Selection and timing of APACHE components: Difference between revisions
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*****Since Oct.15th, I have been using the 24 hour period after the accept time, which means that I am including the applicable Vitals from ER if the patient was from the ER. I wasn't at the task meeting yesterday, so I don't know if this was discussed, but this was my understanding of how we are supposed to collect apache[[User:Mlagadi|Mlagadi]] 11:02, 2020 October 23 (CDT)}} | *****Since Oct.15th, I have been using the 24 hour period after the accept time, which means that I am including the applicable Vitals from ER if the patient was from the ER. I wasn't at the task meeting yesterday, so I don't know if this was discussed, but this was my understanding of how we are supposed to collect apache[[User:Mlagadi|Mlagadi]] 11:02, 2020 October 23 (CDT)}} | ||
From [[APACHE physiological variable collection]], needs integrating: | |||
Select the physiological values that reflect the '''worst''' deviation from normal in the '''first 24 hours''' while "in" the ICU. The clock starts at the '''[[Arrive DtTm ]]'''. If the length of stay in ICU is less than 24, use those values only. | |||
{{DiscussTask | | |||
We decided that a record starts at service acceptance, not unit arrival. This was partly to change the strange exception of [[EMIP]]s. So should this still be "in ICU" or should it now be "on ICU service"? [[User:Ttenbergen|Ttenbergen]] 13:31, 2020 November 25 (CST) | |||
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{{DiscussTask | | |||
We use different instructions for Medicine: [[ALERT Scale timing of assessment]] - can and should those be unified? [[User:Ttenbergen|Ttenbergen]] 13:34, 2020 November 25 (CST) | |||
}} | |||
The ''Worst'' value could be '''high''' or '''low''', depending which gives the most [[APACHE Scoring table#Chemistry_values| points]]. | |||
Keep in mind the diagnosis and try not to include iatrogenically modified values, e.g. BP severely high due to inotropes or decreased LOC due to sedation. | |||
=== Exceptionally high or low values === | |||
[[CCMDB.accdb]] has error checks for values that are ''unlikely'' high or low to prevent errors. The ranges were determined by the [[statistician]] based on previous data(see abs min and abs max in [[APACHE_Scoring_table]]). To keep the checks meaningful the threshold values will not be changed for extreme outliers. | |||
For values outside the '''"warning" limit''', you must '''enter the reason''' for this into the [[Notes field]] so that we can validate that these were not errors. <!-- as of [[CCMDB.mdb_Change_Log_2011#ver_2011-05-04]] --> | |||
For values outside the '''"absolut" limit''', enter the '''closest value allowed''' and enter a comment into the [[Notes field]]. Also, '''email Pagasa the correct value'''. | |||
Revision as of 14:35, 23 December 2020
This page explains how to select physiological or GCS values for entry into the fields used for Apache in CCMDB.accdb.
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APACHE
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Instructions
Choose the worst value that occurs within the 24 hours after Accept DtTm.
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This page is just a place holder for now, I am currently consolidating this info here. Ttenbergen 14:09, 2020 December 23 (CST) |
Moved here from Change to start collection at accept rather than arrive time needs integration: The APACHE elements time frame will start in the off-ward bed location.
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From APACHE physiological variable collection, needs integrating: Select the physiological values that reflect the worst deviation from normal in the first 24 hours while "in" the ICU. The clock starts at the Arrive DtTm . If the length of stay in ICU is less than 24, use those values only.
|
We decided that a record starts at service acceptance, not unit arrival. This was partly to change the strange exception of EMIPs. So should this still be "in ICU" or should it now be "on ICU service"? Ttenbergen 13:31, 2020 November 25 (CST) |
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We use different instructions for Medicine: ALERT Scale timing of assessment - can and should those be unified? Ttenbergen 13:34, 2020 November 25 (CST) |
The Worst value could be high or low, depending which gives the most points. Keep in mind the diagnosis and try not to include iatrogenically modified values, e.g. BP severely high due to inotropes or decreased LOC due to sedation.
Exceptionally high or low values
CCMDB.accdb has error checks for values that are unlikely high or low to prevent errors. The ranges were determined by the statistician based on previous data(see abs min and abs max in APACHE_Scoring_table). To keep the checks meaningful the threshold values will not be changed for extreme outliers.
For values outside the "warning" limit, you must enter the reason for this into the Notes field so that we can validate that these were not errors.
For values outside the "absolut" limit, enter the closest value allowed and enter a comment into the Notes field. Also, email Pagasa the correct value.
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