CAM positive (TISS Item): Difference between revisions

Revision as of 16:10, 6 February 2019

This procedure is a part of CCI Collection via CCI Picklist.

TISS Item
Item Description	CAM positive (TISS Item)
TISS28 Category:	Neurological Support
TISS28 Item	0
TISS28 Description	CAM "+" any time today
TISS28 Points	0
TISS28 Start Date
TISS28 End Date
TISS28 Comment:	[[TISS28Comment::added for Dr. Arora & Critical Care QI Team]]
CCI Picklist
CCI Picklist code:
CCI Collection Mode:	CCI collect each day
CCI Picklist Start Date	Needs to be either CCI TISS Start, or later if TISS start date is later (which it should never be?)

"CCI collect each" items are entered each time they happen
Px Date
- if an Acquired Procedure, enter the Px Date for each day that they happen
- if an Admit Procedure leave the date blank
Px Count
- if they happen more than once on a day, enter the number of times for that day, otherwise enter a Px Count of 1

CAM stands for Confusion Assessment Method-- it is an instrument for use in the intensive care unit to accurately diagnose delirium in critically ill patients who are often nonverbal because of mechanical ventilation."[1]
- To even be evaluable for CAM assessment, a patient must be conscious. Thus, in reality, a given CAM assessment has 3 possible findings: (i) not evaluable, (ii) evaluable and CAM-positive, or (iii) evaluable and CAM-negative.
CAM status is currently recorded in ICUs in two places:
- On the ICU flowsheet, as an indication of CAM-positive versus not being CAM-positive; as above the latter includes evaluable and CAM-negative or not evaluable. Of note, the ICU nurses evaluate for delerium multiple times per day.
- On the TISS sheet, as a bubble for being CAM-positive versus not being CAM-positive. Here there is just a single yes/no bubble, so that NOT being CAM-positive can mean either that there were no evaluable assessments during that day or that there was at least one evaluable assessment and all of those were CAM-negative.
The users of this data (including Rakesh Arora in ICCS) are mainly counting the number of ICU days in which a patient is CAM-positive -- which of course only includes days on which there is at least one CAM-evaluable assessment.

We are collecting CAM as CAM positive (TISS Item).

Problems were flagged in:

	Did these ever get better? Ttenbergen 12:44, 2017 May 11 (CDT) Does anything need to be done about this? Ttenbergen 20:15, 2018 November 27 (CST)

Hard to tell in the numbers (whether marking is legit or not). Maybe another round of survey will help - are the data collectors marking or crossing out the entry if they find inconsistencies from various sources?--JMojica 14:02, 2017 May 11 (CDT)
- If I find inconsistencies I will correct and/or clarify with the bedside nurse Lisa Kaita 14:21, 2017 May 11 (CDT)
- I will do the same as Lisa, but it isn't always easy to clarify the CAM status of a patient if I am checking TISS sheets from previous days. Sometimes the systems review notes don't seem to correlate with the CAM score on the flow sheet. I have to use my judgement in these cases, so the CAM positive days are not always accurate.Mlagadi 14:57, 2017 May 18 (CDT)

The information was requested by Dr Arora - Quarterly report showing the monthly statistics regarding the Delirium/Confusion cases in complication Diagnosis, counts of patients with at least one day marked with CAM+ and total CAM+ days and their associated rates for STB ICMS, ICCS and ACCU.

Report included in the Critical Care Regional OpPlan as requested by the QI Officer - Quarterly report of Delirium cases, Delirium Rates, Delirium Days and Delirium Rate Days for all ICUs in the region

New - WRHA Critical Care Quality Indicator Chart Report for Directors and Managers - Quarterly report of Delirium cases, Delirium Rates, Delirium Days and Delirium Rate Days for all ICUs in the region

@@ Line 19: / Line 19: @@
 We are collecting CAM as [[CAM positive (TISS Item)]].
 [http://www.mc.vanderbilt.edu/icudelirium/docs/CAM_ICU_training.pdf CAM ICU Training]
 == Data problems ==