View source for Minutes Team Meeting December 2, 2009

Minutes of Critical Care Medicine Database [[CCMDB]] Data Collectors meeting held Dec. 2, 2009
==Agenda for [[Team Meeting December 2, 2009]] ==
#[[Peer Audit]] – Trish, Julie, Tina
#General Questions 
#Changes to collection elements and processes, ICU Task group recommendations, New Data Repository, [[:Category:Project]]-Trish
#Guest Speaker:Pam Schille from [[Organ Donor]] Program Transplant Manitoba, Nancy Dodd:  Process quality engineer, Michael Perella
#Next meeting in March 2010. Will be posted on Wiki.
*The plan is to have a quality process engineer speak about the use of the data in the Medicine for change and improvements or Dr. Kendiss Olafson, Cross Canada ICU Collaborative (Vital Signs monitoring) – Project [[QA Infection]] [[VAP]] and [[Central Line Related Blood stream Infection (CLR-BSI)]]).

==[[Peer Audit]]==
*All sites have started piloting week of Dec 1.09
*Purpose and Goal of [[Peer Audit]] – go to [[Peer Audit]]
*Goal of [[Peer Audit]]
*try to quantify our information and see where there are significant discrepancies between unit sites and collectors and concentrate our efforts to improve quality on areas that show highest discrepancy.
*look at what is needed to improve guideline, maintain or eliminate element, change elements collected etc.
*make improvements so that collection for each element is done the same.

**''Question St. B.: "Can we change the collection day?" based on difficulty to get charts on Friday''.
***Response from Julie and Trish: best if collection is done on the first patient admitted on Thursday. The reason being that there is a counter in place for the process. The expectation is that one audit/week will have been sent--if the patient is still on the ward Julie will know the patient's status on the following Wednesday's "sending" day.  Keep Trish posted if it is a problem(s) to do audit on first patient admitted on Thursdays. Acknowledgement made to VGH having scheduled work days.

**''Question St. B.:  "Do we need to do labs and Pharm. as part of audit?''
***Response from Trish: We are close to transitioning to our “new” lab and pharmacy list therefore we will not them in our in peer audit collection. They will be included in the peer audit once new list is implemented sometimes in the New Year.  

**''Question: with Audit pts how can we send in with no labs or no pharmacy?''  
*** select from the lab or pharmacy “drop down” list “no labs”

**''Question: Can we continue numerically or do we have to go back to audit number 111?''
***Response Trish: Reuse the number--the serial number is not that relevant for Peer Audit as there are other unique identifiers.
****Other: 
*****Technical issues in regards to sending are being worked out through the month of December.
*****Audited patient data: remember to change default “location” to the location of the ward you are auditing on.
*****Julie will take the audit information and match it to original data that was sent in. She will provide feedback on Wiki.  This won’t occur until we have accumulated enough audits to see a pattern and provide a report which will be in about 6 months or so.   If sooner you will be made aware.

==General Questions==
**''Question: How many laptop are now in use?''
***five in use. One currently being tested at the Concordia
***testing of new model is now in process (takes 4-8 weeks) 
***Laptop will be rolled out to a few sites as budget allows over the next year.   There is no specific target dates at this time. 

**Laptop users invited to share their experience:  
***way better than the PDA as user only has to work in Access. 
***it is difficult to find the space for laptop in the units. Manual paper collection and entering later was better.
***takes a long time to boot up (10 minutes); space is a problem

**''Question: What are we doing with [[Green sheet]]''?
***Dr. Roberts advised that we will eliminate green sheets for medicine wards.  
***A memo to be sent out to Medicine Directors and Unit Managers.  Trish will forward copy to collectors.
***Green Sheets will remain in use on Critical care units; as they are useful for rounds.

**''Question: Can the [[ALERT Scale]] scores be presented at a meeting in the future?''
***Discussion: (Dr. Roberts)  There is an area of concern in how precise the data is and need to demonstrate this with the audit. 
***Some elements will change. [[ADL]]s: discussion on how to attain consistency--ex. may apply an algorithm which would generate more consistent [[ADL]] scores.
***post data in a standard way-display on the units so managers can compare performance month to month and across the city--gives indication on how well processes are working.

**''Question: "Do you see other wards changing to [[CTU]] at the VGH?''
***Response Dr. Roberts:  "No"..because on a [[CTU]] ..want acute pts. with a wide variety of illness. When looking at community hospital population 40-50% are lengthy stay. .. hard to convert to teaching. Conceivably ..have 2 teaching units and one long term stay... We can only have certain # of [[CTU]]'s as demand is based on increased number of medical students.

==Changes to collection elements and processes, ICU Task group recommendations, New Data Repository, [[:Category:Project]]==
*ICU task group – data collection elements reviewed and recommendations to date.
*New data repository
*Other Special QA projects

==Element reviewed & ICU Task group recommendation==

****For over a year the ICU Database Task group reviews all elements ICU and some medicine.
****Combing through each element and making recommendations to the [[Steering committee]] if element should be collected differently or eliminated.  Reviewed items address and status. 
****ICU re-evaluating Pharm and Lab --list will be reduced by end of January/Feb 2010.  
*****Pharm: getting rid of tallying dose-just count days, regrouping and eliminated some.
*****Labs: Total decreased of 136 labs to 24 items (PDA list 33 labs down to same 24 elements).

**ICU Database Task Team found transfer ready time is not precise/exact --Task group is exploring alternate methods to obtain precise date. Till in progress. 

**Attempted use of ADT system for patient admission/discharge/transfers-found our data was more accurate-so decided against using ADT.
***For information on this see: "Identifying_ICU_admissions" <!-- removed link to defunct and deleted page -->


*APACHE II- '''active treatment''' has defaulted to yes
*APACHE II--Will keep '''Elective Surgery''': Yes or No--clarified on WIKI guidelines
*APACHE II--Will drop classification of '''Med/Cardiac/Surgical'''--Pt will be classified according to Diagnosis by Julie '''ICD-10''':  Follows the codes used by other places and hospital codes. 
**Uncertain of target date-staff will be educated on coding. We will use a subset: MDs will decide on clustering. We will still do the same research.
*''''''Autopsy'''''' Yes or No – plan to drop.

==Main Database Repository==
**Main Database ([[TMSX]] & [[MedTMS]]), will be moving to new database “repository”  & system.  Dean Jin & Tina Tenbergen working on new system.

==Other Special QA Projects==
*The database program has been involved in a number of special projects that support patient standards and quality of care initiatives. 
**for a list see: [[:Category:Project]]

****[[QASeptic]] ([[Septic Shock]] special project)- this project will be evaluated in December 09. The audit will go until April 2010- Julie provides weekly data to Dr. Olafson. 
*****If pt is admitted from “another center” to your ICU in [[Septic Shock]], the date and time of first low BP is the date/time the patient was admitted to your unit.
*****If pt in admitted from ER to your ICU in [[Septic Shock]] then first low BP must be obtained from ER data. 
*****record the first low BP which is not responding to fluids and requires vasopressor.
**''Question: re: surgical pts given antibiotics pre-operatively for presumptive septic shock (GI surgery with spillage)?''
**'''[[p:Joyce Peterson]] was asked to post question on Wiki and question to be forwarded to Dr. Olafson for clarification.'''   Go here to find posted questions: [[QA_Septic_Shock#Question |Septic shock question]].

**[[QA Infection]] [[Central Line Related Blood stream Infection (CLR-BSI)]] Audit: ICUs send in line counts daily. Will go to Aug 31, 2010

**[[Catheter09]]--St. B - (Gayle Darroch) is doing short term project to look at urinary catheters and UTI's-captures if ordered by MD and reason for insertion
***concern is to see if foley insertion is necessary and order by physician
***number of foley catheter related UTI’s

==Other==
*Norine Miller: Concerns voiced by collectors re: time and effort that is required to track information between facilities when patient move around and for [[QA Infection]] (emails, phone calls).  

*a big thank you to Marie L. for giving it a go at taking minutes.--[[User:TOstryzniuk|TOstryzniuk]] 17:48, 7 December 2009 (CST)

[[Category: Minutes 2009]]