Catheter09

Note: This is a proposed project only at this time. Please feel free to comment if any instructions are unclear, though!

The Nursing Leadership Counsel at St Boniface is working on reducing the incidence and duration of urinary catheterizations without appropriate clinical indications for medicine patients at St Boniface General Hospital. We will collect some data for them as part of our temporary studies, initially for three months, but possibly longer pending the results at that time.

Times

• Start Date: will be the week of June 8.09
• Review Date (~75 days after start):
• Preliminary End Date (3 months after start):

• We will start the week of June 8th and pilot the process for a few weeks before vacations start on STB medicine. First round of vacation starts June 15. The collector will learn the process before this date and be able implement for all new admissions.
  • Trish meeting with medicine collectors at STB: June 9.09 @ 1300 hrs in MICU Conference Rm.TOstryzniuk 18:31, 5 June 2009 (CDT)
• Julie is away last 3 weeks of July.TOstryzniuk 15:54, 2 June 2009 (CDT)

Update

• • Catheter09 items for S_tmp for ccmdb & HanDBase completed. Rolled out June 5.09. See CCMDB.mdb Change Log 2009 for update. --TOstryzniuk 14:49, 4 June 2009 (CDT)

Note

• Will this study be impacted by running over the summer months? Ttenbergen 17:23, 1 June 2009 (CDT)
  • Summer is always a challenge. (between May and Aug). I have 10 weeks of vacation between 3 people with no coverage at this time. (3 wks in June, 4 wks in July & 3 wks in Aug). If the program is willing to accept data that is not "immediately" available and up to date and that catch up work can be done in Medical records then it can be done over the summer. (Trish)
  • The vacation free period for STB-MED is Sept 4 to Nov 30.09. (Trish)

Collection Instructions

Make a record in L_TmpV2 for every indwelling urinary catheter on your ward. It does not matter whether the patient arrived with it or was catheterized locally.

We need more data than you can put on one line. We could have recorded a line for each data element, but to speed it up for you we combined them on 2 lines as follows:

1. R-<option> = "Reason" from Item dropdown list; cath event #"1"; "Dr. order" on checkbox; in date; in time.
2. W-<option> = "Where inserted" from Item dropdown box; cath event #"1"; "UTI post" checkbox; out date; out time.

For example:

1. Project: Catheter09; Item: “R-Urinary incontinence”, cath event # "1", Dr order: “yes”, in date: "12 May,09" in time: "10:00"
2. Project: Catheter09; Item: “W-HSC A4”, cath event # "1", UTI post: “no”, “out date”, "14 May 09", out time, 14:00

If a patient was catheterized more than once, enter several sets of records. Make sure you finish entering one set of records before starting the next, as the record date/time will be used to group the records.

Reason for insertion data

Choose the first item starting with an “R-” listed under Catheter09’s item list that applies to this patient. The items are specifically ordered so that if you choose the first one that applies we will get the best results.

Catheter event data (int_var_label)

Catheter event number, i.e. "1" for the first catheterization, "2" for the second

Dr order

Check the checkbox if there is a doctor’s order to catheterize in the chart

Discussion

Template:Discussion I took out

• should be on the physicians order form.

If it were left as is someone might interpret that as a direction to only consider an order on said form. Do we explicitly only want written orders on the correct form? If so, the first line should be changed to

• "Check the checkbox if there is a doctor’s order to catheterize on a doctor's order form in the chart"

Otherwise the point is likely redundant, as I really hope our DCs already know where they would find this. Ttenbergen 10:38, 4 June 2009 (CDT)

in date, in time (insert) / out date, out time (remove)

Date and time the catheter was inserted or removed.

• If you can’t find a time, use midnight.
• If the time is in fact midnight, record 23:59

"Where" Data

Choose the place (elements starting with "W-") where the catheter was inserted.

UTI (urinary track infection)

IMPORTANT

• for a patient to be considered positive (+ve) for a catheter-related urinary tract infection, the urine sample must be taken > 48 hours after the catheter has been inserted.

Data Structure Setup

The s_tmp lines driving this will be similar to the following table. These lines need to be added to the s_tmp table on CCMDB.mdb and on the PDA.

Project	Value	Instructions	int_var_label	float_var_label	bool_var_label	date_var_label	time_var_label	complete_sent
Catheter09	R-arrived with foley (one line per reason	see Wiki Catheter09	cath event "#"	~~	Dr order (checkbox marked = Yes)	in date	in time	TRUE
Catheter09	W-(where inserted). One line per option	see Wiki Catheter09	cath event "#"	~~	UTI (checkbox marked = Yes)	out date	out time	TRUE

Study (Project) "Catheter09

• Name of project

Value - Actual "reason" for insertion options

Note: Arrived with is at the top because it should be chosen for anyone arriving from off unit. Since the instructions say to use the first item on the list which applies, sorting it to the top will make it the option chosen for all who arrive catheterized.

• R-arrived with foley
• R-urinary incontinence
• R-acute/chronic retention
• R-accurate urinary output
• R-Mgt decubitus ulcer (perineal/sacral wounds)
• R-palliative care
• R-hemostasis-active bleeding
• R-ordered by Urologist
• R-order pre OP/procedure
• R-monitoring of hematuria
• R-patient preference
• R-unknown

Instruction

• no specific instruction listed on PDA

Catheter event (int_var_label)

• each foley catheter insertion has 2 lines of information in L_tmp on your PDA. One for insertion the other for removal.
• an identifier allow collector to group the 2 lines to one event.
• For example for ONE patient:
  • Reason for insertion of initial catheter would have a cath event #1. The remove of this catheter would also be marked with cath event #1.
  • If another foley is reinserted, then this would be marked as cath event #2. When it is removed, it would also marked as event 2.
• feel free anyone to reword this example.TOstryzniuk 17:38, 3 June 2009 (CDT)

Value Actual "where" inserted options

• STB ER
• STB ICU
• This Ward
• Other STB ward
• Other Facility

Complete Files Only?

• Will we need this data only once a patient is sent, or as the recording proceeds? I suspect only as a patient is sent... Ttenbergen 17:23, 1 June 2009 (CDT)
  • Good question. Follow-up to this is 'Is there a time period the Investigator wanted the outputs to be summarized? Ex. how many catherization days occured for months of July and Aug. The time reference here is either the date inserted or the date removed. If yes then the data is needed as recording proceeds. But if the interest is data on a per patient level, then the data is needed once a patient is sent. The time reference to be used if needed is the Discharge Date. There will be a long wait for patients having a long stay.' JMojica 11:18, 2 June 2009 (CDT)
    • I almost got the impression that Kim and co. will do their own analysis. This would be all the better for you, Julie, since it would save you time. It might be nice to pump it into an Access file for them, that way they can just pivot-table it any way they want - it's really quite slick. I am suggesting this based on the idea that Julie's time is at a premium here. If we use a tool that allows people to do their own investigation, then we don't need to decide ahead of time how to group. I may be underestimating the skill set required, but it sounds like this would be a good group to try with since they said they have some data analysis capability within their group. Ttenbergen 10:48, 3 June 2009 (CDT)

Data Processing

Our statistician will pull the data from the TmpV2_1.mdb file on the regional server. We will provide this data to the requester in the following format:

Serial

Site (we don't need site since this is only for StB)

Location

Catheter Event

Reason

Dr.Order

Date & time Inserted

Date & time Removed

Total catheter days(calculated - if this comes in an Access file it can be generated internally right there)

Where inserted

Post Insertion (PI) UTI

• We will not provide patient identifiers at this time, but if necessary later we can resolve Serial, Site and location to patient identifiers.

• Summary statistics will be provided like frequencies for Reasons and PI-UTI and descriptive stats (N, mean,median, STD, min, max) for Catheter days. JMojica 10:22, 2 June 2009 (CDT)
  • don't use that acronym here, it may mean different things to medical folks in a genitourinary setting ;-) Ttenbergen 10:48, 3 June 2009 (CDT)
  • see above re. whether to analyze this data for them Ttenbergen 10:48, 3 June 2009 (CDT)