TISS

Therapeutic Intervention Scoring System

General Points

• First introduced in 1974 by David J. Cullen MD

• TISS is a method of quantifying nursing and medical care required by critically ill patients according to the number and type of therapeutic interventions employed.

• By quantifying nursing care, this helps reflect the amount of time as well as complexity of the care being given to a patient.

• TISS has become a widely accepted and validated method of classifying critically ill patients.

• TISS is utilized in the USA, Canada and abroad for many purposes:
  1. Determining severity of illness
  2. Establishing nurse’patient ratios in the ICU
  3. Assessing current utilization of ICU beds
  4. Establishing future needs and numbers of ICU beds
  5. Expresses work activities in statistical terms.

• TISS has been incorporated as an intergral part of the Acute Physiologic and Chronic Health Evaluation (APACHE). Page 80.

• The comparative scores of TISS and APACHE enables us to see trends in the type of nursing care (TISS) provided for certain acutely levels (APACHE), for a specific type of diagnosis.

• Reviewing both scores can help determine whether certain nursing activities can be redirected or standardized in certain types of critically ill patients without affecting patient mortality or morbidity.

• Each of the most common ICU nursing activities is weighted from 1 to 4 point. More points indicate that greater nursing management is required.

• A high daily TISS score indicates an increase in nursing workload.

• TISS is done retrospectively for the previous 24 hours of care in ICU.
  • In some centers it is done ongoing as care is given.--LKolesar 11:29, 21 May 2008 (CDT)

• TISS is generally done by Night staff.
  • In some centers it is done on all shifts as an ongoing tool.--LKolesar 11:29, 21 May 2008 (CDT)

• Day and Evening staff are also required to fill out a TISS if a patient is discharge or passes away on their shift. TISS done on Day or Evening shift reflects the workload from midnight to time of discharge or death.

• If a patient is in the ICU a very short time, a TISS score is required to reflect nursing efforts during this time.

• Do not sent TISS form to the ward with the chart. Please hand it in to the Unit Clerk who will file it in the Research Forms binder.

• Once the first 5 days of TISS are cmpleted, please do not staple together. Hand in the completed form to the Unit Clerk and start a new form. Scanning of forms is affected if stapled.

• TISS is to be done for a patients entire length of stay in ICU.

• If a patient is transfered to another ICU, do not sent the form to the other center.

• If a patient is transfered to another ICU in your center and the Service looking after the patient changes, then a new TISS form is required. E.G., a patient who goes from MICU under Medical Service and is transferred to SICU under Surgical service.

• Shaded items on TISS are MUTUALLY EXCLUSIVE. You can only select ONE item in that group for a 24 hour day.

• Qualilty control of TISS required to be done by data collector for the first 10 days of TISS.

TISS Item Rules

Hourly rule

Item 2 Hourly Neuro checks Item 10 Hourly Vital signs Minimum 6 hrs consecutively in the first 24 hrs in ICU to get points

Blood Products

 23  Infusion of blood ≤5/24 hrs.
 24  Infusion of blood ≥5/24 hrs.
 E.G.     1 u FFP = 350 mls
          1 u PC, HSA 5%, Pentaspan = 250 mls
          1 u HSA 25% = 100 mls

Does not include platelets. Platelets have own slot. This total includes Pentaspan since we are looking at workload.

TISS 23 & 24 & Lab data collection of blood products

E.G. 1u FFP=350 mls

1u PC,HSA 5%, Pentaspan = 250 mls

1u HSA 25% = 100 mls

For the lab data collection of blood products, since the amount in a bag now varies in terms of volume, please record totals as follows:

E.g. FFP 350 + 150 + 175 =675 Divide by 350 (base amt.) = 1.9. Amount given round off to = 2u. We are looking at the number of bags hung not the exact volumes Infused. If a person gets only half a bag of blood or only 2 mls for that matter, the cost is associated with hanging the product regardless of whether the volume is totally infused or not.

48 Hour Rule

  5    RX of seizures, metabolic encephalopathy
 17    Post arrest cardiac or respiratory
 34    Fresh Tracheostomy
 73    Acute digitilization

Any activity marked with 48 hrs on form, should have TISS days marked for 2 days.

Cardiovascular

 15    Temporary Pacemaker-Standby (includes external)

Temp-standby: wires hooked up but pace not turned on.

 16   Temporary Pacemaker-Active (includes external)

Temp-active: turned on but may not be pacing all the time. Testing not included. Permanent pacer not included.

 18    Cardioversion/Defibrillation

While in ICU only.

Discussion

• The TISS 23/24 section states that we want to know the number of bags since we are looking at work load, not product used. It also says to calcualte the total amount of product and round up. The two seem inconsistent.Ttenbergen 09:04, 21 May 2008 (CDT)
  • It is possible that Julie uses this information for other reasons (not nursing workload)--LKolesar 11:06, 22 May 2008 (CDT)
• Under Cardiovascular pacemaker 16 states that testing is not included. Where is testing included, then? Ttenbergen 09:04, 21 May 2008 (CDT)
  • I think this means you can't count that the pacemaker was actively pacing if you just turn it on to test it and then turn it off again. --LKolesar 11:06, 22 May 2008 (CDT)
    • Are we not tracking such testing then? Or are we tracking it under a different code? Ttenbergen 10:22, 26 May 2008 (CDT)

We don't track pacemaker testing (usually done by doctor)--LKolesar 13:20, 26 May 2008 (CDT)