CAM positive (TISS Item)

see TISS Items SMW for other TISS items

TISS Item	CAM positive (TISS Item)
TISS28 Category:	Neurological Support
TISS28 Row Number	9
TISS28 Description	CAM "+" any time today
TISS28 Points	0
TISS28 Item Number	0
TISS28 Comment:	added for Dr. Arora & Critical Care QI Team

About CAM Evaluation

CAM stands for Confusion Assessment Method-- it is an instrument for use in the intensive care unit to accurately diagnose delirium in critically ill patients who are often nonverbal because of mechanical ventilation."[1]
- To even be evaluable for CAM assessment, a patient must be conscious. Thus, in reality, a given CAM assessment has 3 possible findings: (i) not evaluable, (ii) evaluable and CAM-positive, or (iii) evaluable and CAM-negative.
CAM status is currently recorded in ICUs in two places:
- On the ICU flowsheet, as an indication of CAM-positive versus not being CAM-positive; as above the latter includes evaluable and CAM-negative or not evaluable. Of note, the ICU nurses evaluate for delerium multiple times per day.
- On the TISS sheet, as a bubble for being CAM-positive versus not being CAM-positive. Here there is just a single yes/no bubble, so that NOT being CAM-positive can mean either that there were no evaluable assessments during that day or that there was at least one evaluable assessment and all of those were CAM-negative.
The users of this data (including Rakesh Arora in ICCS) are mainly counting the number of ICU days in which a patient is CAM-positive -- which of course only includes days on which there is at least one CAM-evaluable assessment.

We are collecting CAM as CAM positive (TISS Item).

Problems were flagged in:

	* Did these ever get better? Ttenbergen 12:44, 2017 May 11 (CDT) Does anything need to be done about this? Ttenbergen 20:15, 2018 November 27 (CST)

Hard to tell in the numbers (whether marking is legit or not). Maybe another round of survey will help - are the data collectors marking or crossing out the entry if they find inconsistencies from various sources?--JMojica 14:02, 2017 May 11 (CDT)
- If I find inconsistencies I will correct and/or clarify with the bedside nurse Lisa Kaita 14:21, 2017 May 11 (CDT)
- I will do the same as Lisa, but it isn't always easy to clarify the CAM status of a patient if I am checking TISS sheets from previous days. Sometimes the systems review notes don't seem to correlate with the CAM score on the flow sheet. I have to use my judgement in these cases, so the CAM positive days are not always accurate.Mlagadi 14:57, 2017 May 18 (CDT)

The information was requested by Dr Arora - Quarterly report showing the monthly statistics regarding the Delirium/Confusion cases in complication Diagnosis, counts of patients with at least one day marked with CAM+ and total CAM+ days and their associated rates for STB ICMS, ICCS and ACCU.

Report included in the Critical Care Regional OpPlan as requested by the QI Officer - Quarterly report of Delirium cases, Delirium Rates, Delirium Days and Delirium Rate Days for all ICUs in the region

New - WRHA Critical Care Quality Indicator Chart Report for Directors and Managers - Quarterly report of Delirium cases, Delirium Rates, Delirium Days and Delirium Rate Days for all ICUs in the region