and where to put the colored stickers on the chart see the wiki opp collection instructions.
3. completing oldest discharge charts for patients discharged while collector on vacation, starting with oldest first. Pay particular attention to those charts that are still incomplete if it is just prior to quarterly report time.
4. last priority would be the current admissions and discharges.

For those collectors who are doing vacation relief for the regular collectors who are away, catch up from time off can be expedited for the returning collector if the following things are priorized.

1. do opp and color generation. (ADL's are a component of the opp and can be found on the epr. They are in "initial assessment" form under the documents tab.) Everything needed for minimal data will be included if the opp is done.
2. medicine apache score. This can only be found in the regular paper chart, as the ER nurses notes and the MICU flow sheet are still paper.

The only things that need to be taken from the paper chart are the dpst info and the apache score info. If the opp is kept current and up to date then charts would not have to be pulled from medical records by the person returning from vacation. This would help tremendously in catching up from time off for the returning collector.DPageNewton 14:40, 2013 February 20 (EST)

Legacy Info - red for PCH or out-of-province patients

The original implementation of the Overstay colouring algorithm used between project start and 2013-Feb-08 would never assign a red to palliative, out-of-province or PCH patients. As of 2013-Feb-09 the algorithm has moved consideration of PCH and out-of-province status into the logistic regression analysis; the two are still a factor, but a minor one, and both types of patients could now become red in the right circumstances. Palliative patients continue to be evaluated such that they can not be assigned a red.

when you have a problem

• 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 Linda. Thank you for your cooperation with this.Trish Ostryzniuk 18:47, 2013 February 12 (EST)

Template:Discussion I understand that we are no longer photocopying the screening tools to forward to the office; do you want any we have previously copied or should they be destroyed?

notes

Some staff are typing in what color was used into notes in their ccmdb while others are not. Extra steps collector do to manually add information that is helpful for them for overstay project.

• VIC types in: green, red, yellow
• STB E6 types in: g,r,y
• STB E5: no codes for color used typed into notes
• HSC A4, B3/D5, D4 type in: (G), (Y), (R) (change to registry trademark symbol)
• HSC H4/H4H:types in Jul 18 CHK (G). notes for color not consistent for all pts.
• GRA - no codes for overstay color used typed in notes