DeviceUse Study

Project Name

DeviseUse Study (this is the spelling of the study in our program and on the wiki)

Purpose

Monitor resource allocation and monitor complication rates related to length of ICU medical device use. (VAP, Central Line Related Blood stream Infection (CLR-BSI), unplanned extubations) to improve patient quality of patient care in critical care.

Who

Information to be collected from charts daily by Regional Database Team - Critical Care areas.

• Monitoring being done by the Critical Care QI Team along with the cross Canada ICU collaborative project teams CCVSM. Members of the CCQI team will also provide ongoing support and feedback for issue related to collection of this data from chart.
• Only the ICU's in the city will be collecting this information. No device use information will be collected at the CCU's at STB and HSC or the Cardiac ICU at STB. IICU will collect this data.
• Laura Kolesar will be the lead data collector who will work with CCQI team, Statistician & Tina Tenbergen on matters related to this project.

Where

Data will be collected in all ICUs in the region.

Data will be stored de-identified in L TmpV2 in the output folder on the Regional Server.

How often data is sent

• Information sent each week with sending to L TmpV2 even though patient files is not complete.

Instructions for collecting

• The focus is to determine number of days with each device while in the unit
• For each of the following devices, enter an in and out record or start and stop record for each device present:
  • on "in" or "start" record, tick off "present on admission" instead of entering a date if the device is present on admission
    • if date is absent and the box is ticked , the Statistician will use the Admit Date/Time as the "in" or "start" date
    • if date is present and is different from Admit Date/Time, there is no need to tick the box.
  • on "out" or "stop" record, tick off "present on discharge" instead of entering a date if the device is present on discharge
    • if date is absent and the box is ticked , the Statistician will use the Discharge Date/Time as the "out" or "stop" date
    • if date is present and is different from Discharge Date/Time, there is no need to tick the box.
  • devices:
    • Central line (first in and last out)
      • doesn't matter how many central lines a patient has at the same time (hint: if helps to keep track by writing in the note section which line it is for your own benefit.)
    • PICC line
    • ETT in & vent start, use this option if both are simultaneous (if not use individual options which have a "Z" in front)
    • ETT out & vent stop, use this option if both are simultaneous (if not use individual options which have a "Z" in front)
    • zETT in and out is used if done independently of vent.
    • zVent stop and start is used if done independently of ETT in and out.
      • If an unplanned extubation occurs enter a record for this in addition to documenting the ETT out/vent stop records
      • if patient is re-intubated within the same day, then the ETT out/vent stop will not be completed at the same date and time because the ETT /vent days will continue.
    • Trach
    • BIPAP/CPAP start and stop Changed title to BI/CPAP start/stop to make shorter
      • Bipap is only used in non-ventilated, extubated patients.
      • DC BIPAP will be defined as OFF bipap for >=24 hrs
      • Home bipap or cpap is included in this study.
• If the device is removed or stopped for a few days and then a new device is used, a new set of entries is required to get an accurate duration for the device.
• If the patient is in ventilator on admission, choose the device "ETT in & vent start" and not the "zVent start" and tick the box.
• Each item must have a partner: For example if central line "in" is an option, then central line "out" must be entered. If it remains in after discharge then the box is ticked in the "out" option. "Start" items must be paired with "stop" items and "in" items must be paired with "out" items. When you send, if the paired items are not entered for your completed pts, you will get a list of errors when you check your pre-send checker.
  • Another example: when both "ETT in and Vent start" are simultaneous , then decided to stop the vent but kept the ETT in and then the ETT was removed later on another date, only 3 date_times should be recorded namely 1) ETT_in & Vent_start, 2) Zvent_stop, 3) ZETT_out. Despite only having 3 dates, the partners are satisfied (eg. ETT_in & vent_start will be partner for both Zvent_stop and ZETT_out).
    • Example of Valid pairings
      • "ETT in and Vent start" and "ETT out and Vent stop"
      • "ETT in and Vent start" and "Zvent_stop" followed by "ZETT_out"
      • "ETT in" and "ETT out"
      • "ZVent start" and "ZVent stop"
    • Example of NOT valid pairings
      • "ETT in and Vent start" and "ZETT_stop" followed by "ZVent_out"
      • "ETT in and Vent start" and "ZETT_stop" only
      • "ETT in and Vent start" and "ZVent_out" only
      • "ZETT in" and "ETT out and Vent stop"
      • "ZETT in" and "ZVent_out"
      • "ZVent start" and "ETT out and Vent stop"
      • "ZVent start" and "ZETT out"

• Call me if you are unclear about these rules and I will try to clarify. You can always Page me and I will respond ASAP. Pager 932-0653 if you need help on the spot with this. --LKolesar 07:06, 20 October 2011 (CDT)

Further instructions will follow as we start working with this tool. Anyone can start trialing this any time because Tina has put it on the laptops. This only applies to critical care collectors. Feedback is welcomed as you start collecting this information. The actual project will start Jan 1, 2012 but you are expected to work with it on a trial basis somewhat before that date so that you are familiar with it and all the glitches can be worked out.

Start Date

Testing

Anyone who wishes to test this is welcome to do so. Start of testing Oct 1.11. Document any difficulties encountered. Be sure to at least try this out prior to the start date to ensure familiarity.

Data collection

The actual start date of the project will be Jan 1, 2012.

Analysis

The Statistician will derive the intermediate variables:

• Invasive Mechanical Ventilator Days: The number of MV patients in the ICU at approximately the same time every day

• Non-Invasive MV days: The number of Non-invasive MV patients in the ICU at approximately the same time every day

• Total MV days: The number of MV (invasive and non-invasive ) patients in the ICU at approximately the same time every day

• Mechanical ventilation time: The duration of MV (both Non-invasive and invasive) per person

• CL days: The number of patients with a central line in the ICU at approximately the same time every day

• Number of Unplanned extubations

• Number of Re-intubations

The Statistician will perform the analysis of the following Quality Indicators:

• Ventilated Patient Flow (VPF) is a measurement of the proportion of ICU patients having been ventilated at any time during their ICU stay.

• Ventilator Utilization Ratio (VUR) is a measure of the proportion of ICU days being spent on mechanical ventilation.

• Ventilator Associated Pneumonia (VAP) reported as a rate of VAP per 1000 mechanical ventilation days. Also reported as the number of mechanical ventilator days in between VAP cases.

• Unplanned extubation is the unscheduled removal of an artificial airway (endotracheal or tracheostomy tube) due to accidental dislodgement or patient self extubation. The patient need not be ventilated at the time of the event (eg. tracheal collar).

• Failed extubation rate is the requirement for re-intubation within 48 hours of extubation during the same ICU admission. It is expressed as a rate per 1000 MV days. It is also expressed as a percentage of all planned extubations.

• Time on mechanical ventilator is the median time on the ventilator for all ventilated patients. This is calculated monthly.

• Central line associated blood-stream infection is the number of CLA-BSI per 1000 central line days. This is also reported as the number of CL days in between CLA-BSI.

• Number of PICC being used in our units compared to central lines as approximately half of the CLA-BSI in 2010 were associated with PICC.