Minutes Team Meeting October 1, 2014

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In progress......not complete......feel free to review and add or change. Trish Ostryzniuk 13:52, 2014 October 6 (CDT)

Update - status of new ICU/MED repository

Excellent progress in main office for this year. Medicine working from new system as of last week June 20 2014. ICU database targeted to be to new system only as of: January 1, 2015.

VAP - physician support

Collectors have the support of ICU Regional Director, to feel that they should asked ICU physicians directly or by email if needed, if they are having difficulty with a DX of a VAP or other infections which we are following very specific criteria. Collector's have specific criteria they follow when auditing a chart however, on numerous occasions, a collector is finding a diagnosis example: VAP, or MSRA septicemia, yet no where on the chart can they find results that meet the criteria. This is a team patient quality of care project and is a team effort so all staff in unit work as a team. Collectors who are finding they are having an issue when approaching unit attending or physician staff please let me know.

  • p:Julie Mojica reported VAP rate drop. QA teams monitoring closely and posting updates in every ICU.
  • there are posters of both VAP and CLI rates posted in all ICU's in t city that is put out by the Regional QI team. If ICU collectors does not see poster please let Trish know.Trish Ostryzniuk 11:11, 2014 October 7 (CDT)

Hand Hygiene practices on wards

Reminder to staff to maintain good hand hygiene practice when handling charts.

Recent changes Wiki

Reminder to staff in regards to the importance following recent changes on Wiki. Discussed how to open multiple tabs, and how to view diff and changes. Staff are encouraged to asked coworkers or contact Trish or Tina.

  • Laura to review with Elaine and Debbie.

Postal Code - data entry

Mining data - main office seeing data with MB PHIN but postal code is from another province.

  • Statistician has found 621 inconsistent postal codes vs Province vs PHIN. This is 0.1% error rate which is extremely low.
  • the process of mining the data and asking question is to try to understand and explain our information better and decide how to report it.
  • Tina has put into place few consistency checks into ccmdb. e.g. See; Postal Code checks in CCMDB

Followed up at Steering Committee Oct 6.14 - collectors: enter postal code, PHIN and province as found on chart or EPR. Please review Postal Code article.

angiogram in lab counts

p:Laura Kolesar the counting of Angiogram in Lab Collection Process

Coronary Angiograms are counted in the lab counts if the coronary angio is done during the pt stay in the ICU or if done just prior to arrival to the ICU. (The pt must have come directly to the ICU from the heart cath lab). This is the only lab count where this applies. All other lab counts are counted only if they occur during the ICU stay. This has been updated in the labs collected list section of the wiki. --LKolesar 15:01, 2014 October 7 (CDT)

Since we now have unlimited space to add all kinds of things that happen to patients, a question was asked if collector should code in a DX multiple times if patient had repeated problem, procedures, diagnostic proceedure or surgery?

  • one example is diagnostic procedure of angiogram:
  • for example, from the Labs collected list the number of times angio is done is counted but in the admit or acquired DX coding, the current practice is NOT to code the procedure a multiple times in DX slots. Repeatedly coding procedures or surgeries would then have to apply to all other potential DX codes we can do this with. This is data collection creep. If a patient went for 10 skin graft do collectors want to code that 10 times? Everyone would have to be consistent in all their repeated coding and it would take a year to have any useful information. This new info would also not be able to be compare to past data, so we need to be careful what we keep volunteering to collect!!!!!
  • can take to task meeting and revisit if this is what database program should be doing or not.
    • yes we can, Laura, Gail, Joyce can bring item to Nov 6.14 meeting.Trish Ostryzniuk 20:25, 2014 October 8 (CDT)

EPR - custom list - training guideline intro to clinical EPR

  • EPR has a set listing of things you need to see. The LMS training shows you how to create custom listing of patients.
  • If you need help, p:Laura Kolesar or p:Lisa Kaita can also show you. Please let Trish know if you need further assistance.
  • HSC is the last site to start EPR. HSC go live is over October long weekend, Oct 11.14
  • Tina facilitated setting up standard user rights for data collectors in this program so that ALL collector, who log in under their new username (example: jpolaxxdc) would be able to see patient information from other sites in Region.
  • Debbie and Stephanie pointed out already to Tina, that they lost their custom patient listings. Tina has asked her contact to import any custom list staff had. With the import of custom list, staff reported losing their access to other sites. Tina should have this fixed up, if not please let her know.
  • Elaine cannot login to EPR - she was advise to contact eHealth and that for some reason the application may not be configured to her new ID.

round table items

See:Sputum C+S

  • Gail - raised point about unclear collection guide. A discussion took place on what was included in lab count for sputum C+S. i.e. just culture and sensitivity or is AFB included and BAL? Are viral cultures included? TBA? See Sputum C+S for any updates.

Glasgow_Coma_Scale - a continued data collection problem?

  • Laura raised that neuro assessement on sedated patient is a collection problem.
  • Lisa, Shirley Kiesman - issue with the correct GSC assessment for ST. Amant client or old strokes.
  • Collection guidelines was lasted reviewed at Task Team on January 13, 2013 and collection guide updates.
  • All collection Staff: must review the current: GCS collection guidelines and then go HERE and post further comments what exactly the issue are.
  • Laura, [[p:Gail Hall-resign, Nov 29, 2018 | Gail Hall] and Joyce will review your comments and bring it to Nov 6.14 task meeting if determined further discussion is required.

Adding more Surgical DX code

Lois Bilesky - suggested we should be adding more procedure codes, E.G. some AVR's now done in angio.

  • Trish pointed out that it is easy to volunteer to collector more and more (collection creep). It is better if we deem it will be used for some project we add it and then we collect it consistently. If we randomly keep adding things with no purpose in mind, hard to be consistent. Better to say we don't collect it then.
  • If there is a procedure, DX or surgery that we don't collect, please created an article for the DX not collected. Put the article into this Category:Diagnosis not coded (old)
  • main office still working past migrating to new database and all things associated. We will be moving to ICD10 codes at some point and will considered then to add anything new.
  • collectors will be able to review the IDC10 codes before they get implemented. It is a big change for all us.

CLI DX and Dates in Tmp for Medicine

  • medicine collectors are to be monitoring for CLI's in their unit AFTER ward admission.
  • CLI dates in TMP: Julie to check with Dr. Roberts if her wants date of positive blood culture reported in TMP or not. Will update in CLI article HERE when notified. Trish Ostryzniuk 12:26, 2014 October 7 (CDT)
  • no changes for ICU collection

Medicine lack of DX codes for failed discharges/readmits

Debbie, Shirley Kiesman, Louise Lemoine - high rate of failed discharged, no enough adequate primary REASON for failed discharge.

  • reason physician write:
    • noncomplicance
    • failure to cope
    • ?
  • muscle deconditioning not adequate to cover reasons
  • current practice is to code the underlying medical condition that has brought patient back.

Since then, we implemented Adult failure to thrive in 2015-Jun-22.