QA Septic Shock

Projects
Active?:	active
Program:	CC
Requestor:	Dr. Kendiss Olafson
Collection start:
Collection end:

see #Study Run Times for details.

Kendiss Olafson and the QA team are monitoring performance and appropriate interventions for Septic Shock in the ICUs in the Winnipeg Region.

Data Collection Method

For the first episode of Septic Shock (admit or complication) of any ICU patient, the following two entries must be made in the TMP, L_TmpV2 file.

BP Criteria

• Project: QASeptic
• Item: BP Criteria
• Date and Time: that the blood pressure (BP) criteria is met for the first time as per Septic Shock Blood Pressure Guideline guideline
• Comment: only in case of transfer from other ICU, enter transfered from previous ICU with DX of shock already coded; in that case don't code date/time

BP prior to admission

First low BP may be prior to ICU admission.

If a patient with existing septic shock is transferred from one ICU to another, for next ICU transferred into code Item: First BP <90 with no date/time and enter transfered from previous ICU with DX of shock already coded as the comment.

First NEW Antibiotic

The time of antibiotics is the date and time antibiotics are given for sepsis.

• Project: QASeptic
• Item: First Antibiotic
  • includes all antimicrobials, not just antibiotics
  • if causative agent turns out insensitive to that antimicrobial, still enter it; this study is concerned with the delays in treatment, not the use of the correct drug
• Date and Time: Date/Time of first antibiotic given to treat sepsis
• Comment:
  • note reason if an antibiotic was not given
  • state if non-standard source of information was used

Special Cases

Use your judgment to determine the first antibiotic likely administered to treat septic shock.

If a patient was on antibiotics prior to meeting the conditions for shock, then:

• if the antibiotic is not changed after going into shock, use the date/time of the last antibiotic administered prior to onset of shock;
• if the antibiotic is changed and administered  shortly before or  after going into shock then use your judgment to determine the following:
  • if the antibiotic change was likely related to the imminent septic shock, record the date/time that new antibiotic was administered as the start dt/tm; you can state your reason in the comments field.
  • if the antibiotic change was likely unrelated to septic shock, code the date and time of the first administered antibiotic change AFTER or the most recent change BEFORE  (again, use your judgment)

If you are using non-standard data sources such as the in/out sheet, note so in the comment field.

If the patient does not receive Antibiotics (e.g. DC treatment) don't enter a date but provide a reason in the comment section of the "First Antibiotic" entry.

Study Run Times

Third wave - Start Date: March 6, 2017 00:01 / End Date: June 30, 2017 23:59

Any patient who is discharged between the above dates and has a DX of septic shock needs to have a QASeptic Tmp entry.

• The ICU QI team has requested an updated review.

Second wave - Start Date: April 1, 2012 / End Date: June 30, 2012

Three month data collection for the Septic Shock Study. A review of the current data has been completed by the statistician and the ICU QI on June 12.12.

• RE: stop date: Patients ADMITTED up to midnight June 30th will continue to be entered and followed for QASeptic Study until they are discharged from the ICU.
• Any new patients ADMITTED on July 1st 0001 hrs will not be entered into the QASeptic Study.--Trish Ostryzniuk 16:05, 2012 June 13 (CDT).

First wave - Start Date: October 8, 2009 / End Date: July 1, 2011

Every qualifying patient sent after this date will need to have a temp entry, not only patients admitted after this date.

• Review Date - done Feb 2,2010
  • Data is showing some good trends for ICU's in the Region. Dr. Kendiss Olafson from the ICU QI team will present at the data collection team meeting in April 2010.--TOstryzniuk 16:30, 2 February 2010 (CST)--TOstryzniuk 16:30, 2 February 2010 (CST)
  • see: Feb 2.2010 Review Meeting
• Stop for all patient, that include those already in unit prior to July 1 who develop septic shock after July 1
• we will attempt to resume in fall time "after" Education blitz completed by ICU QA team.--TOstryzniuk 14:42, 27 June 2011 (CDT)

Consistency Checks

Tmp Checker will check for the following:

Date or Comment

Every entry for project QA Septic must have either a date or a time.

Dx but no tmp

L_TmpV2 entry is required if:

• a DX of Septic shock exists
• program is "CC"

(implemented by s_tmp_QASeptic_Dx_no_tmp)

Tmp but no dx

A diagnosis must exist if:

• a "QASeptic" entry is present in L_TmpV2
• program must be "CC"
  • implemented by: S tmp QASeptic Dx no tmp

Send mode

Data for all patients meeting requirements for this study, including patients you are not sending this batch, will be sent every time complete patients are sent.

Related articles

• Septic Shock

Legacy

In CCMDB.mdb_Change_Log_2012#ver_2012-09-06 "First SBP<90" was changed to "BP Criteria". Ttenbergen 11:08, 2012 September 12 (CDT)