Minutes Team Meeting December 5, 2011

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Minutes from Team Meeting December 7, 2011

1. DeviceUse Study is on hold for now. We were still in the pilot phase but found both the method of collection and the results cumbersome and inefficient. The plan is to incorporate the desired quality parameters into a new TISS form that will be developed over the next few months. The new TISS will be shorter and more relevant and all patient days will be utilized for the data (not just the first 10 days).

2. VAP guidelines revised to include intermittently or continuously ventilated for at least 48 hours prior to the positive culture result. Joyce Peterson asked a question about trauma pts that often aspirate in the community and then in the next few days have positive sputum cultures. Another question about VAP was asked as to what time frame around the culture result should be viewed for the signs of WBC, fever, sputem, etc. when determining whether it is a VAP. Both of these questions were given to Kendiss Olafson and subsequently the answers that she provided were put on the wiki.

3. Tina presented the new Pharmacy collection format and new drug list . She is going to place the new list as a trial on the laptops so that data collectors can try utilizing it before we go “live” collecting pharmacy with the new format and new drug list . We need to make sure it is user-friendly. As of January 1, 2012, when this new system of collection begins, HSC will be manually collecting pharmacy along with all the other critical care data collectors in the city. Tina also summarized how the pharmacy data is used by researchers and managers.

4. Tina reviewed the “Fix CCMDB.accdb using fix CCMDB” that is on the Regional Server. The instructions are on the wiki. Search for the word “fix” on our wiki to find this information. Tina also reminded the data collectors that problems with the laptops can be often dealt with by ehealth.

5. Tina explained that when a data collector changes their employment status at a hospital but continues to collect data, they need to ensure that their computer status is not stopped or discontinued. Ensure that HR knows that you will be continuing to use the computer log in, outlook, etc.

6. Overstay Predictor Project: p:Dr. Dan Roberts is working towards implementation of this new project which utilizes data that medicine collectors already collect. The ALERT Scale and comorbid parameters will be used to formulate a prediction about a pt within 2 business days of admission. If a pt, based upon these parameters, is thought to be at risk for over staying in the hospital beyond when they are medically stable for discharge, then a multidisciplinary team will begin planning for discharge right away. It is hoped that this tool will facilitate a more timely discharge. The problems that need to be worked out for the data collectors is that vacation coverage will need to be guaranteed. It will be essential that data is done in a timely fashion so we will not be able to get behind on data collection. We plan to ensure better coverage by likely hiring a float data collector. We will also look into better use of casuals. When this study begins, only 2 sites will be pilot sites: STB and Grace.

7. Discussion about the use of Casual Data Collectors. They need to do some collection on a regular basis to remain proficient. Discussed the need to put the available hours on the wiki instead of the regional server so that the casuals can sign up for shifts more easily. Pagasa will supply Laura with a list of the casual data collectors and she will email them to inform them of changes and to see if they still want to be on the casual roster. List of causal collectors and status can be found here: Casual Data Collectors.

8. Transfer ready dates and times. Julie reviewed that transfer ready dates and times for medicine this means that the pt could be discharged and is medically stable.

  • If a pt comes to a ward with the main reason is for paneling or discharge planning then the admit date and the transfer ready are the same. Just add 5 minutes to the transfer ready time to allow access to accept the time. Dr Roberts is working on getting the doctors to put a stamp in the chart to indicated when they are medically stable. The utilization management tool has not been very helpful in determining this information. Our data base has been more valuable in the past to determine over stays. There was also some discussion about transfer ready for critical care. The plan is that an order needs to be written and once written, a de-escalation of care will also occur (ie. remove art line, take off monitor, etc. ) essentially the pt becomes a ward pt once they are transfer ready. This is being worked on at this time.

9. Data collectors mentioned to Tina that a message pops up frequently when inputting new patients that there are no labs. Tina will try to fix this.

10. There is a new initiative that requires the use of Postal Codes to determine socio-economic status and also to determine whether a pt resides in a nursing home. We will begin to collect postal codes in the tmp file starting January 1, 2011.