Minutes Team Meeting December 9, 2015

Minutes for Team Meeting December 9, 2015

1. Recognition of long service employees.
2. new staff were introduced.
3. Discussion re shift schedules (Trish). The purpose of the program for maintenance of standards and quality was outlined. Challenges in staffing were listed, including LOA’s, vacation; and HR shared services issues. Trish is working with HR and the union towards developing fixed rotations for this program. Trish emphasized the need for “fitting operational requirements”. Trish also reminded staff to take their breaks as per collective agreement. If a break needs to be missed, Trish must be notified and permission must be obtained to miss a break. Also, staff must not miss breaks in order to leave early at the end of the day.
4. Nephrology codes: discussion about reasons for CRRT (Julie). Nephrology has requested the database maintain a list of patients on CRRT and the reason for needing it. Our present coding structure is not sufficient for this purpose. A list was shown to the group and there was some discussion about it. Some tweaking of the list may be required. The list will eventually be put onto the tmp section for critical care. The data collectors will choose only one reason for CRRT from this list so they need to make a judgment as to which is the most significant reason for CRRT. Question was raised about what does Post OP CRRT - mean. This is not specific. List will be taken back and review with nephrology for clarification.
5. 2016 Time and Place changes (Con and Tina): Con presented in chart format the structure of the upcoming changes for Dispo field, service, transfers, locations, living situation, discharges, etc. This format will help to meld the critical care and medicine programs so that many of the elements from each program will be put onto this one chart. The pre-living situation and the pre-admit inpatient institution will likely be added first. The whole process will be introduced in steps.
6. Data Analysis Process (Julie): Julie first outlined how she approaches the analysis of data. She went through 8 steps to demonstrate how this is done. Following this, Julie specifically discussed ER Wait in the Medicine program and some of the questionable date being observed. She asked for some feedback how staff may be coding. Julie provided what the "GOAL" is for the ER Wait Project:

• 1. to assess the delay in arrival to the ward form own ER and
  2. for the direct admissions, to see the time (delay) parked in ER when the patient comes from other locations.
  • 1. Julie gave examples of errors that have been made and emphasized the following:
  1. ER admits: must have own ER as admit from location
  2. direct admits: must not have own ER as admit from location (must be any other location because they are being sent from another facility)

6 A case study was supplied by the Vic and Trish encouraged all staff to review on their own as we had time constraints for this meeting.

7 VAP - Ventilator Associated Pneumonia - p:Laura Kolesar reviewed the process for coding VAP for patients that are early pneumonia's that arrive in the ICU already intubated. Often cultures are not sent until after the patient has been ventilated for over 48 hours therefore, when the cultures are positive and all other criteria appear to be met, the data collector will code a VAP. This could be incorrect because the pneumonia process may have started within the first 48 hours of intubation therefore, this does not qualify as a VAP. There are guidelines on the wiki to follow as to having at least 2 criteria to determine if the infection has already started prior to the 48 hour ventilation time frame. If these are present, then it cannot be coded as a VAP. (It would be a CAP).

• Look back not just at +ve sputum culture. if onset of symptoms are BEFORE +ve cultures - then not a VAP. Need at least 2 criteria before start of infection (+ve culture).