Minutes Team Meeting December 1, 2010

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Agenda for Team_Meeting_December_1,_2010#Agenda Team Meeting December 1, 2010

These are the mins from the meeting. Please add anything you may have in your minutes to any of the topics below.

Laptop issues

  • No place to leave them when working on wards. Can't leave unattended. Many sites have no place to lock them because lack work space.
    • Suggestion: Lock to table or desk.Marie Laporte would like lock for Grace ICU site.
    • Shirley Kiesman to check for unused lock at VIC, if can't find one will be ordered for Marie from main office.
    • Tina has a lock and has sent it to Trish's office.
  • Laptop slow - Vic site - Shirley Kiesman - using first generation laptop. Will be first site to be replaced. Tina has 2 spare newer laptops and will look at replacing.
  • Sheila Dowson - still has to scroll down DX list to find Tasks - Tina Tenbergen will check this laptop and find out what the problem is.

Restructuring DX codes in Access

  • Codes will eventually be mapped to ICD10, but current codes would be easier to find if wording was reorganzied to make them easier to find in Access DX list.
    • Laura Kolesar and Lois Bilesky offered to work with Tina Tenbergen to do this. Approved by Trish Ostryzniuk
    • Tina reviewed the "FIND" function in Access. (someone can retype this if they can explain better). When in the DX list, make sure you are not in a specific DX category, click on EDIT tab, click on FIND. A window will pop up and it will allow you to type in the word you are looking for.
    • Tina did a demo about tabbing and navigating through laptop and how to use "FIND" in DX list.
    • need to assess the impact changes to users in main office, data processing, the statistician programs and reports before proceeding with changes.

Pathogen Follow up

  • Some staff are following up all culture reports and email or phone Pagasa with "pathogen to plug in update into main database for files they have already sent in.
    • Others don't follow up culture reports if patient is discharged and ready to send in to main database.
    • Some are waiting 5 days after discharge.
    • Community sites don't see any reports on charts for sometimes for weeks.
    • Reports from Cadham lab don't come to a chart in any timely fashion. Results may not be on chart at discharge.

The 5 day post discharge RULE for Culture report follow up

  • Follow up all culture reports up to 5 days after discharge from unit.

Contaminated specimen - how to code

If a culture is sent and it comes back as a "contaminant" therefore, not pathogenic, then code culture as Negative Culture.

  • Trish Ostryzniuk to ask Dr. Kumar is there is any value to include subcode of "contaminant". Question submitted Dec 2.10--TOstryzniuk 19:04, 2 December 2010 (CST)
    • Dr. Kumar agrees with the above.--TOstryzniuk 14:45, 6 December 2010 (CST)
  • Laura Kolesar pointed out an example of a Central Line Related Blood stream Infection (CLR-BSI) being coded as an admitting code to a community Hospital. Community Hospital Marie Laporte had emailed STB site in regards to this because Community site physician note documenting Line Infection. Laura followed up with ID nurse at STB, who verified that Blood Stream infection was not central line related and was a contaminant.
    • Discussion about the CLR-BSI project that is going on across Canada in Critical Care CCVSM. Central line related BSI are preventable and the goal is for ICUs to have none. Julie inputs this information (see Line Count Form used by ICUs) into a Canada wide program that many ICUs in Canada are participating in.

H3N2

Deb Klopick asked if we wanted to track cases of confirmed H3N2. Trish spoke to Dr. Kumar, he stated if we just coded an pneumonia using subcode 75- "Influenza virus", this would be adequate. Even though it would be nice and we will see more cases of influenza due to this type of pathogen, ALL collectors would have to follow up ALL culture reports well beyond discharge dates to obtain final culture results.

Contact list on Wiki

  • Collectors are asked to maintain their own contact information on Wiki. This includes posting when you are away on vacation.
  • Staff have been asking for a paper copy of contact list. They are finding it cumbersome to find who is working or covering at each unit in the city.
    • If there are any suggestions how to reorganize contacts on Wiki to be more user friendly, let us know.
    • In the Global Address Book for your EMAIL, there are contact groups.
    • All ICU staff are under DC CC
    • All Medicine staff are under DC MED
    • There are also "contact groups" for site specific ICUs and medicine,
      • Example:
        • DC STB MED, contains the names of staff on the Medicine wards at STB.
        • DC STB ICU, contains the names of collection staff in the ICUs at STB

There are similar contact groupings for all sites. If not sure how to find contact Trish or Tina.

Lab List

The LAB LIST for ICUs will be changing on Jan 1.2011. This will apply to all patients profiles for ICU.

  • There will no longer be a need to prioritize labs
  • Staff will no longer have to pick lab tests from a drop down list.
  • There is one list for HSC and another list for all other sites. Both have the same lab tests however there are a few tests at HSC that will still be downloaded rather than manually tallied because HSC can interface with the Delphic RTS.
  • Staff can advise Tina how they would like the lab list organized.
    • Discussion about many staff still using a paper form to count lab tests and then inputting totals into Access. We would like eliminate paper lab form. Tina will meet with Deb Klopick and Joyce Peterson and will look and what she can come up with to improve the lab entry in Access so that paper is no longer needed.
    • STB counts labs retrospectively from the STB Electronic Patient Record computer screen therefore they don't use paper forms.

Pharmacy List

Brief discussion about ICU pharmacy list being collected.

  • some of the issues for collecting pharmacy are the same as labs. Staff using paper collection forms. Process in Access is cumbersome.
  • the pharmacy list revisions are still in progress. If we can make improvements with the labs and eliminate the need for paper forms then some of these changes we may be able to applied to pharmacy.
  • labs first, pharmacy later.

IT support acknowledgement

Laura Kolesar and the collection team acknowledged Tina Tenbergen for the superb IT support that she has been providing to the data collection team.

Stroke (CVA) chart audit

Regional Health Information Services are involved in a cross Canada project looking at performance improvement for new stroke patients and have been collecting data on new stroke population.

Observations

There is a difference between our database and the DAD database in regards to the number of new stroke cases identified. Example:

  1. Our databases coded as admitted with a stroke, but no record in their database.
  2. Their database coded as admitted with a stroke, our database did not code the DX of stroke
  3. Our databases coded a DX of stroke, their database says not a stroke

Purpose of chart audit

  • to explain the discrepancy from the 2 sources of information (DAD and our Databases)
  • improve quality of data collected by changing and improving collection guidelines.


Chart audit Process

  • Julie Mojica will provide an Excel list of charts to be audited at each site.
  • list will be Regional Server called: StrokeAudit.xls
  • Information gathered can be directly input into the Excel list/worksheet on the Regional Server.
  • One or two data collector will be assigned by Trish, the task of auditing the charts.
  • purpose is to review for the DX of NEW stroke:

Chart audit assignments

  • Grace - chart audits (4)- Stephanie - Completed Dec 3.10
  • VIC site - chart audit (5) - SKiesman - Completed Dec 8.10
  • HSC site - chart audit (11) - Pat, GHall - Completed Dec 13.10
  • STB site - chart audit (9) - Laura