TISS28 collection & scanning Survey April 16, 2013

Hi everyone. The new TISS28 has now been in place for 3.5 month. We would like feedback once again from data collectors and from data processing in regards to these forms. Feedback from the data collection & processing front lines is helpful for continued bedside nursing education and also for the main database office to assess for applicable QA checks that could be automated in data processing (see: TISS28 Scanning quality checks), where possible. Beside commenting on compliance in your unit here, I need specific details in regards to items you observe done well or not on new forms.

The last survey done Jan 7.13 was very helpful and the information went back to QA officer, nursing education, ICU TASK team and managers. Also provided main office with important observation when interpreting TISS data and also some tweeking of wording on form.

Dats, thank you in advance for taking the time to comment here.

NOTE; when referring to any items on the TISS28 form, please indicate the TISS28 item number you are referring to. For example, if Hourly vital sign is missed or done well, refer to TISS #2. Thanks again.

Site

HSC

MICU/CCU Same issues as STB MICU plus:

• #2-Vital signs are occasionally counted for OH1 when all elements of monitoring are not met
• #9-CAM positive is not accurate on the TISS form
• #17&#46-vascaths that dialysis patients have even prior to admission are not counted occasional as central lines
• LAST DAY - not done most of the time but the form is never missing.That I'm very grateful for!
• Compliance at filling in the form except for the last day is very good.
• Accuracy is improved since form has been changed to better language and it's easy to check
• line through bubble rather than filling in dot (HSC_MICU). Can't ID individual doing this.

SICU

STB

I find that there is more overall compliance with completing the new form. The problem spots are as follows:

• #9-Cam + is sometimes marked when it is not documented on the flow sheet and sometimes it is missing when it is documented
• #12-more than 5L per day IV fluids is usually missed as people are not going back to check if this amount of volume was given
• #24-chest physio is often missed
• #26-inhalation therapy is often missed
• #28 & #29-I always ensure when the extubations are marked as this is sometimes missed
• #40 to #44 -I always ensure when the specific interventions and
• #45-trips out of the ICU I always check to make sure they are done because this area has commonly missed items
• #46-49-Need to also check the 2300 hr items as these are sometimes done wrong

Overall, I find this tiss much easier to trouble shoot and check and compliance is much better. --LKolesar 10:17, 2013 April 16 (EDT)

In CCU,compliance with the new TISS is much improved since the last "audit". Problematic for my unit remain:

• #8 Foleys are seldom documented
• #20 O2 nasal prongs...Frequently missed
• #26 Puffers, nebulizers....Frequently missed
• #31 IV Lasix more than 30mg/day....Frequently missed
• #39 Code "Stemi" Angiocath intervention certainly qualify as "EMERGENCY" surgery and yet this is frequently missed as well
• (Note to Marla: code stemi angios are not E1 surgery and should not be included in the tiss item # 39 Emergency Surgery. This was previously clarified.) --LKolesar 15:48, 2013 April 16 (EDT)

I have mentioned these "omissions" and compliance has much improved but not yet "stellar". Marla Penner

• I Agree with Laura, Lois

Template:Discussion Lois, do you observe anything other that is "specific to CICU" other than what Laura posted for her unit? Thanks

VIC

There is better compliance with the new TISS .I found like Laura, the following get missed:

• #9 - Cam +
• #12 - more than 5L IV fluid in ICU
• #24 - Chest Physio
• #26 - Inhalation therapy
• #45 - RN accompanied trips - will be filled out yet the transport team goes only not the ICU nurse this depends if the test/procedure is done in the hospital or out of the hospital so you have to check whether the transport team went or the nurse.

Main office - Data Processing observations

• blue pen used to fill out form
• incorrect unit
• incorrect first date on form (admission date different than registry date)
• missing last day TISS - very common. (not marked with no Treatment or acutal last day in ICU NOT DONE.
• VERY faint(anemic) pencil marks to fill in bubbles on form
  • bubble not clearly filled in (half filled or bubble is circled outside)