CRRT Project: Difference between revisions

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CRRT - HSC ONLY - Tmp project starting Sept 19.16
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  Project has been indefinitely postponed; requester found that they would not be able to generate the data for us to collect. Ttenbergen 13:12, 2016 February 8 (CST)--[[User:TOstryzniuk|Trish Ostryzniuk]] 16:39, 2016 February 9 (CST)
'''HSC ONLY'''
*Start Date from CCMDB TMP: '''Monday Sept 19, 2016'''
**CRRT usage from TISS only: January 1, 2016
*Evaluation Date: Jan 12.2017
*End date: none


CRRT is going to be a permanent "temporary project" to collect reasons why patients receive [[CRRT]]([https://en.wikipedia.org/wiki/Hemofiltration]) treatment.
([https://en.wikipedia.org/wiki/Hemofiltration])  


== Status ==
== Purposes ==
{{discussion}}
*To identify the reason(s) why CRRT therapy was requested by the attending nephrologist for quality improvement and resource utilization in the Renal Program.  
Julie mentioned that Nephrology is working on a FORM for the chart that the Nephrology ATTENDING must fill.  This will be the form where Collectors will get there information from for reason for CRRT  See list below.  Collectors, any comment with List below?[[User:TOstryzniuk|Trish Ostryzniuk]] 17:24, 2016 February 4 (CST)
*To track the CRRT usage for workload and resource utilization in the Critical Care Program.
 
For now we are waiting for a final decision on the form from Dr. Bueti. This collection will not start until the form is deployed Ttenbergen 11:00, 2016 February 8 (CST)
 
== List of Reason for CRRT  (updated Feb 4.16) ==
#[[AKI]] due to pre-renal/hypovolemia
#AKI due to sepsis/distributive shock
#Hepatorenal syndrome
#AKI due to cardiorenal syndrome
#AKI-contrast-induced
#AKI Drug-induced(Ibuprofin,Genta/Vanco)
#AKI due to endogenous toxin (myoglobin(rabdo)/hemoglobin/paraprotein)
#AKI due to exogenous toxin exposure
#AKI postop, NOS (not otherwise specified)
#AKI due to thromotic microangiopathy/vascular event
#AKI due to acute glomerulonephritis
#AKI due to acute interstitial nephritis
#AKI due to urinary obstruction
#ESRD-on CRRT :  this selection does not make sense, this list is for reasons for crrt.--[[User:LKolesar|LKolesar]] 12:00, 2016 March 15 (CDT)
#ESRD-on IHD
#Drug OD -no AKI (removal of drug only)
#Fluid reduction WITHOUT AKI or ESRD
# Form not available or not filled out


== Data Collection Instructions ==
== Data Collection Instructions ==
=== for which patients to code  ===
=== for which patients to code  ===
All Critical Care patients who are in CRRT therapy at HSC and STB hospitals.
HSC Critical Care patients only who get CRRT therapy


=== how to code ===
=== how to code ===  
<detail>
Nephrology will completed a FORM (Renal Diagnostic Codes Checklist).  This form is attached to a consult form in the HSC_ICU's and will stay on patient chart.    The Nephrology ATTENDING must fill the form  reason for CRRT. Collectors will get there information from for reason for CRRT 
Project: CRRT
Item:  enter is this field the marked renal codes from the Renal DX code form on patient chart. 




==== Discussion  ====
{{discussion}}
If possible, for STB, it would be optimal if the sheet that the renal attending could be put on the electronic chart.  It could pop up when the orders are written for CRRT or the doctors could put it into their electronic progress notes.  We may find that compliance using a paper sheet may not be good here.  --[[User:LKolesar|LKolesar]] 10:48, 2016 February 9 (CST)
*listed item 9: AKI-post op
**I would like to suggest using AKI: Fluid Volume Management...Pre-or Post-op


One of major reasons for CRRT in Non-Renal failure population at all sites having this renal replacement therapy(RRT) option often rises from the severe burn and trauma victim group.
One of major reasons for CRRT in Non-Renal failure population at all sites having this renal replacement therapy(RRT) option often rises from the severe burn and trauma victim group.
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However TISS28 does not contain the diagnostic reasons for CRRT therapy so a request to collect this information  separately by the data collectors of the Critical Care Database was made. The Renal Program had identified the possible reasons for CRRT therapy and proposed to list them in a form for the attending Nephrologist to mark.
However TISS28 does not contain the diagnostic reasons for CRRT therapy so a request to collect this information  separately by the data collectors of the Critical Care Database was made. The Renal Program had identified the possible reasons for CRRT therapy and proposed to list them in a form for the attending Nephrologist to mark.


== Purposes ==
*To identify the reason(s) why CRRT therapy was/were requested by the attending nephrologist for quality improvement and resource utilization in the Renal Program.
*To track the CRRT usage for workload and resource utilization in the Critical Care Program.
== Start/End Dates ==
*Start Dates:
**CRRT usage from TISS28 - Jan 1, 2016
**Reasons for CRRT - <when?> Potential: March 1.16 - cancelled indefinitely. --[[User:TOstryzniuk|Trish Ostryzniuk]] 16:39, 2016 February 9 (CST)
*End Date: there is no planned end date


=={{CCMDB Data Integrity Checks}}==
=={{CCMDB Data Integrity Checks}}==
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*Reasons for CRRT - will be added to the SAS program above.
*Reasons for CRRT - will be added to the SAS program above.
==== Discussion  ====
{{discussion}}
If possible, for STB, it would be optimal if the sheet that the renal attending could be put on the electronic chart.  It could pop up when the orders are written for CRRT or the doctors could put it into their electronic progress notes.  We may find that compliance using a paper sheet may not be good here.  --[[User:LKolesar|LKolesar]] 10:48, 2016 February 9 (CST)


== See also ==
== See also ==

Revision as of 15:58, 15 September 2016

HSC ONLY

  • Start Date from CCMDB TMP: Monday Sept 19, 2016
    • CRRT usage from TISS only: January 1, 2016
  • Evaluation Date: Jan 12.2017
  • End date: none

([1])

Purposes

  • To identify the reason(s) why CRRT therapy was requested by the attending nephrologist for quality improvement and resource utilization in the Renal Program.
  • To track the CRRT usage for workload and resource utilization in the Critical Care Program.

Data Collection Instructions

for which patients to code

HSC Critical Care patients only who get CRRT therapy

how to code

Nephrology will completed a FORM (Renal Diagnostic Codes Checklist). This form is attached to a consult form in the HSC_ICU's and will stay on patient chart. The Nephrology ATTENDING must fill the form reason for CRRT. Collectors will get there information from for reason for CRRT Project: CRRT Item: enter is this field the marked renal codes from the Renal DX code form on patient chart.


One of major reasons for CRRT in Non-Renal failure population at all sites having this renal replacement therapy(RRT) option often rises from the severe burn and trauma victim group.

Their need for fluids(crystalloid/colloid, blood products and nutritional support[TNA])over a 24hour period can often exceed 20 liters in the first several days of ICU care...the severe burns with skin losses require significant volume replacement throughout their acute injury and debridement stages. CRRT allows for this excessive volume administration as diuretics cannot maintain a stable balance and further renal compromise is almost a certain outcome as well as progressive respiratory issues/failure in the ventilated patient. Allowing room for early nutritional replacement is a significant benefit and aids in improved outcomes. CRRT can remove up to 2L per hour-where and when necessary over a 24 hour period.

How to determine?

<detail>


Background

The patients on CRRT therapy during the stay in ICU are being tracked by a CRN in Critical Care Program since ?? (date to be asked). The CRN collects the patient names, the hospital number, the renal diagnosis for reason for CRRT, the initiation and duration of therapy in paper form. The Renal Program states that they need the demographics of patients who were on CRRT as well as the reasons why CRRT were requested by Neprologists for quality improvement, resource utilization and billing purposes. Critical Care Program shares these information to the Renal Program by faxing the hand written data sheets to them on a monthly basis.

In Jan 2013, the Critical Care Program implemented the usage of the new TISS28 form which include various nursing activities, interventions and procedures including CRRT. The bed side nurse records on the TISS form these activities if present on a daily basis for each patient during the whole duration of stay at ICU. The data collectors of the Critical Care Database quality check the entries of the TISS forms for completion and consistencies. Since the same information is being collected by the CRN and bed side nurses, a comparative analysis between the two process of data collections and an additional real time audit by an independent auditor were done. TISS CRRT had 96% matched with the real time CRRT while 85% matched with the CRN CRRT.

The Critical Care and Renal Programs made a decision last Feb 2, 2016 to consider the TISS28 as the source of CRRT data starting Jan 2016.

However TISS28 does not contain the diagnostic reasons for CRRT therapy so a request to collect this information separately by the data collectors of the Critical Care Database was made. The Renal Program had identified the possible reasons for CRRT therapy and proposed to list them in a form for the attending Nephrologist to mark.


Template:CCMDB Data Integrity Checks

None yet

SAS Program

  • CRRT Days from TISS28 - The SAS program is in X:\Julie\CC Projects\CRRT_Ryan&Bueti\ICU_CRRT_byMonth.sas. The program generates the list of patient names, PHIN, Chart#, Date of Birth, First day on CRRT, year, month and calendar days on CRRT and total CRRT days.
  • Reasons for CRRT - will be added to the SAS program above.

Discussion

Template:Discussion If possible, for STB, it would be optimal if the sheet that the renal attending could be put on the electronic chart. It could pop up when the orders are written for CRRT or the doctors could put it into their electronic progress notes. We may find that compliance using a paper sheet may not be good here. --LKolesar 10:48, 2016 February 9 (CST)

See also

  • <any related articles?>