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BRR is a [[ICU Var 2]] tag that we use in our database for ICU patients who have been placed on the '''Cardiac Arrest Cooling Protocol'''
{{LegacyContent
|explanation=Will be included in ICD10
|successor=[[Targeted Temperature Management (TTM)]]
|content=


*BRR - stands for "Brrrr" as in shivering or cold.
[[Task Team Meeting - Rolling Agenda and Minutes#ICU Database Task Group Meeting – November 8, 2018 | DB task meeting minutes Nov 8.18]]-- User:TOstryzniuk|Trish Ostryzniuk]] 13:41, 2018 December 24 (CST) -->


{{Project
| Project = {{PAGENAME}}
| ProjectActive = active
| ProjectProgram = CC
| ProjectRequestor = Dr. Dean Bell/Dr. Kendiss Olafson
}}


*If ADMIT or COMPLICATION diagnosis is [[Cardiac/Respiratory Arrest | Cardiac Arrest Witnessed 100-2]] '''AND''' the cooling protocol is applied '''THEN''' both of the following items must be marked:  
{{TT | question =
*[[ICU Var 2]] BRR '''AND''' TISS item [[TISS Neurological | T6-hypothermia]]
* start and stop date should be in table? [[User:TOstryzniuk|Trish Ostryzniuk]] 13:56, 2018 December 24 (CST)
** yes, it's somewhere on my list to change all the tmp project templates to have the dates built in. Tagged now so staying on the list. }}


'''BRR/XBR''' is an entry we use to identify whether patients are receiving therapeutic hypothermia [[Targeted Temperature Management (TTM)]] following a '''cardiac arrest''' according to the [[Cardiac Arrest Cooling Protocol]]. By identifying all patients that receive this therapy a further audit can be done to identify if therapy was appropriate or not.
We do '''not track cooling for reasons other than cardiac arrest'''.


== Guidelines / Collection Instructions ==
For any ICU patient with one of the following diagnoses:
* [[Cardiac arrest]]


==Cardiac Arrest Cooling Protocol==
or pre-ICD10:
*Target temp: 32°C to 34°C for 12 to 24 hours.
* [[Witnessed Cardiac Arrest]]
* [[Unwitnessed Cardiac Arrest]] 


*Code is not to be applied when a cooling protocol is used to normalize temperature for non-arrested patients.
Code in TMP follows:
* Project: Cooling
*item
**'''BRR''' (BRR stands for "Brrrr" as in shivering or cold)
*** cooling protocol was applied at any point post arrest
**'''XBR''' - no cooling protocol applied


Taken from the Hypothermia Protocol:
'''Do not code BRR or XBR''' when a cooling protocol is used to normalize temperature for any type of '''non-cardiac arrest''' patients.
*Cooling is indicated if ALL of the following are checked: 
**Witnessed Arrest (Dx code: 100-2)
**Initial rhythm ventricular fibrillation/tachycardia(Dx code: 131-4, or 131-1)
**Time to ACLS <15 minutes
**Total ACLS time <60 minutes
**Persistent GCS < or = 9
**Systolic BP currently over 90 mmHg (pressors allowed)
**< 8 hours elapsed since Return of Spontaneous Circulation (ROSC)
--[[User:LKolesar|LKolesar]] 13:54, 22 January 2009 (CST)
--[[User:TOstryzniuk|TOstryzniuk]] 20:37, 26 January 2009 (CST)


== CCI ==
[[Task Team Meeting - Rolling Agenda and Minutes#ICU Database Task Group Meeting – October 3, 2018]] confirmed that we can stop collecting this when we start collecting CCI [[Targeted Temperature Management (TTM)]]. We may want to import the old entries as CCI codes? Ttenbergen 00:19, 2018 October 10 (CDT)


Possible Value:
== Cross Checks ==
'''BRR''' if the protocol was applied.
see [[Check BRR/XBR vs cardiac arrest dx]]


[[User:TOstryzniuk|TOstryzniuk]] 16:19, 22 July 2008 (CDT)
== Background ==
=== '''Start Dates''' ===
* '''2004 August'''
* XBR and [[CCMDB.accdb]] cross checks were added to detect occasions where entry was just forgotten/missed '''March 19.09'''
* reviewed with Kendiss Olafson and Dean Bell.--[[User:TOstryzniuk|TOstryzniuk]] 17:58, 26 August 2009 (CDT)
* cross-checks changed to include [[Unwitnessed Cardiac Arrest]] '''August 27.09'''
* moved from ICU Var 2 into TMP on Dec 18, 2014


===Data Integrity Rules===
=== '''Stop Date''' ===
FOR: ICU_Var2: BRR and DX code of Cardiac Arrest
'''2018 Dec 31'''
*If ANY admit or complication DX on an ICU patient is '''100-0 or 100-1 or 100-2'''
*Stop in TMP.  All patient still in unit after this date, code as: [[Targeted Temperature Management (TTM)]]
**then [[ICU Var 2 | Var 2]]: '''MUST''' have either [[BRR]] or XBR (new code)
***BRR - mean cooling protocol applied for cardiac arrest
***XBR - means no cooling protocal applied for cardiac arrest


=== Why the code XBR? ===
The rationale for the code XBR is to identify those patients who had a cardiac arrest but '''were not cooled''' regardless if they met criteria for cooling or not. XBR was implemented after an audit of cardiac arrest was done and it was found that there were several cardiac arrests coded that were missing code BRR.  By leaving Variable 2 blank for a cardiac arrest, it is not clear to Kendiss or Julie whether a data collector missed tagging it or if indeed cooling was not applied.  Coding XBR indicates to both Kendiss and Julie that a collector verfied that the cooling protocol was not applied. 


*SUGGESTION for updated version of CCMDB: look here:[[CCMDB.mdb_Change_Log_2009#ICU_Var2:_BRR_.26_Complication_DX_code_of_Cardiac_Arrest |Suggestion for Catching missed BRR in ACCESS]].--[[User:TOstryzniuk|TOstryzniuk]] 16:03, 28 January 2009 (CST). 
=== removed 12 hr requirement ===
*tina, I am not sure were this rule disappeared from the big automatic integrity check list.  I found it in history and put the rule here.[[User:TOstryzniuk|TOstryzniuk]] 16:22, 18 March 2009 (CDT)
Discussed at task 2018-04-11: we are removing the 12 hr requirement because the use and application of the protocol has changed since inception and this restriction is no longer reasonable.  


== Related articles ==
{{Related Articles}}


[[Category: ICU Variable Codes]]
[[Category:Project ICU only]]
[[Category: Data Integrity Rules]]
[[Category:Arrest]]
}}

Latest revision as of 17:07, 2020 May 5

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DB task meeting minutes Nov 8.18-- User:TOstryzniuk

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