Overstay Predictor Project Collection Instructions: Difference between revisions

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If the patient was discharged/died before a colour could be assigned write "not assessed" and write the discharge date on the Nurse Discharge Screening Tool, take a copy and put it in the Transition Coordinator Binder. Enter "Form Data Missing" in the temp field.
{{LegacyContent
|explanation=we stopped [[Overstay]]
|successor=
|content=
This article documents what data collectors need to do to collect information for the [[Overstay Predictor Project]].  


The nurse can update the form within the first 24 hours after admission if, for example they receive information from the patients family that contradicts the patients answers. It is possible that depending on when you review that document these changes are not captured. This a known risk that we are accepting.
'''This project was one of the Vacation and staff shortage collection priorities!'''


=== ensuring completeness within 24 hrs ===
== In addition to [[Minimal Data Set]] ==
The bedside nurses have 24 hours from the time of [http://ccmdb.kuality.ca/index.php/Admit,_Transfer_and_Discharge_date_and_time#Definition_for_Medicine| admission to the unit] to fill out the ''Nurse Discharge Screening Tool''. This time frame allows for the nurse to clarify unanswered questions with the patient or caregivers during the day.
The following items need to be entered '''before the generation of the chart colour in the next step''' because the algorithm uses this data:
* [[Date of Birth]]
* [[Province]]
* "Accept DtTm" if used, else "Arrive DtTm"
* [[Pre-admit Inpatient Institution]]
* [[ADL]]
* [[Glasgow Coma Scale]]
* '''important:''' [[List of diagnoses affecting Overstay Project]]


'''If you can't find the form or an answer is still missing 24 hrs after admission:''':
== Generate colour ==
* enter the project "Overstay" "form data missing" entry into the tmp table
Once the required information has been entered click the "Overstay" button on the patient viewer screen next to the [[Notes field]] and it will turn a colour based on an [[Overstay Predictor Project Algorithm | algorithm]].  
** If the nurse form is incomplete the patient will be evaluated as if the nurse form had identified a problem, i.e. the patient will become yellow or red; the program will give a message that data had been missing.
* check with the bedside nurse and remind them to complete it; enter the remaining data into CCMDB.mdb if it now becomes available.
** I thought if we come across incomplete data we notify the manager and it is their responsibility to tell their staff to complete the data.Please clarify this. Each nurse has been told  and emailed  what they are to do is it my responsibility to REMIND nurses to fill it in?
{{discussion}}


If a patient was admitted and discharged within the 24 hours and no "Nurse Discharge Screening Tool" was completed enter "Form data missing".
The program will ask you if this is the final colour you will submit. If so, it will be stored and sent. The colour will also be automatically added to the beginning of the Notes field, since most collectors were manually putting it there anyways.  


=== entering the data ===
* '''Red''' - significant risk for discharge delays
Within two business days after the bedside nurse has completed the ''Nurse Discharge Screening Tool'' the rest of the Predictor data must be collected. For the first 6 questions and the question about their living arrangements, create a record in tmp entries and check the check box if the answer is '''Yes''' and indicate where they live.  
** email to notify unit manager - see [[#Notifying_the_Unit_Manager]]
**put red stick on chart - see [[#Red Chart Stickers]]
* '''Yellow''' - anyone who is not red
**no email to manager
**no sticker on chart
* '''Gray''' -  there are no gray stickers, gray is just a colour the laptop will give when it gets bad data for the algorithm.one of two scenarios:
** data needed to generate the colour is missing; you will not be able to generate a colour; there will be a specific error, please act on it
** the patient is transferred from a ward where the colour should have been generated already.


Question 4 consists of several sub-questions re. the patient's inability to manage daily activities. If even one of the activities raises a concern then the summary answer for the question needs to be '''no'''.
== Red Chart Stickers ==
If the colour is '''red''' place a 3/4" red round sticker on the spine of the patient chart. Ward clerks will need to order these. Collectors will tell ward clerks when supplies are getting low.  


Take answers to questions directly from the form, no interpretation, even if you disagree after reading the chart. We will be testing the answers provided by the nurses to determine if they are a better predictor of transition support needs or can be used in conjunction with existing admission data to improve the effectiveness of the prediction tool. If the data were interpreted by the collector it would introduce another factor and make this test less valid. If you identify a discrepancy please note it in the Temp Comments field also known as column Q.
=== Other coloured dots on charts ===
There is currently a small red dot used to indicate long term chart. These are not ours and users of the chart who use these ought to be aware of them.  


=== What you See in TMP for overstay - 6 rows ===
== Notifying the Unit Manager ==
[[file:Overstay TMP - What you see in TMP.JPG |700px| Overstay Tmp what you see]]
If a patient is identified as red, [[CCMDB.accdb]] will populate an email subject line with the name of the patient and that they have been identified as overstay colour red. The collector must send the email to the unit manager (see [[List of Unit Managers]]). It should not be necessary to add additional information to the body, this way all info is visible when the manager sees the email arrive, and they don't have to open it.


=== What you ENTER in TMP for overstay - list of choices ===
If we find that additional info is required, let's talk about it and add it to the program, rather than add anything manually, so we know this is done consistently.
[[file:Overstay TMP-what you ENTER.JPG |700px| Overstay TMP What to ENTER]]


===How to enter data into TMP from the bedside nurse Overstay form including an example if a question on form is not filled in===
== Possible Scenarios ==
For a more details about wording in TMP items for overstay go to [[Media:!Nursing_Discharge_Screening_Tool_Sept_18.pdf|Bedside Nursing Discharge Screening Paper Form]].
=== Possible Scenario - Patient transferred from other ward - admit ward was participating ward ===
*There are 7 rows of items for overstay in TMP.  6 questions and 1 item asking specifically where patient lives prior to hospital admission.  If any item are not answered, enter a "form missing" record for each in TMP. (Example: showing questions #2 below is missing data on form & how to fill in)
If the patient was admitted from a another '''medicine''' ward at the same location that also participates in the Overstay project, then the original Yellow/Red designation is retained.  
*Overstay  1. Alert and Oriented
It will be the responsibility of the manager of the originating ward to notify the manager of the receiving ward of any red patients.  
**Column B in TMP - check if A&O or leave blank if not A&O.
*Overstay  2. form missing 
**Not fallen in 6 mths not marked on form
**Column B in TMP - BLANK
*Overstay   3. Ambulates
**Column B in TMP - check if ambulating, leave blank if not ambulating
*Overstay  4. managing independently
**Column B in TMP - check if managing independent, leave blank if not managing independently
*Overstay  5. living situation
**Column B in TMP - Check if the patients and family/support are confident that the patient can be discharged to their current living situation
*Overstay  6. home smoke 
**Column B in TMP - check  if answers appropriately to “You wake up in the middle of the night and smell smoke in your home, what do you do?”  Blank if response is not normal.


==== admitted from ====
==== Previous ward's collector ====
For each patient also enter where they are admitted from;
When you find out that your patient has been discharged to another ward where we collect please notify that collector. There seem to be different informal methods used by different collectors for this right now. We will test if that is good enough, and only formalize it if there are problems.  
* Project Overstay
* Item: one of
** From House
** From Apartment
** From Assisted Living
** From House
** From Other (e.g. homeless, inmate...)
** From Personal Care Home
** '''From  location missing''' - enter if the admitted-from information is not recorded on the form
***nurses or data collectors can utilize the patient's address to assist with the answer if it is not obtained by questioning the patient.  For example, it is easy to see if any address in an apartment VS a house by the address. --[[User:LKolesar|LKolesar]] 15:28, 2012 November 30 (EST)


== Changes to regular data entry required for the Overstay Project ==
==== New ward's collector ====
A number of items in addition to the regular [[Minimal Data Set]] needs to be entered '''before the generation of the chart colour in the next step''' because the algorithm uses this data:
Ensure that these charts have the appropriate colour dot on them as communicated to you.


* "from" and "questions" tmp entries, or else "transferred" entry if applicable
Enter the patient as normal and click the overstay button. It will give you a message ''"Patient comes from participating ward, use their overstay colour on charts. CCMDB will list gray."''. We will match the data to the original ward behind the scenes.
* DOB
* province
* Admit Date
** Enter admit date as before; we are aware that this can be different from the time of admission to the unit and the algorithm takes that into account
* admit-from
* ADL
* Glasgow Coma Scale
* Charlson Comorbids
** still working on list for the wiki; in the meantime, please just code all comorbids for the patient
* admit diagnoses if applicable:
** [[Dementia]] or [[Violent 2nd to dementia]]
** [[Palliative Care]]


== Chart Stickers ==
=== Possible Scenario - Patient transferred from other ward - admit ward was '''NON'''-participating ward ===
Once the required information has been entered click the new “Overstay” button on the patient viewer form next to the notes field and it will turn a colour based on an [[Media:Two_Stage_Predictive_Model_of_Patients_in_Need_of_a_Transition_Coordinator.pdf | underlying algorithm]].
If the patient is transferred either '''from''' or '''via''' any unit not participating in the Overstay project (e.g. an ICU) generate a colour.
* GREEN - low/no risk for discharge issues
* YELLOW - some risk for discharge issues
* RED - significant risk for discharge issues assign a transition coordinator.
* GRAY - if some needed data is missing you will not be able to generate a colour in the ccmdb database; there will be a specific error
Based on the color displayed circle the colour on the Discharge Screening tool. Also place a colored sticker on the spine of the patient chart. The sticker 3/4 inch stickers will be located in the transition coordinator binder at the unit clerk desk. 
Take a copy of all discharge screening tools and leave the copy on the Transition Coordinator binder. We will be collecting these forms for the time being to evaluate the form.


The color on the button is not stored in ccmdb.mdb, so it will not be visible next time you open the patient. This is by design as you should only need to use the colour once.
=== Possible Scenario - colour change due to data entry error ===
'''The only case where the colour should be changed is if the data-collector made a error on data entry. We don't want you to change colour because data becomes available after the initial assessment window.'''


Note: There is currently a small red dot used to indicate long term chart. There is also a small yellow dot used to indicate VRE.
If you realize you made a data entry error and you have fixed it, you can click the Overstay button again. It will ask you again if this is final, and if you click yes the original entry will be '''overwritten''' and the new colour be added to the beginning of the Notes field. This means you may have multiple colours in notes, the first one being the current one.


=== colour if data is missing ===
It is '''not necessary to document''' when a colour changes. Just change the colour.
See the dialog boxes in the program for information on color coding if data is missing.


=== no need to document sticker colour changes ===
=== Possible Scenario - Patient died/discharged before data collection ===
It will not be necessary to '''document''' when a sticker colour changes. Just change the colour.
Enter anyway and generate colour. Do not contact Unit Manager.  


After 24 hours all information required to make the assessment as to if the patient is at risk should be available (or not known to the nurse within the first 24 hours and thus considered a risk). The only case where the colour should be changed is if the data-collector knew they had made an error on data entry in which case there is no need to record the previous colour. If the change results in the patient no longer needing a transition coordinator, then the data coordinator needs to notify the transition coordinator to ensure they are ware of the change.
=== Possible Scenario - EMIP patient that never made it to the ward ===
Enter anyway and generate colour. Do not contact Unit Manager.  


== Notifying the Transition Coordinator ==
=== Possible Scenario - Off ward patients ===
''see also [[#Special Case - Patient transferred from other participating ward]]
Almost all of these will be [[#Possible Scenario - Patient transferred from other ward - admit ward was participating ward]], so use those collection instructions. It will be the responsibility of that manager to notify the next manager.  
If the patient has been designated as "red" for purposes of overstay prediction, the data collector will notify a Transition Coordinator by placing the patients name on the ''Transition Coordinator Assignment Sheet''.  


== Overstay bug in [[CCMDB.mdb_Change_Log_2013#ver_2013-02-13]] ==
For the rare patient admitted to an off-ward location without hitting one of our regular wards first, generate a colour and put it on the chart, but don't worry about contacting a manager. This was discussed as a special case not worth following up on. It Is OK.
=== extra line ===
*'''VIC''': overstay showing a extra line of code, so there are seven rows for overstay instead of six. ''Location From'' is seventh one.  Shirley was able to delete the extra row from serial 8345 and enter data.
*I too have the extra line of code here at SBGH. [[User:DPageNewton|DPageNewton]] 19:09, 2013 February 12 (EST)
** ''''I added a separate option for cases where from data is not available in ver 2013-02-04; I mistakenly set that new option to auto-populate when a new patient is entered. I have changed this for ver 2013-02-13. New patients started while ver 2013-02-04 was used will have the extra line; please delete it. Unless I hear otherwise, I think this is fixed, and this entry can be deleted in 2 weeks.''' Ttenbergen 10:54, 2013 February 14 (EST)


=== inappropriate reds ===
== Start/Stop/Site participation ==
*'''STB'''-inappropriate REDS being generated.  ID by Debbie this week.  Unble to connect with Tina on Feb 11 & 12th.
see [[Overstay Project Start Stop dates]]
*'''STB'''-I found a patient that was flagged red that should not be. The ADL's were all unassisted. The admit diagnosis & ccm were not any of the flagged diagnosis. The living arrangment was house. For questions 1-6, only question 2 (falls) was a no. The patient was flagged red. This is very inappropriate. The transition coordinators will not be happy if we are now going to start coming up with inappropriate reds for them. [[User:DPageNewton|DPageNewton]] 14:44, 2013 February 12 (EST) 
*'''STB''' I have come across another (second) patient that I think is inappropriately assigned a red color. As of this moment I will NOT be entering these names in the transition coordinator binder, until such time as this issue is sorted out. As data collectors we are told we must adhere to strict guidelines as to time frame for work done. It is more than a little frustrating that these issues are not addressed and attended to in the same strict time frame guidelines. This delay in addressing issues in turn will affect the time frame for our assigning opp colors. Serial #'s for the two patients I think are inappropriately assigned red are SBGH E5 #'s 9683 & 9684. [[User:DPageNewton|DPageNewton]] 19:00, 2013 February 12 (EST)
** '''There were several problems with colour generation in ver 2013-02-04; ver 2013-02-13 should correct these. Again, if you see more colour ratings that seem wrong, please let me know Ttenbergen 10:54, 2013 February 14 (EST)
Please re-create colours for patients entered between Sat Feb 9 and Wed Feb 13!


==== red from PCH ====
{{Data Integrity Check List}}
*'''VIC''' serial 8345 -RED flagged when admit from is '''Personal Care Home'''.  Though if from Personal Care home then should not be RED.--[[User: SKiesman|Shirely Kiesman]].-[[User:TOstryzniuk|Trish Ostryzniuk]] 16:51, 2013 February 12 (EST)
** '''The new algorithm as of ver 2013-02-04 no longer disallows reds from PCH, the only criteria now excluding pts from red is ''palliative care''. However, in this case colour was probably mis-assigned since the algorithm was indeed wrong.''' Ttenbergen 10:54, 2013 February 14 (EST)
*** Are you saying Tina that a patient who comes from a nursing home can be coded RED now but previously were not?
**** Yes, that is correct. Before they were coloured green or yellow based solely on the nurse form but excluded from further analysis. The newest model includes them in the analysis, so we also include them in coding. This is also true for patients from outside of Manitoba. Ttenbergen 13:02, 2013 February 14 (EST)


=== lacking instructions ===
= Clarification of difference to previous process=
*collection instruction: there is no where on wiki that clearly explains how to collect overstay in tmp properly.  For example, the B column, it is not clear how this functions or relates to some projects or items.  Looking and the TMP is not intuitive on how & when items relate to Column B, (check mark or leave blank).  Visual folks find it hard to follow unless shown.  Tmp column labels, as mentioned before, are not intuitive.
The following documentation is relevant to pre-empt questions only until the transition to the new process is complete.  
** As with all tmp entries, if you actually click the "edit" button the columns that are labeled only as letters in list view are labelled better. We keep talking about this. I can not label the columns in list view because they mean different things for each line. Would it help if I made the list view un-editable and forced collectors to use the edit view to enter tmp data? It would be tedious but it would also make it more intuitive and less ambiguous. Thoughts? Ttenbergen 10:54, 2013 February 14 (EST) {{discussion}}


== Special Case - Colour Generation during collection staff shortages ==
== even at STB ==
* Also, during vacation periods, there is a very good possibility that information will not be entered and colours will not be generated on the teaching units. When/if these patients are transfered to non-teaching, will the nurses on 5B be filling out the screening tool within 24hr. of transfer to ward?  I can not find the answers to these questions on self learning collection instructions on Wiki. Please advise.[[User:ENagy|ENagy]] 17:30, 2012 November 8 (EST)
For a while STB medicine collectors stopped putting red dots on the charts. They will now be required to put dots on the charts again. We discussed only notifying the manager by email with the requestor of the project, but they really want the dots. One thing we considered was the possibility of putting something equivalent to the red dot onto [[Medworxx]]. I am looking into that.
** I am not sure if you are referring to nurses on vacation or data collectors. I will leave it to Trish to managed the data collector coverage model and the unit managers to manage nursing coverage. We will be monitoring form adherence to the process on an ongoing bases.[[User:LHathout|LHathout]]''
*** Collecting enough information to generate the overstay colour is the highest priority thing to do in medicine data collection. Trish, can you specify how this would be handled? Ttenbergen 13:28, 2013 February 14 (EST)


== Special Case - Patient transferred from other participating ward ==
== DPST form - STOP July 31.17 ==
If the patient is transferred from one medical unit to another within the facility only the one ''Nurse Discharge Screening Tool'' is required and the original Green/Yellow/Red designation is retained. The designated colour should be written on the form.
Collectors will '''no longer''':
The completed form will travel with the chart so when you review a new admissions to the unit you will see that the form has already been filled out and a colour has been assigned.
*collect any information from the DPST forms or be responsible for them  (tmp file for the questions will be gone)
*post information in the Transition Coordinator binders or
*notify and assign allied Health.  


=== entry instructions ===
Collectors can ignore the form and just collect the minimal data set outlined above to generate a colour.
* ''erase'' the 6 questions
*wards may continue to fill out the DPST form at admission ''For their own purposes.''
* enter an entry Project "Overstay", Item '''"Transferred form" '''
* ensure that the new chart has a dot of the right colour
* if '''red''' add the patients name to the assignment sheet


== when you have a problem ==
== Transition Coordinator Binder - Stop July 31.17 ==
*Reminder to all staff.........please email Tina or post issue on Wiki rather phone calls. If phone call is getting you voice message than email her & CC Fred and Linda.  Thank you for your cooperation with this.[[User:TOstryzniuk|Trish Ostryzniuk]] 18:47, 2013 February 12 (EST)
Collectors will '''no longer''':
*post any kind of information in the Transition Coordinator binder 
*notify and assign reds to allied Health team 


= Instructions admissions before Jul 30 2017 =
see [[Pre-2017-07-30 Overstay Predictor Project Collection Instructions]]
* All reds generated prior to July 31st are already in our data, just leave them as they were.
}}


[[Category: OverstayProject]]
[[Category: OverstayProject| *]]

Latest revision as of 14:16, 2022 April 19

Legacy Content

This page contains Legacy Content.
  • Explanation: we stopped Overstay
  • Successor:

Click Expand to show legacy content.

This article documents what data collectors need to do to collect information for the Overstay Predictor Project.

This project was one of the Vacation and staff shortage collection priorities!

In addition to Minimal Data Set

The following items need to be entered before the generation of the chart colour in the next step because the algorithm uses this data:

Generate colour

Once the required information has been entered click the "Overstay" button on the patient viewer screen next to the Notes field and it will turn a colour based on an algorithm.

The program will ask you if this is the final colour you will submit. If so, it will be stored and sent. The colour will also be automatically added to the beginning of the Notes field, since most collectors were manually putting it there anyways.

  • Red - significant risk for discharge delays
  • Yellow - anyone who is not red
    • no email to manager
    • no sticker on chart
  • Gray - there are no gray stickers, gray is just a colour the laptop will give when it gets bad data for the algorithm.one of two scenarios:
    • data needed to generate the colour is missing; you will not be able to generate a colour; there will be a specific error, please act on it
    • the patient is transferred from a ward where the colour should have been generated already.

Red Chart Stickers

If the colour is red place a 3/4" red round sticker on the spine of the patient chart. Ward clerks will need to order these. Collectors will tell ward clerks when supplies are getting low.

Other coloured dots on charts

There is currently a small red dot used to indicate long term chart. These are not ours and users of the chart who use these ought to be aware of them.

Notifying the Unit Manager

If a patient is identified as red, CCMDB.accdb will populate an email subject line with the name of the patient and that they have been identified as overstay colour red. The collector must send the email to the unit manager (see List of Unit Managers). It should not be necessary to add additional information to the body, this way all info is visible when the manager sees the email arrive, and they don't have to open it.

If we find that additional info is required, let's talk about it and add it to the program, rather than add anything manually, so we know this is done consistently.

Possible Scenarios

Possible Scenario - Patient transferred from other ward - admit ward was participating ward

If the patient was admitted from a another medicine ward at the same location that also participates in the Overstay project, then the original Yellow/Red designation is retained. It will be the responsibility of the manager of the originating ward to notify the manager of the receiving ward of any red patients.

Previous ward's collector

When you find out that your patient has been discharged to another ward where we collect please notify that collector. There seem to be different informal methods used by different collectors for this right now. We will test if that is good enough, and only formalize it if there are problems.

New ward's collector

Ensure that these charts have the appropriate colour dot on them as communicated to you.

Enter the patient as normal and click the overstay button. It will give you a message "Patient comes from participating ward, use their overstay colour on charts. CCMDB will list gray.". We will match the data to the original ward behind the scenes.

Possible Scenario - Patient transferred from other ward - admit ward was NON-participating ward

If the patient is transferred either from or via any unit not participating in the Overstay project (e.g. an ICU) generate a colour.

Possible Scenario - colour change due to data entry error

The only case where the colour should be changed is if the data-collector made a error on data entry. We don't want you to change colour because data becomes available after the initial assessment window.

If you realize you made a data entry error and you have fixed it, you can click the Overstay button again. It will ask you again if this is final, and if you click yes the original entry will be overwritten and the new colour be added to the beginning of the Notes field. This means you may have multiple colours in notes, the first one being the current one.

It is not necessary to document when a colour changes. Just change the colour.

Possible Scenario - Patient died/discharged before data collection

Enter anyway and generate colour. Do not contact Unit Manager.

Possible Scenario - EMIP patient that never made it to the ward

Enter anyway and generate colour. Do not contact Unit Manager.

Possible Scenario - Off ward patients

Almost all of these will be #Possible Scenario - Patient transferred from other ward - admit ward was participating ward, so use those collection instructions. It will be the responsibility of that manager to notify the next manager.

For the rare patient admitted to an off-ward location without hitting one of our regular wards first, generate a colour and put it on the chart, but don't worry about contacting a manager. This was discussed as a special case not worth following up on. It Is OK.

Start/Stop/Site participation

see Overstay Project Start Stop dates

Data Integrity Checks (automatic list)

 AppStatus
Query check tmp generate allowedCCMDB.accdbimplemented
Query check overstay no colourCCMDB.accdbretired
Query check overstay pt from our medCCMDB.accdbretired
Query check overstay not enteredCCMDB.accdbretired

Clarification of difference to previous process

The following documentation is relevant to pre-empt questions only until the transition to the new process is complete.

even at STB

For a while STB medicine collectors stopped putting red dots on the charts. They will now be required to put dots on the charts again. We discussed only notifying the manager by email with the requestor of the project, but they really want the dots. One thing we considered was the possibility of putting something equivalent to the red dot onto Medworxx. I am looking into that.

DPST form - STOP July 31.17

Collectors will no longer:

  • collect any information from the DPST forms or be responsible for them (tmp file for the questions will be gone)
  • post information in the Transition Coordinator binders or
  • notify and assign allied Health.

Collectors can ignore the form and just collect the minimal data set outlined above to generate a colour.

  • wards may continue to fill out the DPST form at admission For their own purposes.

Transition Coordinator Binder - Stop July 31.17

Collectors will no longer:

  • post any kind of information in the Transition Coordinator binder
  • notify and assign reds to allied Health team

Instructions admissions before Jul 30 2017

see Pre-2017-07-30 Overstay Predictor Project Collection Instructions

  • All reds generated prior to July 31st are already in our data, just leave them as they were.
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