CRRT Project

 Project has been indefinitely postponed; requester found that they would not be able to generate the data for us to collect. Ttenbergen 13:12, 2016 February 8 (CST)--Trish Ostryzniuk 16:39, 2016 February 9 (CST)

CRRT is going to be a permanent "temporary project" to collect reasons why patients receive CRRT([1]) treatment.

Background

The patients on CRRT therapy during the stay in ICU are being tracked by a CRN in Critical Care Program since ?? (date to be asked). The CRN collects the patient names, the hospital number, the renal diagnosis for reason for CRRT, the initiation and duration of therapy in paper form. The Renal Program states that they need the demographics of patients who were on CRRT as well as the reasons why CRRT were requested by Neprologists for quality improvement, resource utilization and billing purposes. Critical Care Program shares these information to the Renal Program by faxing the hand written data sheets to them on a monthly basis.

In Jan 2013, the Critical Care Program implemented the usage of the new TISS28 form which include various nursing activities, interventions and procedures including CRRT. The bed side nurse records on the TISS form these activities if present on a daily basis for each patient during the whole duration of stay at ICU. The data collectors of the Critical Care Database quality check the entries of the TISS forms for completion and consistencies. Since the same information is being collected by the CRN and bed side nurses, a comparative analysis between the two process of data collections and an additional real time audit by an independent auditor were done. TISS CRRT had 96% matched with the real time CRRT while 85% matched with the CRN CRRT.

The Critical Care and Renal Programs made a decision last Feb 2, 2016 to consider the TISS28 as the source of CRRT data starting Jan 2016.

However TISS28 does not contain the diagnostic reasons for CRRT therapy so a request to collect this information separately by the data collectors of the Critical Care Database was made. The Renal Program had identified the possible reasons for CRRT therapy and proposed to list them in a form for the attending Nephrologist to mark.

Purposes

• To identify the reason(s) why CRRT therapy was/were requested by the attending nephrologist for quality improvement and resource utilization in the Renal Program.
• To track the CRRT usage for workload and resource utilization in the Critical Care Program.

Status

Template:Discussion Julie mentioned that Nephrology is working on a FORM for the chart that the Nephrology ATTENDING must fill. This will be the form where Collectors will get there information from for reason for CRRT See list below. Collectors, any comment with List below?Trish Ostryzniuk 17:24, 2016 February 4 (CST)

For now we are waiting for a final decision on the form from Dr. Bueti. This collection will not start until the form is deployed Ttenbergen 11:00, 2016 February 8 (CST)

List of Reason for CRRT (updated Feb 4.16)

1. AKI due to pre-renal/hypovolemia
2. AKI due to sepsis/distributive shock
3. Hepatorenal syndrome
4. AKI due to cardiorenal syndrome
5. AKI-contrast-induced
6. AKI Drug-induced(Ibuprofin,Genta/Vanco)
7. AKI due to endogenous toxin (myoglobin(rabdo)/hemoglobin/paraprotein)
8. AKI due to exogenous toxin exposure
9. AKI postop, NOS (not otherwise specified)
10. AKI due to thromotic microangiopathy/vascular event
11. AKI due to acute glomerulonephritis
12. AKI due to acute interstitial nephritis
13. AKI due to urinary obstruction
14. ESRD-on CRRT : this selection does not make sense, this list is for reasons for crrt.--LKolesar 12:00, 2016 March 15 (CDT)
15. ESRD-on IHD
16. Drug OD -no AKI (removal of drug only)
17. Fluid reduction WITHOUT AKI or ESRD
18. Form not available or not filled out

Data Collection Instructions

for which patients to code

All Critical Care patients who are in CRRT therapy at HSC and STB hospitals.

how to code

<detail>

Discussion

Template:Discussion If possible, for STB, it would be optimal if the sheet that the renal attending could be put on the electronic chart. It could pop up when the orders are written for CRRT or the doctors could put it into their electronic progress notes. We may find that compliance using a paper sheet may not be good here. --LKolesar 10:48, 2016 February 9 (CST)

• listed item 9: AKI-post op
  • I would like to suggest using AKI: Fluid Volume Management...Pre-or Post-op

One of major reasons for CRRT in Non-Renal failure population at all sites having this renal replacement therapy(RRT) option often rises from the severe burn and trauma victim group.

Their need for fluids(crystalloid/colloid, blood products and nutritional support[TNA])over a 24hour period can often exceed 20 liters in the first several days of ICU care...the severe burns with skin losses require significant volume replacement throughout their acute injury and debridement stages. CRRT allows for this excessive volume administration as diuretics cannot maintain a stable balance and further renal compromise is almost a certain outcome as well as progressive respiratory issues/failure in the ventilated patient. Allowing room for early nutritional replacement is a significant benefit and aids in improved outcomes. CRRT can remove up to 2L per hour-where and when necessary over a 24 hour period.

How to determine?

<detail>

Start/End Dates

• Start Dates:
  • CRRT usage from TISS28 - Jan 1, 2016
  • Reasons for CRRT - <when?> Potential: March 1.16 - cancelled indefinitely. --Trish Ostryzniuk 16:39, 2016 February 9 (CST)

• End Date: there is no planned end date

Template:CCMDB Data Integrity Checks

None yet

SAS Program

• CRRT Days from TISS28 - The SAS program is in X:\Julie\CC Projects\CRRT_Ryan&Bueti\ICU_CRRT_byMonth.sas. The program generates the list of patient names, PHIN, Chart#, Date of Birth, First day on CRRT, year, month and calendar days on CRRT and total CRRT days.

• Reasons for CRRT - will be added to the SAS program above.

See also

• <any related articles?>