STB ACCU Collection Guide

As discussed, Laura Kolesar will document data collection procedures specific to STB_CCU.--TOstryzniuk 11:08, 28 August 2009 (CDT)

CCU orientation at St. Boniface Hospital Sept 2009 Prepared by Laura Kolesar

Charting Note: We are in phase 2 of electronic patient record implementation. This means that all patient log data, location information, lab and diagnosis imaging results, tests, physicians’ orders and pharmacy are obtained electronically. Eventually all data will be obtained electronically. The CCU patient chart has a flow sheet for the nurses to fill out their vital signs and patient assessments. If the patient has had an acute MI, a care map type of flow sheet is used. This has four steps as the patient progresses in their recovery. A second option for nurses’ charting is a CCU flow sheet for all other types of patients other than acute MI. (examples: arrythmias, pre op optimizations, cardiomyopathy, chest pain NYD, etc. ). Occasionally a COR sheet (like those used on the wards) can be continued in CCU and even the Y2 procedure note page has been continued on a rare occasion for a patient who needs some CCU management post angio.

Special Note: Patients that arrive in CCU for post procedure care post angio only because the pre and post angio area is closed, are not included in our database.

Overflows: MSICU and ICCS can also have CCU patients as CCU overflows. They will often be located in one of these areas if they require intubation and /or IABP. However, they are still attended by the CCU doctors and the CCU data collector must enter them as a CCU patient. They usually remain under CCU unless further multi system issues exist that the CCU attending wishes to transfer the care to the ICU. In this case the patient is discharged from CCU and admitted to the ICU and the ICU data collector will then start a profile and continue to follow this patient. (insure that the respective tiss sheet follows the patient as they are moved between units if they continue to be a CCU pt.) Make sure the overflow is marked in the variable 5 slot.

From/To slots: A code stemi is when a patient comes directly to the heart cath lab via EMS. This will result in an admit code from home (ZZ). If a patient comes from the heart cath lab you need to put where they were prior to this. For example Dauphin ER or ICU. If the patient was at St.B. ER but was transferred from another hospital prior to this, put the first entry hospital in the admit from. On the paper log sheet we put a small heart figure to indicate all primary angios in the admit from space but you also need to put where the patient was just prior, which is also written in this space.

Diagnostic Coding: Primary angiograms are those that go first to the angio room and then to CCU afterwards. In this case the first admit diagnosis should be angiogram, then angioplasty, then stent, then the MI with location subcode and then other items like CHF or TNK if applicable. The exception to this rule is when the patient has a cardiac arrest before arriving in CCU or has cardiogenic shock. These will then be coded first and then the primary angio sequence. If you are past the quota for number of admit diagnosis codes, you can use only angioplasty if necessary (take out angiogram and stent if needed).

If the patient comes from an ICU (different hospital) do not use the MI as the first diagnosis. Other options could be post infarct angina, unstable angina, chf, cardiogenic shock, etc. The second diagnosis could be the MI.

Labs: remember to count cardiac MRI, echos and angiograms in the labs.

Pharmacy: Nitropatch amount is always one, only the number of days is counted. Observe all infusions in CCU and try to keep track of how many doses and days the patient is on the infusions. The rest of the pharmacy is easy to track on the EPR. Infusion drugs can be neglected to be signed for in the electronic MAR. Infusions commonly used in CCU are all antiarrythmics, all inotropes, some vasopressors and some antihypertensives.

TISS: If the patient is a primary angio, item #91 should not be marked. However if the patient had a plasty, #96 operative procedure can be marked. If the angio happens as a complication (after arriving in CCU), then #91 can be marked.

If the patient has a temporary pacemaker, make sure one of the Tiss items #15 or 16 is marked for each day the patient has the pacemaker. If the patient goes for a permanent pacemaker, the OR #96 must be marked and then the next day the #15 or 16 should not be marked. If the permanent pacemaker is done and then the patient goes to the cardiology ward afterwards and does not return to CCU, #96 is not marked and the code permanent pacemaker is not entered as a complication. The patient is instead transferred to the OR and the profile is completed.

NOTE: Instructions for doing apache scores and collecting all other data is already on the WIKI. These instructions are specific to CCU at StB.