Overstay Predictor Project Collection Instructions

This article explains how to collect data in the CCMDB.mdb for the Overstay Predictor Project.

For every medicine patient admitted to the Grace 5N, as soon as possible, but definitely within 48 business hrs of admission the data collector will need to enter the data in the Nursing Discharge Screening Tool form into the CCMDB.mdb, enter a certain amount of regular data early to generate a colour, put a sticker of that colour onto the chart, and in case of certain colours notify the transition coordinator.

The Nursing Discharge Screen Tool

Find the white Nursing Discharge Screening Tool form with the admission documentation on the patient chart and check if there is either a yes or no for all the first 6 questions. The form is to be completed within 24 hours of admission; if it is not possible at time of admission, the admitting nurse will pass the responsibility for completion to the next duty nurse.

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.

ensuring completeness within 24 hrs

The bedside nurses have 24 hours from the time of admission to the unit to fill out the Nurse Discharge Assessment Form. This time frame allows for the nurse to clarify unanswered questions with the patient or caregivers during the day.

If you can't find the form or an answer is still missing 24 hrs after admission::

• enter the project "Overstay" "form data missing" entry into the tmp table
  • 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; still the remaining data into CCMDB.mdb if it now becomes available.

entering the data

For the first 6 questions on the form, create a record for each in tmp entries and check the check box if the answer is Yes. If any answer is no include a tmp entry indicating where the patient lives. This is answer number 1 under the General Information Living Arrangements?. The purpose it to exclude patients currently living in a personal care home from being assigned a transition coordinator since these patients infrequently overstay.

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 summary answer for the question needs to be "no".

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 the patient is transferred from one medical unit to another within the facility they will continue to be monitored by a Transition Coordinator till the time of discharge, so only one Discharge Screening Tool is required.

For each patient, add a "From..." entry into the Tmp table, e.g. "From Personal Care Home" or "From Home". Patients admitted from a personal care home can not become "red", but at most "yellow".

• sorry we had not updated the wiki with this. Linda, pls confirm that this is what you wanted by removing this comment. Ttenbergen 16:45, 2012 August 24 (CDT) Template:Discussion

Changes to regular data entry required for the Overstay Project

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:

• DOB
• 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
• ADL
• any Overstay Predictor Diagnosis Code Used (note exclusion of most comorbids and all acquireds/complications)
  • if a dx is entered as a working diagnosis but not yet confirmed, do enter that diagnosis
  • only dxs as listed in Overstay Predictor Diagnosis Code Used need to be entered early, i.e. the rest can be entered as they were before

• The following data needs to be entered at admission time (i.e. like minimal data set) for the coloring algorithm.
  • province
  • whether the patient is admitted from a nursing home (into overstay tmp data)
  • admit diagnosis of "Palliative Care"

Chart Stickers

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 underlying algorithm.

• 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

Based on the color displayed put that colored sticker on the spine of the patient chart. The sticker 3/4 inch stickers will be located adjacent to the transition coordinator binder at the unit clerk desk.

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.

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.

colour if data is missing

• if any data is missing from the nurse form, the colour will be evaluated as if the nurse had flagged a problem
• If any non-nurse-form variable is missing, right now the program evaluates to a gray button. If some data were not available at admit time, should the colour default to something instead of going gray? Ttenbergen 13:48, 2012 July 27 (CDT) Template:Discussion

no need to document sticker colour changes

Will it be necessary to document a difference in sticker colours if we need to change the colour once the algorithm has run?

• No need. The original colour is based on the items you enter into tmp, so we can go back from that if needed. Ttenbergen 12:47, 2012 April 27 (CDT)
  • Actually, that makes no sense since the data would be overwritten to generate the new sticker colour. So, Linda, do we need to document sticker colour changes? Should there be sticker colour changes? Ttenbergen 16:39, 2012 August 24 (CDT)

Notifying the Transition Coordinator

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 beside the transition coordinator on call for the time period of the patient's admission. The transition coordinators will be assigned to cover between Friday to Monday, the next shift will go to Wednesday, the last will be Wednesday to Friday. If the designation is made after 1500 on the day of entry, the assignment will be deferred to the next day's coordinator. The rotation of Coordinators is made up of Home Care, Social Work, Physio, And OTs. After assignment, that service is responsible for following that patient throughout their hospital stay.