Catheter09
Note: This is a proposed project only at this time. Please feel free to comment if any instructions are unclear, though!
The Nursing Leadership Counsel at St Boniface is working on reducing the incidence and duration of urinary catheterizations without appropriate clinical indications for medicine patients at St Boniface. We will collect some data for them as part of our temporary studies, initially for three months, but possibly longer pending the results at that time.
Times
- Estimated Start Date: ???
- Review Date (~75 days after start):
- Preliminary End Date (3 months after start):
Discussion
- It would be good to start it next week so that we can work out any problems. Would like to pilot it for a few weeks before vacations start on STB medicine. First round of vacation starts June 15. At least collector will learn the process before this date and be able implement before she goes. Julie is away last 3 weeks of July.TOstryzniuk 15:54, 2 June 2009 (CDT)
- Tina, can I have a copy for my PDA and Julie and I can review? thanks.TOstryzniuk 15:54, 2 June 2009 (CDT)
- Trish, I think this is a perfect opportunity to get you adding a project to temporary studies. Someone in addition to me needs to know how to do this. If you follow the guideline I set up below and add the data to the s_tmp on the PDA and in Access you'd be set. If you want to set up a meeting for me to come by and watch to make sure all goes right, please book me for an hour or so. Ttenbergen 10:48, 3 June 2009 (CDT)
- Tina, can I have a copy for my PDA and Julie and I can review? thanks.TOstryzniuk 15:54, 2 June 2009 (CDT)
Discussion
- Will this study be impacted by running over the summer months? Ttenbergen 17:23, 1 June 2009 (CDT)
- Summer is always a challenge. (between May and Aug). I have 10 weeks of vacation between 3 people with no coverage at this time. (3 wks in June, 4 wks in July & 3 wks in Aug). If the program is willing to accept data that is not "immediately" available and up to date and that catch up work can be done in Medical records then it can be done over the summer. (Trish)
- The vacation free period for STB-MED is Sept 4 to Nov 30.09. (Trish)
Collection Instructions
Make a record in L_TmpV2 for every indwelling urinary catheter on your ward. It does not matter whether the patient arrived with it or was catheterized locally.
We need more data than you can put on one line. We could have recorded a line for each data element, but to speed it up for you we combined them on 4 lines as follows:
- R-<option> = "Reason" from Item dropdown list; "Dr. order" on checkbox; DT-Inserted = Insertion date/time
- W-<option> = "Where inserted" from Item dropdown box; "post-insert UTI" checkbox; DT-Removed = Removal date/time
For example:
- Project: Catheter09; Item: “R-Urinary incontinence”, Dr order: “yes”, “DT-Inserted”, Date: 12 May 09 10:00
- Project: Catheter09; Item: “W-HSC A4”, post-insert UTI: “no”, “DT-Removed”, Date: 14 May 09 14:00
If a patient was catheterized more than once, enter several sets of records. Make sure you finish entering one set of records before starting the next, as the record date/time will be used to group the records.
Discussion
adding an incident coutner
- To group the records per incidence clearly, I suggest we add a Catheter counter (1,2,3,and so on) under the INT_var field. So for the first incident, the counter will be 1 for the four records.JMojica 10:59, 2 June 2009 (CDT)
- allows data collectors to sort and "group" incidents especially if there will be more than one. TOstryzniuk 11:50, 2 June 2009 (CDT)
- If I understand the suggestion this would be the identifier that groups the 4 lines to one event. We can certainly add that, but it also adds one more thing that DCs have to tap into the PDA. It may be worth it, though. I am worried about calling it "counter" because someone will inevitably try to use it to just state how many catheterizations the patient has had. Do you think calling it just "event" would work? At least that is non-intuitive enough that DCs would look it up, and once they have looked it up it should make enough sense. Ttenbergen 10:48, 3 June 2009 (CDT)
- event sounds good.TOstryzniuk 16:34, 3 June 2009 (CDT)
- If I understand the suggestion this would be the identifier that groups the 4 lines to one event. We can certainly add that, but it also adds one more thing that DCs have to tap into the PDA. It may be worth it, though. I am worried about calling it "counter" because someone will inevitably try to use it to just state how many catheterizations the patient has had. Do you think calling it just "event" would work? At least that is non-intuitive enough that DCs would look it up, and once they have looked it up it should make enough sense. Ttenbergen 10:48, 3 June 2009 (CDT)
Reason data
Choose the first item starting with an “R-” listed under Catheter09’s item list that applies to this patient. The items are specifically ordered so that if you choose the first one that applies we will get the best results.
Dr order
Is there a doctor’s order to catheterize in the chart?
- should be on the physicans order form.
DT-inserted / DT-removed
Date and time the catheter was inserted or removed.
- If you can’t find a time, use midnight.
- If the time is in fact midnight, record 23:59
"Where" Data
Choose the place (elements starting with "W-") where the catheter was inserted.
Data Structure Setup
The s_tmp lines driving this will be similar to the following table. These lines need to be added to the s_tmp table on ccmdb.mdb and on the PDA.
| Project | Value | Instruction | int var label | float var label | bool var label | date var label | time var label | complete send |
| Catheter09 | R-<one line per reason> | catheterization reason, dr order | -- | -- | Dr Order | -- | -- | True |
| Catheter09 | DT-Inserted | insertion date | -- | -- | -- | Insert dt | Insert tm | True |
| Catheter09 | DT-Removed | removal date | -- | -- | -- | Remove dt | Remove tm | True |
| Catheter09 | W-<one line per option> | insert location; post-insertion UTI | -- | -- | PI UTI | -- | -- | True |
Actual "reason" options
Note: Arrived with is at the top because it should be chosen for anyone arriving from off unit. Since the instructions say to use the first item on the list which applies, sorting it to the top will make it the option chosen for all who arrive catheterized.
- Arrived to the unit with catheter
- Urinary incontinence
- Acute/chronic retention
- Accurate urinary output monitoring
- Management of perianal/sacral wounds
- Palliative care
- Hemostasis for active bleeding
- Ordered by Urologist
- Ordered pre-procedure/surgery
- Monitoring of hematuria
- Patient preference
Actual "where" options
- SBGH ER Dept
- SBGH ICU
- This Ward
- Other SBGH Unit (we don't just consider our units for that)
- Other Facility
Complete Files Only?
- Will we need this data only once a patient is sent, or as the recording proceeds? I suspect only as a patient is sent... Ttenbergen 17:23, 1 June 2009 (CDT)
- Good question. Follow-up to this is 'Is there a time period the Investigator wanted the outputs to be summarized? Ex. how many catherization days occured for months of July and Aug. The time reference here is either the date inserted or the date removed. If yes then the data is needed as recording proceeds. But if the interest is data on a per patient level, then the data is needed once a patient is sent. The time reference to be used if needed is the Discharge Date. There will be a long wait for patients having a long stay.' JMojica 11:18, 2 June 2009 (CDT)
- I almost got the impression that Kim and co. will do their own analysis. This would be all the better for you, Julie, since it would save you time. It might be nice to pump it into an Access file for them, that way they can just pivot-table it any way they want - it's really quite slick. I am suggesting this based on the idea that Julie's time is at a premium here. If we use a tool that allows people to do their own investigation, then we don't need to decide ahead of time how to group. I may be underestimating the skill set required, but it sounds like this would be a good group to try with since they said they have some data analysis capability within their group. Ttenbergen 10:48, 3 June 2009 (CDT)
- Good question. Follow-up to this is 'Is there a time period the Investigator wanted the outputs to be summarized? Ex. how many catherization days occured for months of July and Aug. The time reference here is either the date inserted or the date removed. If yes then the data is needed as recording proceeds. But if the interest is data on a per patient level, then the data is needed once a patient is sent. The time reference to be used if needed is the Discharge Date. There will be a long wait for patients having a long stay.' JMojica 11:18, 2 June 2009 (CDT)
Data Processing
Our statistician will pull the data from the TmpV2_1.mdb file on the regional server. We will provide this data to the requester in the following format:
- Serial
- Site (we don't need site since this is only for StB)
- Location
- Catheter Event
- Reason
- Dr.Order
- D-Inserted
- D-Removed
- Total catheter days(calculated - if this comes in an Access file it can be generated internally right there)
- Where
- Post Insertion (PI) UTI
- We will not provide patient identifiers at this time, but if necessary later we can resolve Serial, Site and location to patient identifiers.
- Summary statistics will be provided like frequencies for Reasons and PI-UTI and descriptive stats (N, mean,median, STD, min, max) for Catheter days. JMojica 10:22, 2 June 2009 (CDT)
- don't use that acronym here, it may mean different things to medical folks in a genitourinary setting ;-) Ttenbergen 10:48, 3 June 2009 (CDT)
- see above re. whether to analyze this data for them Ttenbergen 10:48, 3 June 2009 (CDT)