HSC Critical Care Collection Guide

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See also:

Information relevant to all HSC ICU collectors

See HSC ICU locations and serial number sharing 2015-05-01.

HSC MICU/CCU Collection Guide

see HSC MICU Collection Guide

Pharmacy

If patients are transferred to the wards the medication records may be in the nurses Mar binder or in a thinned chart.The ward clerks will help locate these thinned charts.

25% Albumin is often given and is often not on the intake and output sheet but will be found on the medication record. Cross reference the blood administration record.

Transfer times MICU/CCU

Template:Discussion is this relevant only to MICU/CCU, or to Med collectors or STB CCU collectors as well? Want to make sure it's in the right place. Ttenbergen 15:02, 2015 May 20 (CDT)

To determine transfer times the first set of vital signs is the guide. Medicine collectors at HSC can find the transfer time by looking at the first set of vital signs in MICU. Unless there is a clearly documented time elsewhere in the chart the ward transfer time is usually 10 minutes prior to first set of vitals. It is a rare occurrence that those vital signs are not done. Collectors do need to be careful as there can be many pages of flowsheets for one day.The old addendum sheets are not supposed to be used but I will also occasionally see an addendum sheet.

STB CCU is used as a bed borrow sometimes post angio and then patients are sent to HSC CCU. The only way to tell if it was a bed borrow or not is to look for a nursing transfer record or check our data base's transfer tracker.

If patients overflow in to SICU they remain MICU data collectors patients.Surgical patients that come to MICU under the MICU attending care are also the MICU collector's patients.

HSC SICU Collection Guide

Log Book

The SICU log census book is kept at the South Nursing station. This is seen when first entering the unit. The log is in a shelf at the desk, next to the Unit Clerk. The binder with the completed TISS and Record of Special Treatment and Test sheets is in the same shelf. The test sheets are a good source for admission and discharge dates and times that may not have been put into the log book. Patients who were not entered into the log book may also be found here, especially after a weekend as they may have float clerks who will not know to do the entry. Another way to discover unlogged patients is by looking at the TISS sheets collected in the binder if the patient has already been discharged.

Green Sheets

The Green sheets are in a binder on the Rounds Table. When not being used in Rounds, it is usually kept in the side corridor which will leads to the new hotel. Completed Green Sheets are left at the front of the binder after the patient is discharged. Next to the desk at the North nursing station is an upright set of shelves which has a space for the TISS and Green sheets which the data collector keeps stocked.

Work Space

  • There is a desk space next to the FAX machine at the South desk that may be vacant for a workspace, but there is no electrical outlet available.
  • There is a larger space at the North Nursing Station which may be free. There are electrical outlets there and a computer which accesses KEA.

Coding for OR events during admission

See Coding for OR events during admission

( Depending on how that article pans out it may end up back here, or the link might be moved up to ICU instructions or the general curriculum.Ttenbergen 22:39, 2013 August 26 (CDT))

PACU

The admission time for a patient admitted from PACU may not be entered accurately in the log book if they have been held in PACU due to lack of space. Always check to ensure the time used for the database is accurate. The SICU physician will enter the admission to SICU on the order sheet and that is considered the time of admission. Any extra time in PACU is then considered overflow in PACU.


Transfer Ready Date

SICU/IICU must have a 'transfer ready date/time; entered, unless they are transferring to another ICU bed (not including IICU). Transfer to IICU is treated like a transfer to a ward, but the data collection once there is treated like an ICU patient.

The preferred source for the Transfer Ready date and time is the Green Sheet. If that is blank, the next source is the doctors' order sheet.

Patient Type

Overflow

If a patient overflows into another unit, it is still called by its home unit in the location, and the number must be taken from the home unit log. The data is collected by the collector where the patient resides and put onto the home unit database. Return to the home unit is not a transfer.

If a patient is overflowed into PACU, SICU follows them there. The PACU staff do not complete TISS sheets and transfers out may not get into the log book so must be followed up by the Data Collector.

Rounds

Rounds start at 09:00 so the chart may not be available at that time. On Wednesdays Rounds start an hour or 2 later.

APACHE

  • These numbers are collected from the ICU Addendum Sheet/s and the flowsheets. If the patient comes from PACU, they do not use the ICU Addendum sheets. Under Admit Type, the surgery must be an E1 to qualify as Emergent. This info is found on the white typed OR sheet which indicated the start and end times, procedure, etc. (Not the Anesthetic Record).
  • The best source for the GCS is the admitting RN's notes. Patients are often initally on Propofol and this is shortly DC'd which then allows a proper assessment. The neuro patients or head trauma patients may be sedated for long periods of time and the admission GCS may need to be used. Those patients will generally have a very poor neuro status even without Propofol.

Clipboards

These are kept at each bedside and have

  • the current Flowsheet
  • possibly the Flowsheet for the day before for reference during Rounds
  • the MARs

Charts

The charts are kept at each bedside. Lab sheets are usually in the chart.

Thinned charts and old charts are kept above the desk by the FAX machine at the South Desk.

Charts of deceased patients are not kept in the Unit for the Data Collector. As is true for all deceased patients' charts, they are at the Death Desk.

Flowsheets

  • The infusion drugs are listed under the vital signs and not on the MAR's. The IV med's given are listed on the Fluid Balance section of the Flowsheet, as wellas any colloid. The colloids should be in red, but are not always. The number of the unit may be listed, but not the type, e.g. FFP vs PRB. This may require checking the Blood Admin record for clarification.

Antibiotic counting

  • When counting antibiotics, be sure to check the yellow STAT sheet for antibiotic boluses.
    • Template:Discussion Are these unique to HSC SICU? Also used as MICU? How about at other sites?
    • not used at other sites it sounds like, but are they used in MICU? Ttenbergen 11:43, 2015 May 20 (CDT)

Labs

There was a reference to where labs were listed but I lost it. Please replace this section with where they are documented.

HSC IICU Collection Guide

see HSC IICU Collection Guide

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