Catheter09

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 October 1, 2009.--TOstryzniuk 17:10, 25 September 2009 (CDT)
• Review Date (~75 days after start): 15 Dec 2009 (meeting booked with Trish, Tina)
• Preliminary End Date (3 months after start): 31 Dec 09

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. 'This data needs to be completed as soon as possible for all patients, not only those who are being sent, since the data is sent for all patients every time data is sent.

In the TMP file, every patient must have TWO lines of entries for every foley catheter incident. 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: Under Item:

1. R-"Reason" from Item dropdown list; cath event #"1"; "Dr. order" on checkbox; in date; in time.
2. W-"Where inserted" from Item dropdown box; cath event #"1"; "UTI post" checkbox; out date; out time. (may not have a removal date if: died, moved to ICU or moved to another ward with same foley)

• For example:

*1. Project: Catheter09

• Item: “R-Urinary incontinence” (drop down list for: reason for insertion)
• cath event # "1"
• Dr order: “yes”
• in date: "12 May,09"
• in time: "10:00"

*2. Project: Catheter09

• Item: “W-HSC A4” (drop down list for: where was foley inserted)
• 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.

• Julie, so you want this data sent when information is not complete or just send when complete. I see we stated we want it sent each week regardless if complete but the s_tmp is set to send only when complete. Can discuss further tomorrow. TOstryzniuk

"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

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

Date and time the catheter was inserted or removed.

• Make a reasonable effort to find the right time/date
  • If you can’t find a time, use midnight
    • If the time is in fact midnight, record 23:59
  • If you can't find a date, use your best guess
  • If you can't find a time or date, enter your best approximation given the available data

"Where" Data

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

UTI (urinary track infection)

Check the UTI check box for any patient who acquired a UTI while catheterized.

For the UTI to be considered catheter related, the positive (+ve) urine sample must be taken between >48 hrs after the catheter has been inserted and <=48 hrs after the catheter was removed.

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

• the "sent_complete" column in the s_tmp in CCMDB.mdb is currently set to false (not checked in s_tmp). --TOstryzniuk 16:13, 23 September 2009 (CDT)
  • changed to true, will go out with version 1.89. (this can be deleted in a week)Ttenbergen 13:57, 24 September 2009 (CDT)

Study (Project) "Catheter09

• Name of project

Value - Actual (R) "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 (W) "where" inserted options

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

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)