H1N1

This study is ending as of July 2 for ICU and as of July 6.09 for MEDICINE.TOstryzniuk 16:53, 6 July 2009 (CDT)

Researchers for Dr. Kumar are now collecting data more detailed than ours about H1N1 on the ICUs, so we will discontinue collecting tmp data there. Keep what data you have collected and send it, but don't collect any more. We are continuing to collect this tmp study on Medicine wards. Ttenbergen 14:04, 2 July 2009 (CDT)

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 every time 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)
  • HIN1 suspected negative, confirmed or unknown pathogen- extubation date

Definitions and coding information

H1N1 SUSPECTED

• 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- then the patient is a suspect
• 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)
• leave the suspect date in the TMP file even if the swab in negative.
• If the patient is discharged or death occurs prior to the swab results then code CAP-unknown pathogen

• 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- then the patient is a suspect
• 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)
• leave the suspect date in the TMP file even if the swab in negative.
• 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/or treated with with antiviral drugs (E.G. oseltamivir (Tamiflu®), zanamivir (Relenza®) and amantadine
• 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 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)
• leave the suspect date in the TMP file even if the swab in negative.
• If the patient is discharged or death occurs prior to the swab results then code[[Disseminated Infection]-68-unknown pathogen

H1N1 NOT SUSPECTED

• not suspected patients that are admitted with DX of CAP and/or COPD
• not swabbed and isolated and not treated with antiviral drugs then code whatever the diagnosis is ie- CAP with the bacterial pathogen,culture negative or culture 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

• not suspected patientsthat are admitted with the DX of severe flu like symptoms without CAP - code 89 Disseminated Infectionif they are 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 was sent and the 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 not 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 the date of the order 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 confirmation is when the unit is notified of the positive result.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.
• please make sure H1N1 data for all suspected or confirmed patients is up-to-date when you send.

Data Integrity

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

 Discussion 

• • Reviewing H1N1 coding, it appears detailed and easy to follow.

My only question would be, for patients who are admitted for over a month and transfer to different wards, if the CAP is resolved does it need to be repeatedly--FLindell 15:35, 3 July 2009 (CDT) captured throughout this admission. If I understand correctly the variable H1N1 will continue to be coded. Thank you Fran

• • • I would not code that CAP if the patient was not being treated anymore and the problem was resolved.I would keep the information on H1N1 in the TMP files.GHall 17:39, 3 July 2009 (CDT)