Apache II General Collection Guidelines
Select the worst value
Select the physiological values that reflect the worst deviation from normal in the first 24 hours in ICU.
WORST value could be HIGH or LOW, depending on the one that gives you the most points. Keep in mind the diagnosis and try not to include iatrogenically enhance symptoms, e.g. BP severely high due to inotropes or decreased LOC due to sedation.
If the length of stay in ICU is less than 24, use those values only. NOTE: The Higher the APACHE score, the sicker the patient.
Missing Values
Do not record the value zero and do not leave any blanks.
If a specific value for any APACHE field is not available in the first 24 hours in ICU then: A) Select a value closest to the time prior to admission into ICU. Make a note on your collection sheet where the information was obtained from (ER or Ward etc) and from which date and time period it was obtained from. B) If no information is available, then assume it was not tested because it was normal, and record normal values for all APACHE data. Also note this on your collection in your collection notes.
For patients who "died" in ICU
For patients who "died" in ICU and have no data available in ICU to record for an APACHE select the APACHE data that is closest to the time 'prior to' ICU admission ( values from ER, ward, etc.).
If these are NOT available then:
1. For vital signs (Pulse, BP mean, RR only), select the lowest limit value on the APACHE table that will give you the highest score.
2. Record normal values for: TEMP, CO2, NA, K, Creat, HCT and WBC.
To do before de-stubbing
- there is reference to "the collection sheet" - does that mean we need to track this electronically? If not, why do we need to take this down? Or do we, still?
To do before de-stubbing
- address other de-stubs above
- finish moving from paper