Overstay Predictor Project Collection Instructions

If the patient was discharged/died before a colour could be assigned write "not assessed" and write the discharge date on the Nurse Discharge Screening Tool, take a copy and put it in the Transition Coordinator Binder. Enter "Form Data Missing" in the temp field.

The nurse can update the form within the first 24 hours after admission if, for example they receive information from the patients family that contradicts the patients answers. It is possible that depending on when you review that document these changes are not captured. This a known risk that we are accepting.

ensuring completeness within 24 hrs

The bedside nurses have 24 hours from the time of admission to the unit to fill out the Nurse Discharge Screening Tool. This time frame allows for the nurse to clarify unanswered questions with the patient or caregivers during the day.

If you can't find the form or an answer is still missing 24 hrs after admission::

• enter the project "Overstay" "form data missing" entry into the tmp table
  • If the nurse form is incomplete the patient will be evaluated as if the nurse form had identified a problem, i.e. the patient will become yellow or red; the program will give a message that data had been missing.
• check with the bedside nurse and remind them to complete it or notify the manager; enter the remaining data into CCMDB.mdb if it now becomes available.

If a patient was admitted and discharged within the 24 hours and no "Nurse Discharge Screening Tool" was completed enter "Form data missing".

entering the data

Within two business days after the bedside nurse has completed the Nurse Discharge Screening Tool the rest of the Predictor data must be collected. For the first 6 questions and the question about their living arrangements, create a record in tmp entries and check the check box if the answer is Yes and indicate where they live.

Question 4 consists of several sub-questions re. the patient's inability to manage daily activities. If even one of the activities raises a concern then the summary answer for the question needs to be no.

Take answers to questions directly from the form, no interpretation, even if you disagree after reading the chart. We will be testing the answers provided by the nurses to determine if they are a better predictor of transition support needs or can be used in conjunction with existing admission data to improve the effectiveness of the prediction tool. If the data were interpreted by the collector it would introduce another factor and make this test less valid. If you identify a discrepancy please note it in the Temp Comments field also known as column Q.

What you See in TMP for overstay - 6 rows

Overstay Tmp what you see

What you ENTER in TMP for overstay - list of choices

Overstay TMP What to ENTER

How to enter data into TMP from the bedside nurse Overstay form including an example if a question on form is not filled in

For a more details about wording in TMP items for overstay go to Bedside Nursing Discharge Screening Paper Form.

• There are 7 rows of items for overstay in TMP. 6 questions and 1 item asking specifically where patient lives prior to hospital admission. If any item are not answered, enter a "form missing" record for each in TMP. (Example: showing questions #2 below is missing data on form & how to fill in)

1. Overstay 1. Alert and Oriented
   • Column B in TMP - check if A&O or leave blank if not A&O.
2. Overstay 2. form missing
   • Not fallen in 6 mths not marked on form
     • Column B in TMP - BLANK
3. Overstay 3. Ambulates
   • Column B in TMP - check if ambulating, leave blank if not ambulating
   • Overstay 4. managing independently
   • Column B in TMP - check if managing independent, leave blank if not managing independently
4. Overstay 5. living situation
   • Column B in TMP - Check if the patients and family/support are confident that the patient can be discharged to their current living situation
5. Overstay 6. home smoke
   • Column B in TMP - check if answers appropriately to “You wake up in the middle of the night and smell smoke in your home, what do you do?” Blank if response is not normal.

Template:Discussion

• anyone one to try and rewrite this note below and make it clear here what the process is. Grace and STB? Thanks for your help.-Trish Ostryzniuk 20:01, 2013 February 14 (EST)
  • NOTE: The original ward where a patient is admitted to from the ER is where the Overstay assessment form is completed and information entered into overstay TMP data. If the patient is transferred FROM a ward we are collecting on then the receiving ward does NOT start a NEW Overstay form nor does the the collector enter overstay into TMP. Instead in TMP, for the 6 questions, the collector must select: "Transferred form". In this case a color will not be generated and the button will be gray color.

# 7 Enter (admitted) from

For each patient also enter where they are admitted from;

• Project Overstay
• Item: one of
  • From House
  • From Apartment
  • From Assisted Living
  • From House
  • From Other (e.g. homeless, inmate, group home...)
  • From Personal Care Home
  • From location missing - enter if the admitted-from information is not recorded on the form
    • nurses or data collectors can utilize the patient's address to assist with the answer if it is not obtained by questioning the patient. For example, it is easy to see if any address in an apartment VS a house by the address. --LKolesar 15:28, 2012 November 30 (EST)

Changes to regular data entry required for the Overstay Project

A number of items in addition to the regular Minimal Data Set needs to be entered before the generation of the chart colour in the next step because the algorithm uses this data:

• "from" and "questions" tmp entries, or else "transferred" entry if applicable
• DOB
• province
• Admit Date
  • Enter admit date as before; we are aware that this can be different from the time of admission to the unit and the algorithm takes that into account
• admit-from
• ADL
• Glasgow Coma Scale
• Charlson Comorbids
  • still working on list for the wiki; in the meantime, please just code all comorbids for the patient
• admit diagnoses if applicable:
  • Dementia or Violent 2nd to dementia
  • Palliative Care

Chart Stickers

Once the required information has been entered click the new “Overstay” button on the patient viewer form next to the notes field and it will turn a colour based on an underlying algorithm.

• GREEN - low/no risk for discharge issues
• YELLOW - some risk for discharge issues
• RED - significant risk for discharge issues assign a transition coordinator.
• GRAY - if some needed data is missing you will not be able to generate a colour in the ccmdb database; there will be a specific error

Based on the color displayed circle the colour on the Discharge Screening tool. Also place a colored sticker on the spine of the patient chart. The sticker 3/4 inch stickers will be located in the transition coordinator binder at the unit clerk desk. Take a copy of all discharge screening tools and leave the copy on the Transition Coordinator binder. We will be collecting these forms for the time being to evaluate the form.

The color on the button is not stored in ccmdb.mdb, so it will not be visible next time you open the patient. This is by design as you should only need to use the colour once.

Note: There is currently a small red dot used to indicate long term chart. There is also a small yellow dot used to indicate VRE.

colour if data is missing

See the dialog boxes in the program for information on color coding if data is missing.

no need to document sticker colour changes

It will not be necessary to document when a sticker colour changes. Just change the colour.

After 24 hours all information required to make the assessment as to if the patient is at risk should be available (or not known to the nurse within the first 24 hours and thus considered a risk). The only case where the colour should be changed is if the data-collector knew they had made an error on data entry in which case there is no need to record the previous colour. If the change results in the patient no longer needing a transition coordinator, then the data coordinator needs to notify the transition coordinator to ensure they are ware of the change.

Notifying the Transition Coordinator

see also #Special Case - Patient transferred from other participating ward If the patient has been designated as "red" for purposes of overstay prediction, the data collector will notify a Transition Coordinator by placing the patients name on the Transition Coordinator Assignment Sheet.

Overstay bug in CCMDB.mdb_Change_Log_2013#ver_2013-02-13

extra line

• VIC: overstay showing a extra line of code, so there are seven rows for overstay instead of six. Location From is seventh one. Shirley was able to delete the extra row from serial 8345 and enter data.
• I too have the extra line of code here at SBGH. DPageNewton 19:09, 2013 February 12 (EST)
  • 'I added a separate option for cases where from data is not available in ver 2013-02-04; I mistakenly set that new option to auto-populate when a new patient is entered. I have changed this for ver 2013-02-13. New patients started while ver 2013-02-04 was used will have the extra line; please delete it. Unless I hear otherwise, I think this is fixed, and this entry can be deleted in 2 weeks. Ttenbergen 10:54, 2013 February 14 (EST)

inappropriate reds

Please re-create colours for patients entered between Sat Feb 9 and Wed Feb 13!

• could someone check this "new model" of the overstay project? Six of the nine charts that I did yesterday came up as red. That is a HUGE number. My transition coordinators are howling. I, as well as my transition coordinators feel that some of these red designations are inappropriate. The serial numbers of the patients that came up red are: E5-9692; 9694; 9696; 9699; 9700; 9702. (Debbie)
  • the proportion of patients who are designated red does indeed seem a bit high, we are looking into this. Ttenbergen 17:17, 2013 February 21 (EST)

red from PCH

• VIC serial 8345 -RED flagged when admit from is Personal Care Home. Though if from Personal Care home then should not be RED.--Shirely Kiesman.-Trish Ostryzniuk 16:51, 2013 February 12 (EST)
  • The new algorithm as of ver 2013-02-04 no longer disallows reds from PCH, the only criteria now excluding pts from red is palliative care. However, in this case colour was probably mis-assigned since the algorithm was indeed wrong. Ttenbergen 10:54, 2013 February 14 (EST)
    • Are you saying Tina that a patient who comes from a nursing home can be coded RED now but previously were not?
      • Yes, that is correct. Before they were coloured green or yellow based solely on the nurse form but excluded from further analysis. The newest model includes them in the analysis, so we also include them in coding. This is also true for patients from outside of Manitoba. Ttenbergen 13:02, 2013 February 14 (EST)

lacking instructions

• collection instruction: there is no where on wiki that clearly explains how to collect overstay in tmp properly. For example, the B column, it is not clear how this functions or relates to some projects or items. Looking and the TMP is not intuitive on how & when items relate to Column B, (check mark or leave blank). Visual folks find it hard to follow unless shown. Tmp column labels, as mentioned before, are not intuitive.
  • As with all tmp entries, if you actually click the "edit" button the columns that are labeled only as letters in list view are labelled better. We keep talking about this. I can not label the columns in list view because they mean different things for each line. Would it help if I made the list view un-editable and forced collectors to use the edit view to enter tmp data? It would be tedious but it would also make it more intuitive and less ambiguous. Thoughts? Ttenbergen 10:54, 2013 February 14 (EST) Template:Discussion

Special Collection Instructions-for SBGH medicine during vacation/sick leave of regular collectors

• SBGH has now gone to paperless charting or epr. This means that we can now review almost the entire chart on the computer. The exceptions to this are: 1. the discharge planning screening tool (dpst) form. The information found on this form is one part of the information we need for the overstay predictor project (opp). 2. the medicine apache score. These elements are usually found in the ER nurses notes, or the MICU flowsheet (for those patients transferred to medicine from MICU). Both of these forms are still paper.
• The priority for medicine data collection at this point in time is this:

1. minimal data entry and assignment of serial #'s to all admissions. 2. overstay predictor project with color assignment, i.e. keeping current and up to date with same. For instructions on what to do with entering reds into the transition coordinator binder, and where to put the colored stickers on the chart see the wiki opp collection instructions. 3. completing oldest discharge charts for patients discharged while collector on vacation, starting with oldest first. Pay particular attention to those charts that are still incomplete if it is just prior to quarterly report time. 4. last priority would be the current admissions and discharges.

• For those collectors who are doing vacation relief for the regular collectors who are away, catch up from time off can be expedited for the returning collector if the following things are priorized.

1. do opp and color generation. (ADL's are a component of the opp and can be found on the epr. They are in "initial assessment" form under the documents tab.) Everything needed for minimal data will be included if the opp is done. 2. medicine apache score. This can only be found in the regular paper chart, as the ER nurses notes and the MICU flow sheet are still paper.

• The only things that need to be taken from the paper chart are the dpst info and the apache score info. If these two pieces of information can be done by the relieving collector then two things are accomplished:

1. the opp is kept current and up to date. 2. charts would not have to be pulled from medical records by the person returning from vacation. This would help tremendously in catching up from time off for the returning collector.DPageNewton 14:40, 2013 February 20 (EST)

Special Case - Colour Generation during collection staff shortages

• Also, during vacation periods, there is a very good possibility that information will not be entered and colours will not be generated on the teaching units. When/if these patients are transfered to non-teaching, will the nurses on 5B be filling out the screening tool within 24hr. of transfer to ward? I can not find the answers to these questions on self learning collection instructions on Wiki. Please advise.ENagy 17:30, 2012 November 8 (EST)
  • I am not sure if you are referring to nurses on vacation or data collectors. I will leave it to Trish to managed the data collector coverage model and the unit managers to manage nursing coverage. We will be monitoring form adherence to the process on an ongoing bases.LHathout
    • Collecting enough information to generate the overstay colour is the highest priority thing to do in medicine data collection. Trish, can you specify how this would be handled? Ttenbergen 13:28, 2013 February 14 (EST)

Special Case - Patient transferred from other participating ward

If the patient is transferred from one medical unit to another within the facility only the one Nurse Discharge Screening Tool is required and the original Green/Yellow/Red designation is retained. The designated colour should be written on the form. The completed form will travel with the chart so when you review a new admissions to the unit you will see that the form has already been filled out and a colour has been assigned.

entry instructions

• erase the 6 questions
• enter an entry Project "Overstay", Item "Transferred form"
• ensure that the new chart has a dot of the right colour
• if red add the patients name to the assignment sheet

Legacy Info - red for PCH or out-of-province patients

The original implementation of the Overstay colouring algorithm used between project start and 2013-Feb-08 would never assign a red to palliative, out-of-province or PCH patients. As of 2013-Feb-09 the algorithm has moved consideration of PCH and out-of-province status into the logistic regression analysis; the two are still a factor, but a minor one, and both types of patients could now become red in the right circumstances. Palliative patients continue to be evaluated such that they can not be assigned a red.

when you have a problem

• Reminder to all staff.........please email Tina or post issue on Wiki rather phone calls. If phone call is getting you voice message than email her & CC Fred and Linda. Thank you for your cooperation with this.Trish Ostryzniuk 18:47, 2013 February 12 (EST)