STB ACCU Collection Guide

This article contains collection information specific to the CCU (Cardiac Care Unit) at St Boniface.

Charting Note

We are in phase 2 of electronic patient record implementation. This means that all patient log data, location information, lab and diagnosis imaging results, tests, physicians’ orders and pharmacy are obtained electronically. Eventually all data will be obtained electronically.

The CCU patient chart has a flow sheet for the nurses to fill out their vital signs and patient assessments. If the patient has had an acute MI, a care map type of flow sheet is used. This has four steps as the patient progresses in their recovery. A second option for nurses’ charting is a CCU flow sheet for all other types of patients other than acute MI. (examples: arrythmias, pre op optimizations, cardiomyopathy, chest pain NYD, etc. ). Occasionally a COR sheet (like those used on the wards) can be continued in CCU and even the Y2 procedure note page has been continued on a rare occasion for a patient who needs some CCU management post angio.

Post-Angio patients exclusion

Patients that arrive in CCU for post procedure care post angio only because the pre and post angio area is closed, are not included in our database.

Overflows in MSICU and ICCS

MSICU and ICCS can also have CCU patients as CCU overflows. They will often be located in one of these areas if they require intubation and /or IABP. However, they are still attended by the CCU doctors and the CCU data collector must enter them as a CCU patient. They usually remain under CCU unless further multi system issues exist that the CCU attending wishes to transfer the care to the ICU. In this case the patient is discharged from CCU and admitted to the ICU and the ICU data collector will then start a profile and continue to follow this patient. (insure that the respective TISS sheet follows the patient as they are moved between units if they continue to be a CCU pt.) Make sure the overflow is marked in the variable 5 slot.

STEMI code for From/To slots

A code STEMI is when a patient comes directly to the heart cath lab via EMS. This will result in an admit code from home (ZZ). If a patient comes from the heart cath lab you need to put where they were prior to this. For example Dauphin ER or ICU. If the patient was at St.B. ER but was transferred from another hospital prior to this, put the first entry hospital in the admit from. On the paper log sheet we put a small heart figure to indicate all primary angios in the admit from space but you also need to put where the patient was just prior, which is also written in this space.

Discussion

• This doesn't actually tell me when to use the STEMI code.Ttenbergen 16:36, 1 October 2009 (CDT)
• Is STEMI ever used in the "to" slot? Ttenbergen 16:36, 1 October 2009 (CDT)
• I think we should integrate this completely in Admit_From_&_Discharged_To#STEMI and only link there from here. Ttenbergen 16:36, 1 October 2009 (CDT)
  • CODE STEMI is a city wide alert system (similiar to a CODE BLUE) that is called on the PA system in the hospital to alert specific personnel to assist with this patient. For the data base purposes, after discussing this with Trish, she just wanted to capture this specific situation by the from code being ZZ and the first diagnosis being angiogram or plasty. This has nothing to do with the actual STEMI diagnosis which is usually coded with the specific location of the MI. (like inferior, posterior, anterior, etc.) I think all the nurses who are data collectors are aware of the difference here. --LKolesar 10:37, 2 October 2009 (CDT)
    • I realize that dx STEMI and admit-from STEMI are not the same thing. I suggested moving this to the admit-from Stemi documentation here.Ttenbergen 14:46, 2 October 2009 (CDT)

Diagnostic Coding vs Admit-From

Primary angiograms are those that go first to the angio room and then to CCU afterwards. In this case the first admit diagnosis should be angiogram, then angioplasty, then stent, then the MI with location subcode and then other items like CHF or TNK if applicable. The exception to this rule is when the patient has a cardiac arrest before arriving in CCU or has cardiogenic shock. These will then be coded first and then the primary angio sequence. If you are past the quota for number of admit diagnosis codes, you can use only angioplasty if necessary (take out angiogram and stent if needed).

If the patient comes from an ICU (different hospital) do not use the MI as the first diagnosis. Other options could be post infarct angina, unstable angina, chf, cardiogenic shock, etc. The second diagnosis could be the MI.

Labs

• Lab Collection Process

Remember to count cardiac MRI, echos and angiograms in the labs.

• With the EPR we do not count any labs or pharms until the patient is discharged from the unit, it is the last thing we do.--LKolesar

Pharmacy

Nitropatch amount is always one, only the number of days is counted. Observe all infusions in CCU and try to keep track of how many doses and days the patient is on the infusions. The rest of the pharmacy is easy to track on the EPR. Infusion drugs can be neglected to be signed for in the electronic MAR. Infusions commonly used in CCU are all antiarrythmics, all inotropes, some vasopressors and some antihypertensives.

Discussion

• Again, is this truly special to the CCU? This should probably be in one of Category:Pharmacy instead. Those are a bit of a mess, though, and may not be worth upgrading for now if we are going to change how they are collected soon. Ttenbergen 16:36, 1 October 2009 (CDT)

TISS

If the patient is a primary angio, item #91 (what's 91) should not be marked. However if the patient had a plasty, #96 operative procedure can (can or must?) be marked. If the angio happens as a complication (after arriving in CCU), then #91 can be marked.

If the patient has a temporary pacemaker, make sure one of the Tiss items #15 or 16 is marked for each day the patient has the pacemaker. If the patient goes for a permanent pacemaker, the OR #96 must be marked and then the next day the #15 or 16 should not be marked. If the permanent pacemaker is done and then the patient goes to the cardiology ward afterwards and does not return to CCU, #96 is not marked and the code permanent pacemaker is not entered as a complication. The patient is instead transferred to the OR and the profile is completed.

Discussion

• Again, is this truly special to the CCU? These sound like general TISS instructions that should be addressed in . Ttenbergen 16:36, 1 October 2009 (CDT)

Further info

NOTE: Instructions for doing apache scores and collecting all other data is already on the WIKI. These instructions are specific to CCU at StB.

Discussion

• this should probably just link back to the ICU Curriculum, though I have no idea in what state of completion that is. Ttenbergen 16:36, 1 October 2009 (CDT)