ACP Status collection in ICU

see Comfort Care for collection of similar info in Medicine

not active yet, we are still working on this!Ttenbergen 15:41, 2015 August 6 (CDT)

This article is about collecting the "ACP Status" temp entry.

Coding Instructions

When you enter a new ICU patient two records will be automatically generated in the tmp table:

• ACP Status at admit (ie within 6 hours of admission)
• ACP Status at end (ie at end of stay resp. at death)

Change the ITEM for each of them to the ACP status at that time. Options are as follows

• ACP C - comfort care
• ACP R - Template:Discussion what means this one?
• ACP M+ - no cardiac resuscitation with intubation either happened or allowed
• ACP M- - no resuscitation / no intubation
• ACP n/a - no documented ACP on the chart

Don't fill Checkbox, dates, numbers, not used for this project

What if ACP-M is documented without +/-?

If ACP M is just written with no qualifiers then one would classify as ACP M-. Since a significant proportion of patient do want intubation but do not want CPR, I do think it is useful to distinguish). Kendiss Template:Discussion

• "-" means no intubation, so how does that work with "Since a significant proportion of patient do want intubation but do not want CPR"? Ttenbergen 15:41, 2015 August 6 (CDT)

Start and stop date

• Start Date: 2015-08-??
• Stop Date: none

Data use / Reporting and Analysis

• would allow QI team to follow:
  • % of patient with documented ACP during ICU
  • Level of care at both admission and discharge
  • % of patients with change in level of care during ICU
  • Level of care at the time of ICU death

Collectability

just leaving this here, it was discussed during implementation is this easy info to get at admission?--Trish Ostryzniuk 17:12, 2015 May 29 (CDT)

• Yes, it easy to obtain this information at the time of admission, it is 9/10 that ACP is established in ER. Do you want us to collect when a change occurs (often pt come in as a M and 24-72 hrs later, it is changed to APC -C ,or this occurs much later in the admission as well)--PStein 08:23, 2015 June 1 (CDT)
  • I agree with Pat. Is this for ICU and Medicine?--CMarks 13:50, 2015 June 1 (CDT)
    • I agree with Pat's comment. The pt would come in as ACP R & the status would be changed once discussion with family or pt took place. This usually happens 24-48 hours after admission or much later in the admission if pt status changes or the family cannot agree on the treatment plan.-- Judy K, Jun 4, 2015
      • At GGH ICU this is easy to obtain, I agree with Pat the ACP status often changes several times during an admission, do you want to capture these changes? or just ACP at admission and discharge? Template:Discussion
        • Is this ICU only? or medicine as well?Template:Discussion
          • ICU QI team has requested to collect this info. We will discuss at TASK team meeting and discuss asking Dr. Roberts for medicine.
            • Would this include up to the first 24 or 48 hours, or would this need to be in place before arrival? - Judy Kublick Jun 4.15.
              • At STB obtaining ACP is done from EPR and the changes are in the orders. It is easy to obtain.--LKolesar 11:22, 2015 June 1 (CDT)
                • STB CICU - Yes it is usually on the chart. Is this going to be just for ICUs.-- Lois
                  • VIC ICU - Med: I agree that is is usually easy to obtain. I find that it is often an "R" as a default until the MD has a chance to speak more in depth with family or the patient. So yes, it does often change throughout the stay, and my concern would be that the initial ACP status is not always the most "accurate" representation. So if it changes within the first 24 to 48 hours, which one would we enter? Mlagadi 09:05, 2015 June 2 (CDT) Template:Discussion
                    • GRA-MED: not always available on admission to Medicine but is always discussed at some point in the admission; often changes during stay SCortilet 15:13, 2015 June 2 (CDT)
                      • HSC _B3_D5: Same as Lois-usually on chart or the request is made for confirmation if not: or if the medical status on presentation is suggestive of a need for clarification or adjustment but that would require a time frame to arrange with client/family.--Llemoine 07:46, 2015 June 3 (CDT)