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| | '''''See also: |
| | *''''' [[HSC General Collection Guide]] for information that applies to both HSC Medicine and HSC ICU Data collection. |
| | *''''' [[ICU Curriculum]] for information that applies to ICU Data Collection at all sites |
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| If you want to see current guideline for sites go to: [[Medicine Curriculum]] or [[ICU Curriculum]] and look at top of this article to find link to hosp/unit specific guideline in progress.--Thanks everyone.[[User:TOstryzniuk|TOstryzniuk]] 20:18, 21 October 2010 (CDT)
| | == HSC Critical Care Wards == |
| | *''''' [[HSC MICU Collection Guide]] |
| | *''''' [[HSC SICU Collection Guide]] |
| | *''''' [[HSC IICU Collection Guide]] |
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| *[[ICU Curriculum]]
| | == Workload balancing == |
| ==HSC MICU/CCU Collection Guide== | | See |
| '''MICU/CCU'''
| | * [[PatientFollow Project]]. |
| The unit is divided into three sections:
| | * [["Show PatientFollow allocation" button]] - see that button for actual allocations |
| *front 1-10 | | * [[HSC_IICU_Collection_Guide#Workload_Sharing_for_HSC_IICU]] is done differently, see there. |
| *back 11-15 and 19-20 | |
| *CCU 16,17,18 | |
| There are two main desk front and back.The filled in TISS sheets green sheets and test information will be kept in a white binder at each desk.The TISS sheets still in progress will be on a clip board at each desk.Test information is kept for 5 days and then the collector can discard into confidential waste.
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| There is a Black log book for all MICU patients kept at the front desk. Do not change the numbers as the unit keeps their own data on patients and the numbers collectors use are different.
| | == Related articles == |
| Serial number sequencing for MICU/CCU will used the shared number system (using 1-50 of every group of 100).
| | {{Related Articles}} |
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| The green log book for CCU is kept at the back desk.CCU patients are identified by green marker over the serial number on the collector's data collection log and by writing CCU in the index beside the log number.The numbers are shared with the MICU patients using 1-50 of every group of 100.The SICU data collector uses numbers 51-100 of every 100 numbers.
| | [[Category: Health Sciences Center Office]] |
| | | [[Category: Site Specific Collection Guide]] |
| Generally all patients coming to MICU are medical as it is a closed unit.However if the patient comes directly out of the OR it would be a surgical patient under a MICU attending.Refer to patient type on wiki.We don't code GI bleeds as surgical and most are treated by endoscopy.If they came from OR then they are coded surgical.
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| A white board by the front desk lists the patients. It also lists who is on the transfer list and other valuable info.
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| If a patient expires try to get the chart at the death desk if it isn't available on the unit. The death desk is on the main floor beside medical records. Once that desk is finished with the chart they will often be found in the transplant audit which is behind the main medical record desk.
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| The Efilm room is in JJ363 and is available for counting Xrays,ultrasounds,CT's and MRI tests.Do not log off this computer as others use it.You have to watch when counting CXR that they are not abdominal Xrays which we do not count.Echo dates need to be obtained from the chart and are often done in this unit.
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| Green Sheets are kept on the rounds table. Collectors should check daily to make sure each patient has one stamped up. The clerks are very good at this but occasionally one gets missed.
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| For more complex patients you may need to coordinate with other collectors.Use only initials and birth date to identify patients.Once the communication has gone check off the follow up column on the collectors data collection log.Use the transfer Tracker to see what time out of hospital transfers came from other ICU's. If the time is off notify the collector at the other site.If an error with the times occurs notify Pagasa to correct the sent files.
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| If a MICU patient overflows into another unit, it is still MICU patient in the location. The number must be taken from the home unit log. The data is collected by the collector where the patient resides and put onto the MICU laptop. Return to the MICU is not a transfer.
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| Pharmacy collection is a process that requires alot of time.The patients often have infections and are on multiple antibiotics.Most patients are on sc heparin,nexium/ranitidine.Vancomycin can be signed off on any color of med sheet.Renal patients are often on epo drugs.If patients are transfered to the wards the medication records may be in the nurses Mar binder or in a thinned chart.The ward clerks will help locate these thinned charts.
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| 25% Albumin is often given and is often not on the intake and output sheet but will be found on the medication record.Cross reference the blood administration record.
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| Workload in this unit is very high.It can be frustrating for other collectors who need to collaborate times, diagnosis etc with the MICU collector.Lots of transfers occur between medicine wards at HSC and MICU/CCU and IICU.Ever effort will be made to get these transfer times right.Measurement of medications,tests and xrays are done between these times so accuracy is important.Collection in this unit runs a bit behind and occasionally corrections need to be made to data sent by others. The transfer tracker is very useful to see what times collectors are putting.
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| To determine transfer times the first set of vital signs is the guide.Medicine collectors at HSC can find the transfer time by looking at the first set of vital signs in MICU. Unless there is a clearly documented time elsewhere in the chart the ward transfer time is usually 10 minutes prior to first set of vitals.It is a rare occurance that those vital signs are not done.Collectors do need to be careful as there can be many days of addendum sheets.
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| For patients transferred from ICU to the ward but have a pit stop in dialysis the discharge time from ICU is the time they leave the ICU.
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| If patients overflow in to SICU they remain MICU data collectors patients.
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| The following links are a few that apply to ICU for quick reference or review:
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| *see [[:Category:Arrest | Category Arrest]] for general info on coding arrests
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| *see: [[Unwitnessed Cardiac Arrest]]
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| *see: [[Respiratory Arrest]]
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| *see:[[Septic Shock]]
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| *see:[[Severe Sepsis]]
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| *see: [[BRR | Cardiac Cooling Protocol tracking]]
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| *see:[[10100 - Cardiogenic Shock]]
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| ==Medical Records==
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| Fax number 75002
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| Lorna is in charge of Audit 59.The audit limit is 20 charts shared between HSC medicine data collectors and ICU data collectors.
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| ==HSC SICU Collection Guide==
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| ===Discussion===
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| {{Discussion}} - [[User: Jpeterson | Joyce Peterson]] to enter information here.
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| *The SICU log census book is kept at the South Nursing station. This is seen when first entering the unit. The log is in a shelf at the desk, next to the Unit Clerk. The binder with the completed TISS and Record of Special Treatment and Test sheets is in the same shelf. The test sheets are a good source for admission and discharge dates and times that may not have been put into the log book. Patients who were not entered into the log book may also show here her, especially after a weekend as they may have float clerks who will not know to do the entry.
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| *The Green sheets are in a binder on the Rounds Table. When not being used in rounds, it is usually kept in the side corridor which will leads to the new hotel. Completed Green Sheets are left in the binder after the patient is discharged.
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| *There is a desk space next to the FAX machine at the South desk that may be vacant for a workspace, but there is no electrical outlet available. There is a larger space at the North Nursing Station which may be free. it has electrical outlets and a computer which accesses KEA. Next to this desk is an upright set of shelves which has a space for the TISS and Green sheets which the data collector keeps stocked.
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| *The numbering for SICU/IICU patients goes from 51-100, e.g. patient 14599 is followed by 14600, then 14651.
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| *'''REG/ADL/VAR''':
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| *The admission time for a patient admitted from PACU may not be entered accurately in the log bookif they have been held in PACU due to lack of space. Always check to ensure the time used for the database is accurate. The SICU physician will enter the admission to SICU on the order sheet and that is considered the time of admission. Any extra time in PACU is then considered overflow in PACU.
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| *A patient may be listed in the log book as admitted from HSC ER, but this must be checked since they may have originated from another hospital/nursing station and just passed through the HSC ER.
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| *SICU/IICU must have a 'transfer ready date/time; entered, unless they are transferring to another ICU bed (not including IICU). Transfer to IICU is treated like a transfer to a ward, but the data collection once there is treated like an ICU patient.
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| *Discharge date and time fror a patient who is an organ donor is not the time of death, but the time/date they leave the ICU to go to the OR.
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| *The patient type is always 'surgical' in SICU and 'medical' in IICU.
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| *The Filter section is relevant if a patient is on Long-Term Ventilation.
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| *Variables:
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| *All patients who suffer a cardiac arrest must have the BRR/XBR completed.
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| *If a patient is overflowed into PACU, SICU follows them there. The PACU staff do not complete TISS sheets and transfers out may not get into the log book.
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| *If patient overflows into another unit, it is still called by its home unit in the location, and the number must be taken from the home unit log. The data is collected by the collector where the patient resides and put onto the home unit database. Return to the home unit is not a transfer.
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| *DIAGNOSES:
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| *If a patient is admitted from the OR, the first admit must be a surgery.
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| *If the patient is a traum who goes to the OR, the diagnosis is found under TRAUMA, e.g. craniotomy to evacuate a traumatic SDH from an MVA, will be 'Subdural hematoma-POST-OP - MVA'.
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| *If a patient has a diagnosis of septic shock, at present the Septic Shock Study requires that the Temp Studies must have a date and time of the first low bp and antibiotic related to the septic episode. This may have to be found in notes from another hospital or the Vital Signs record from the ward. If a patient has a VAP, only the date and the time needs to be entered.
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| --[[User:Jpeterson|Jpeterson]] 15:23, 4 May 2011 (CDT)
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| ==HSC IICU Collection Guide==
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| If the patients come from a surgical area the SICU data collector will collect on them but they will be typed as medical patients.The SICU shared number system will be used.If the patients come from a medical area they will be labelled as medical patients and the MICU shared number system will be used.
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| A test book is keep on the shelf on the side of the main desk and completed TISS and green sheets are kept there.
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| TISS are kept on the clipboards at the bedside. You really have to watch the dates and numbers on these as time goes on it is easy to get mixed up!
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| Green sheets are kept on the front of the chart as far as I can tell,they tend to get moved around.
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| Go to IICU once a week for pharmacy collection purposes, collect the TISS and hand it in as soon as the page is complete.The data on line counts needs to be as current as possible.
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| Often we will run out of complication spots. Try to focus on the infections, and serious complications over the stay which is often many months.
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| [[Category:Health Sciences Center Office]] | |
| [[Category:Site Specific Collection Guide]] | |
| [[Category: Data Collection Guide]] | | [[Category: Data Collection Guide]] |