Minutes Team Meeting 12 June 2008

Agenda

• Discuss how the MOST Score is being collected - Trish or Linda
• What the MOST Score is used for - Dr. Roberts
• Discuss discharges to ER – Julie
• Review Vital Signs project – Julie
• Review the Wiki application – Tina
• Questions and Answers - Everyone

Questions/Concerns Submitted

1. Clarify definition for Hypotension NYD- it says not due to shock or post-op in the code book we don't know when to use this. Why can't we just have hypotension NYD for a code? In other words if patients don't meet the specific criteria for septic shock or hypovolemic shock or cardiogenic shock it would be NYD.

2.Clarify definition Septic Shock. (Criteria are in DX code guide for Septic Shock. The exact question here according to Gail Hall was as follows: if a patient doesn't meet the criteria for septic shock as outline in the Diagnosis code criteria for Septic shock, for example is hypothermic instead of hyperthermic, yet the physician is calling it septic shock, what is the collector suppose to do: *a. follow the criteria and if they are NOT met then don't code a septic shock or

• b. If physician DX is the working DX and that is what they are treating, then code as septic shock or
• c. Use the hypotension NYD code.
  • NEEDS FURTHER FOLLOW-UP
    • TOstryzniuk 17:06, 29 July 2008 (CDT) Trish Pending

3. Clarify definition Cardiogenic Shock *there are criteria to follow in diagnosis code guideline therefore I am not sure what the exact question is here?[[User:TOstryzniuk|TOstryzniuk]] 17:06, 29 July 2008 (CDT)

4. Clarify definition Cardiac Arrests-It's impossible to see how many occur right before admission to Medicine as some patients are admitted to medicine bypassing ICU. *Not sure what the question is here?TOstryzniuk 17:06, 29 July 2008 (CDT)

5. Clarify definition Violent behavior code - supposed to be 2nd to dementia but is used for anyone who is violent. *Use for anyone. (note: not just tagging general bad moods here).

6. Clarify definition Panelling or Discharge Planning why does it say in the code book primary reason for admission to ward bed? *the reason for adding this patient status code (it is not a DX code), was to try and track those patients whose primary reason for moving to a medicine ward bed was no longer due to an acute disease process however they were waiting for other services or nursing home placement and that is the primary reason why they are still in an acute care med bed.

• discussion about these patients was that they had chronic disease condition and that was the reason why they were still in med ward beds and not sent home. Many of these patient have multiple chronic underlying diseases and the question was, how do we then decide which one was the primary one that was still keeping them in a med ward bed?
• .............more to be added here later..............````

7. Clarify definition Muscle deconditioning

8. Clarify definition Pain Control - non post op *we are not wanting to tag every patient who is being treated for pain.

• use this code only if the reason for ICU or ward admission is due to severe out of control pain that is a primary reason for admission is for the management of severe out of control pain.

*example is Cancer patients who primary reason for admission to medicine ward is pain management. TOstryzniuk 18:08, 29 July 2008 (CDT)

9. Clarify definition Pain Control - post op - we feel it is highly overused.

• Most surgical patients need some degree of pain management post op. We don't need to tag everyone that is having their pain treated post-operatively. This code should only be used for those who's pain is clearly severe and out of control and because of this it is significantly contributing to the reason for ICU admission. In terms of ward admission, again if the primary problem is out of control pain this could be the primary reason a physician admits.
• the reason for having this code was that there were many patients being admitted from the recovery room who's primary reason to ICU was purely pain control and nothing else that warranted ICU admission.TOstryzniuk 18:08, 29 July 2008 (CDT)

10. Clarify definition Palliative Care - need further criteria to code correctly.

• seePalliative Care article for updated information.

*Work in progress which looks like it is getting there.

• Data Collecter contribution is encouraged.TOstryzniuk 18:08, 29 July 2008 (CDT)

1. Acute coronary insufficiency and Unstable angina (151, 152) - description in code book should be reversed

*it will stay as is so that it is consistent. Even if it is wrong, it is consistently wrong.

11. There currently is no codes for: hematuria- we have lots of people who are getting CBI for hematuria NYD. *Hematuria is a symptom it is not a diagnosis, therefore we willnot add it as a code. TOstryzniuk 18:54, 24 June 2008 (CDT)

12. ADL.

1. • assessment for feeding; when a person arrives to the unit within the first 24 hours NPO either for a test or for GI Bleed does this qualify as Dependant?
   • The KATZ says 'Dependant is assistance to eat; does not eat (I interpret this to include NPO); must be fed; fed partly or completely by NG or IV.(Linda)
   • ADL assessement is based on the capablity of a patient if he was "allowed" to perform the activity he would be able to. If restricted due to hospital policy or for procedure or surgery, then assess feeding as UNASSISTED.TOstryzniuk 19:05, 24 June 2008 (CDT.
2. Continence for assessment; does the use of a foley from home or within the first 24 hours qualify as Dependant. The KATZ states "Dependant as assistance; incontinent or catheter used (as with the use of a foley).ADL link.

**Please see KATZ ADL article which should now addressed all ADL questions above. TOstryzniuk 17:06, 29 July 2008 (CDT)

13. Will a position be created to focus on quality control through chart audits to ensure our data is consistent? It would be nice to have some feed back. *There have been discussion at the Regional Database Steering Meetings. If anything changes we wil let you know.TOstryzniuk 18:08, 29 July 2008 (CDT)

14. The Diagnostic coding book would benefit from a thorough "overhaul" to itemize specific criteria for coding definitions. As a group each month we could perform audits in each Dx category with the goal of talking about codes etc in order to all understand when and where to use them. *this has been discussed numerous times over the years. Program in working through "priorities" and has been discussing options.

15. Possible impacts of the new Code Blue policy at HSC? *what exactly is the question/concern here? TOstryzniuk 17:06, 29 July 2008 (CDT)