H1N1: Difference between revisions

From CCMDB Wiki
Jump to navigation Jump to search
← Older editNewer edit →
GHall (talk | contribs)
approved
1,530 edits
No edit summary
Line 1: Line 1:
== Note ==
I understand that Gail will be uploading an edit to this article shortly, so I will not edit the existing article and instead put my update here. It will need to be pulled into Gail's version when it arrives!
=== update ===
=== update ===
The options, as of June 26, will be
The options, as of June 26, will be
Line 26: Line 23:
*rolled out to all sites: June 11.09
*rolled out to all sites: June 11.09


==Definitions==
=Definitions=
*fine tuned as per Dr Kumar June 19.09
==='''H1N1 SUSPECTED'''===
==='''H1N1 SUSPECTED'''===
*admit with DX of severe respiratory [[CAP]] with subcode [[75 - Influenza virus]], [[COPD]]), or severe flu without CAP - [[Disseminated Infection]] with subcode [[75 - Influenza virus]] - '''swabbed''' & '''isolated''' & '''treated with antiviral drug (E.G. '''oseltamivir (Tamiflu®), zanamivir (Relenza®) and amantadine,''')  
The following are examples of '''H1N1 suspected patients''' that are admitted with DX of severe respiratory [[CAP]] and/or [[COPD]]
*treatment with antiviral drugs (E.G. oseltamivir (Tamiflu®), zanamivir (Relenza®) and amantadine) makes the patient a suspect regardless of the isolation status.
* swabbed & isolated and/or treated with antiviral drug (E.G. oseltamivir (Tamiflu®), zanamivir (Relenza®) and amantadine)
* the date the swab was '''ordered''' is the "suspect date" to put in the TMP file (time is not required)
* the date the unit is notified that the swab was positive the confirmed date to put in the TMP file (time is not required) and code the patient [[75 - Influenza virus]] "
* the date the unit is notified the swab was negative  is the "negative date" to put in the TMP file (time is not required)
* If the patient is discharged or death occurs prior to the swab results then code CAP-unknown pathogen


*DX with severe pneumonia [[CAP]] or [[COPD]] or comes in with what appears to be severe flu [[75 - Influenza virus]], pt is '''swabbed''' & '''isolated''' but '''not treated''' with antiviral drug''' (E.G.'''oseltamivir (Tamiflu®), zanamivir (Relenza®) and amantadine,''')


*admit with DX of severe,[[CAP]] or [[COPD]] or comes in with what appears to be severe flu [[75 - Influenza virus]] without CAP- [[Disseminated Infection]]- start '''TX with antiviral drug''' (E.G.'''oseltamivir (Tamiflu®), zanamivir (Relenza®) and amantadine,''')  
The following are examples of '''H1N1 suspected patients''' that are admitted with DX of severe flu without CAP''' - [[Disseminated Infection]  
*treatment with antiviral drugs (E.G. oseltamivir (Tamiflu®), zanamivir (Relenza®) and amantadine) makes the patient a suspect regardless of the isolation status.
* swabbed & isolated and/or treated with antiviral drug (E.G. oseltamivir (Tamiflu®), zanamivir (Relenza®) and amantadine)
* the date the swab was '''ordered''' is the "suspect date" to put in the TMP file (time is not required)
* the date the unit is notified that the swab was positive is confirmed is the "confirmed date" to put in the TMP file (time is not required) and code the patient [[Disseminated Infection][75 - Influenza virus]]  
* the date the unit is notified that the swab was negative  is the "negative date" to put in the TMP file (time is not required)
*If the patient is discharged or death occurs prior to the swab results then code[[Disseminated Infection]-[[68-unknown pathogen]]
 
==='''OTHER H1N1 SUSPECTS'''===
If patients with other illnesses are either swabbed and isolation and/or treated with with antiviral drugs (E.G. oseltamivir (Tamiflu®), zanamivir (Relenza®) and eamantadine
*code with the admit diagnosis (whatever it is)
* the date the swab was '''ordered''' is the "suspect date" to put in the TMP file (time is not required)
* the date the unit is notified that the swab was positive is confirmed is the "confirmed date" to put in the TMP file (time is not required) and code the patient [[Disseminated Infection][75 - Influenza virus]]
* the date the unit is notified that the swab was negative  is the "negative date" to put in the TMP file (time is not required)
*If the patient is discharged or death occurs prior to the swab results then code[[Disseminated Infection]-[[68-unknown pathogen]]


   
   
==='''H1N1 NOT SUSPECTED'''===
==='''H1N1 NOT SUSPECTED'''===
*admit with DX of severe respiratory  [[CAP]], [[COPD]], or severe flu like symptoms without CAP - code 89 [[Disseminated Infection]] with subcode [[75 - Influenza virus]] - swabbed but not isolated and not treated with antiviral drugs.
The following are examples patients who are '''not suspects that''' are admitted with DX of [[CAP]] and/or [[COPD]]
 
* not swabbed and isolated and/or '''not treated''' with antiviral drugs (E.G. oseltamivir (Tamiflu®), zanamivir (Relenza®) and eamantadine then cod CAP with the bacterial pathogen,culture negative or not sent and/or COPD. If the culture results are positive for another type of influenza then put [[CAP]] with subcode 75 [[influenza virus]
*suspect date is generally at unit admission or if suspected after admission to unit then use swab date. (most are now being suspected in ER and swabbed there prior to ward admit so just use ward admit date).
* If the patient is discharged or death occurs prior to the swab results then code CAP-unknown pathogen
*confirmed H1N1 is date unit notified not date swab sent. 
*Time is not required.


==Instructions==
*admit with DX of severe flu like symptoms '''without CAP''' - code 89 [[Disseminated Infection]] not swabbed and isolated or treated with with antiviral drugs code 89 [[Disseminated Infection]]with the bacterial pathogen,culture negative or not sent. If the culture results are positive for another type of influenza then put code 89 [[Disseminated Infection]]-influenza.
*If  '''H1N1 SUSPECTED'''  
*If the patient is discharged or death occurs prior to the swab results then code[[Disseminated Infection]-[[68-unknown pathogen]]  
*Tmp item should be H1N1 suspected with date first suspected which is generally the unit admit date. (time not needed)
:AND
*DX code should be an infection code, primarily [[CAP]] with subcode 75 [[influenza virus]]or it can be main code 89 [[Disseminated Infection]] with subcode [[75 - Influenza virus]]


*If  '''H1N1 is CONFIRMED'''
*TMP item should be H1N1 confirmed with date the unit was notified by the lab. (time not needed)
:AND
*DX code should be and infection code, primarily [[CAP]] with subcode 75 [[influenza virus]] or COPD or code 89 [[Disseminated Infection]] with subcode [[75 - Influenza virus]]




*Confirmation of DX should be marked in chart. Confirmation date is the date that confirmation came from the lab. If patient is discharged or moved without culture report then TMP option of suspected N1N1 remains.
==REVIEW==


*Confirmation of DX should be marked in chart. Confirmation date is the date that confirmation came from the lab. If patient is discharged or moved without culture report then TMP option of "suspected H1N1 remains".
*TMP file can have one or two tmp items for H1N1:  
*TMP file can have one or two tmp items for H1N1:  
**suspected, with a date  
*suspected, with a date  
**suspected with date & confirmed with date  
*suspected with date & confirmed with date(when the unit was notified)
**suspected with date & negative with date  
*suspected with date & negative with date(when the unit was notified)
 
*If patients have '''not''' either been swabbed and isolated and/or been treated with antivirals they are '''not suspects'''
==Other Discussion==
*Generally the order for swabs is written on admission, but if the order is written after admission use that date as the "suspect date".
*there is alternate tracking being done and I will look after this to update tag in tmpv2  Working with Kumar.[[User:TOstryzniuk|TOstryzniuk]] 20:59, 10 June 2009 (CDT)
*any patient who is positive for Influenza A should be coded in TMP as a '''suspected H1N1'''.  H1N1 is a subspecies of Influenza A.Once the swab comes back negative for H1N1 then code [[CAP]] with subcode 75 [[influenza virus] or [[Disseminated Infection][75 - Influenza virus]]  
 
*for patients with other illness that are swabbed but not treated or isolated don't code suspected H1N1 unless the swab is positive.Then the suspect date is the time the swab was ordered and the confirmed.The diagnosis would be whatever they where admitted with.
**So you code under temp studies, the suspect date(the date the swab was sent)? Once a swab comes back positive, do you then change the suspect date and stamp to confirmed with the specimen date?
*Isolation precautions for H1N1 should be gowns,gloves and mask(total isolation).We are not collecting data for "mask only isolation" in the TASKS on MEDICINE.Again if patients are swabbed and isolated and/or treated with antivirals they are suspects regardless.   
[[User:TAngell|TAngell]] 09:11, 18 June 2009 (CDT)
***Generally the suspect date is at admission, but if it after admission then use the swab sent date. A number are already suspected when admitted to ER and will be swabbed there so just use ward admit date.  
****No you don't change suspect date entered into tmp for that patient, you add another page to tmp an select "H1N1 confirmed" and enter the date when ward was notified. Culture send date is not confirmation date.  [[User:TOstryzniuk|TOstryzniuk]] 09:22, 19 June 2009 (CDT)


== Data Integrity ==
== Data Integrity ==
No automated data integrity checks for this are done at collection or send time.  
No automated data integrity checks for this are done at collection or send time.  


Will Julie do any checks later, and which?
== Discussion ==
[[User:Ttenbergen|Ttenbergen]] 13:33, 11 June 2009 (CDT)
**julie will do cross checks in SAS.[[User:TOstryzniuk|TOstryzniuk]] 19:58, 11 June 2009 (CDT)
 
 
 
== Discussion ==
{{discussion}}
 
===June 12.09===
* Just some clarification...any patient who is positive for Influenza A should be coded in TMP as a '''suspected H1N1'''.  H1N1 is a subspecies of Influenza A. 
*Also, I have a patient who had an adm Dx of COPD exacerbation, who is not progressing as she should and thus is being investigated for flu.  These patients also need to be captured in the "flu database".  What I have done is added a dx of CAP and put suspected H1N1 in the temp files.  [[User:BDeVlaming|BDeVlaming]] 14:21, 11 June 2009 (CDT)
**I assume they don't think true pneumonia but rather H1N1 mild triggering COPD...that is common. There I would tag as suspected but not report it as a DX of CAP.  Anand Kumar, MD [[User:TOstryzniuk|TOstryzniuk]] 15:03, 12 June 2009 (CDT)
*June 12.09
**Some pts are coming in with CAP but the physicians are not convinced that they are suspect, therefore not isolated nor screened.  Should be be tagging ALL new admits with CAP or COPD exacerbations as SUSPECT then?---[[User:TOstryzniuk|TOstryzniuk]] 15:20, 12 June 2009 (CDT) Joanne Hutton.
***No, don't tag unless positive culture for H1N1 or we'll have way to many cases.  Tag if positive for H1N1 even if no CAP... code 89[[Disseminated Infection]] with subcode [[75 - Influenza virus]] often triggers asthma or [[COPD]] exacerbation. Anand Kumar, MD.[[User:TOstryzniuk|TOstryzniuk]] 12:30, 15 June 2009 (CDT)


===June 15.09===
**Any CAP or COPD that comes in whether they are placed in isolation or not and a swab is sent, should be considered suspect and tagged as such?[[User:TOstryzniuk|TOstryzniuk]] 12:36, 15 June 2009 (CDT)
***People are going to start screening for H1N1 just in case. That is probably what they are doing. Same with CAP/COPD isolation…it’s just precautionary.  I would only tag '''suspected H1N1''' if they start '''oseltamivir'''. Anand Kumar.[[User:TOstryzniuk|TOstryzniuk]] 12:36, 15 June 2009 (CDT)




* Hi I have a lot of patients who are coming in with bronchitis,or CAP or COPD exacerbation and brochiectasis ,they are not being swabbed for H1N1. Should I be coded them as suspects plus they are not on isolation.?
***No, don't tag unless positive. Anand Kumar, MD.[[User:TOstryzniuk|TOstryzniuk]] 12:30, 15 June 2009 (CDT)




*Next question  I have a patient who was admitted for pneumonia and bronchiectasis 3 days later they did a swab for H1N1 due to patient was in contact with friends from St. Therese prior to admission. Patient was discharged culture was not back to check. So I code Suspect under TMP but the patient was never on isolation. Are we going to get phone calls to check why patient wasn't on isolation?[[User:SKiesman|SKiesman]] 11:31, 15 June 2009 (CDT)
**No.[[User:TOstryzniuk|TOstryzniuk]] 13:52, 17 June 2009 (CDT)


===June 17,09===
*I have a pt who was tagged as suspect, but the result was negative for any influenza virus.  Would it be easier if we had another tag for confirmed negative?  I am wondering if it would save time later for people following up on the influenza patients.
[[User:BDeVlaming|BDeVlaming]] 16:12, 17 June 2009 (CDT)
**Yes.  I will add this option tomorrow.[[User:TOstryzniuk|TOstryzniuk]] 22:44, 17 June 2009 (CDT)


***So is it correct to say: that we only code a suspect H1N1 if the
drug is started?


**** This then is regardless if isolation is started or a swab is sent, because if they start the drug, it is suspected. If they don't start the drug it is not suspected.


[[User:TAngell|TAngell]] 09:29, 18 June 2009 (CDT)




Revision as of 12:49, 28 June 2009

update

The options, as of June 26, will be

  • H1N1 suspected
  • H1N1 confirmed
  • H1N1 negative
  • Extubation Date

The entries will be sent for all patients everytime you send, including for patients you are not sending today. Therefore, please make sure H1N1 data for all patients is up-to-date when you send. Ttenbergen 11:03, 26 June 2009 (CDT)


Start and End Date

  • June 10.09 is start date. No end date at this time. Kumar and Roberts will advise. TOstryzniuk 19:59, 11 June 2009 (CDT)
  • any patient that is currently on your PDA (still in your unit) or any file that you have already sent in to the master database that was suspected or confirmed should be labeled. Please call Trish or Pagasa if any file you have sent in since the end of April was suspected or confirmed and we will add this information to TmpV2.
  • I will also be cross checking our database with another source each week and will update the database.
  • added to s_tmp table:
    • H1N1 suspected
    • H1N1 confirmed
    • H1N1 negative (if patient still in unit and reported negative then add to TMP before you sent)
  • rolled out to all sites: June 11.09

Definitions

H1N1 SUSPECTED

The following are examples of H1N1 suspected patients that are admitted with DX of severe respiratory CAP and/or COPD

  • treatment with antiviral drugs (E.G. oseltamivir (Tamiflu®), zanamivir (Relenza®) and amantadine) makes the patient a suspect regardless of the isolation status.
  • swabbed & isolated and/or treated with antiviral drug (E.G. oseltamivir (Tamiflu®), zanamivir (Relenza®) and amantadine)
  • the date the swab was ordered is the "suspect date" to put in the TMP file (time is not required)
  • the date the unit is notified that the swab was positive the confirmed date to put in the TMP file (time is not required) and code the patient 75 - Influenza virus "
  • the date the unit is notified the swab was negative is the "negative date" to put in the TMP file (time is not required)
  • If the patient is discharged or death occurs prior to the swab results then code CAP-unknown pathogen


The following are examples of H1N1 suspected patients that are admitted with DX of severe flu without CAP - [[Disseminated Infection]

  • treatment with antiviral drugs (E.G. oseltamivir (Tamiflu®), zanamivir (Relenza®) and amantadine) makes the patient a suspect regardless of the isolation status.
  • swabbed & isolated and/or treated with antiviral drug (E.G. oseltamivir (Tamiflu®), zanamivir (Relenza®) and amantadine)
  • the date the swab was ordered is the "suspect date" to put in the TMP file (time is not required)
  • the date the unit is notified that the swab was positive is confirmed is the "confirmed date" to put in the TMP file (time is not required) and code the patient [[Disseminated Infection][75 - Influenza virus]]
  • the date the unit is notified that the swab was negative is the "negative date" to put in the TMP file (time is not required)
  • If the patient is discharged or death occurs prior to the swab results then code[[Disseminated Infection]-68-unknown pathogen

OTHER H1N1 SUSPECTS

If patients with other illnesses are either swabbed and isolation and/or treated with with antiviral drugs (E.G. oseltamivir (Tamiflu®), zanamivir (Relenza®) and eamantadine

  • code with the admit diagnosis (whatever it is)
  • the date the swab was ordered is the "suspect date" to put in the TMP file (time is not required)
  • the date the unit is notified that the swab was positive is confirmed is the "confirmed date" to put in the TMP file (time is not required) and code the patient [[Disseminated Infection][75 - Influenza virus]]
  • the date the unit is notified that the swab was negative is the "negative date" to put in the TMP file (time is not required)
  • If the patient is discharged or death occurs prior to the swab results then code[[Disseminated Infection]-68-unknown pathogen


H1N1 NOT SUSPECTED

The following are examples patients who are not suspects that are admitted with DX of CAP and/or COPD

  • not swabbed and isolated and/or not treated with antiviral drugs (E.G. oseltamivir (Tamiflu®), zanamivir (Relenza®) and eamantadine then cod CAP with the bacterial pathogen,culture negative or not sent and/or COPD. If the culture results are positive for another type of influenza then put CAP with subcode 75 [[influenza virus]
  • If the patient is discharged or death occurs prior to the swab results then code CAP-unknown pathogen
  • admit with DX of severe flu like symptoms without CAP - code 89 Disseminated Infection not swabbed and isolated or treated with with antiviral drugs code 89 Disseminated Infectionwith the bacterial pathogen,culture negative or not sent. If the culture results are positive for another type of influenza then put code 89 Disseminated Infection-influenza.
  • If the patient is discharged or death occurs prior to the swab results then code[[Disseminated Infection]-68-unknown pathogen


REVIEW

  • Confirmation of DX should be marked in chart. Confirmation date is the date that confirmation came from the lab. If patient is discharged or moved without culture report then TMP option of "suspected H1N1 remains".
  • TMP file can have one or two tmp items for H1N1:
  • suspected, with a date
  • suspected with date & confirmed with date(when the unit was notified)
  • suspected with date & negative with date(when the unit was notified)
  • If patients have not either been swabbed and isolated and/or been treated with antivirals they are not suspects
  • Generally the order for swabs is written on admission, but if the order is written after admission use that date as the "suspect date".
  • any patient who is positive for Influenza A should be coded in TMP as a suspected H1N1. H1N1 is a subspecies of Influenza A.Once the swab comes back negative for H1N1 then code CAP with subcode 75 [[influenza virus] or [[Disseminated Infection][75 - Influenza virus]]
  • for patients with other illness that are swabbed but not treated or isolated don't code suspected H1N1 unless the swab is positive.Then the suspect date is the time the swab was ordered and the confirmed.The diagnosis would be whatever they where admitted with.
  • Isolation precautions for H1N1 should be gowns,gloves and mask(total isolation).We are not collecting data for "mask only isolation" in the TASKS on MEDICINE.Again if patients are swabbed and isolated and/or treated with antivirals they are suspects regardless.

Data Integrity

No automated data integrity checks for this are done at collection or send time.

 Discussion 

Retrieved from "https://ccmdb.kuality.ca/index.php?title=H1N1&oldid=13494"