TISS

Therapeutic Intervention Scoring System

TISS Collection Guidelines

"Black Blobbing" - Fill the circles on the TISS form completely

The scanning program will not detect circles that are not filled completely with a sufficiently dark marker. Since it is impossible to control how bedside staff fill out the form, or for data collectors to gauge accurately what the scanner will be able to recognize, the has mandated that all TISS forms must have their filled circles “black blobbed” fully with a marker prior to handing in for scanning.

• this is part of the quality assurance that the collectors must do on the first 10 days of TISS only.

• • Here is an example of part of a TISS form when pencil is used: [|dates not visible]

TOstryzniuk 15:20, 3 December 2008 (CST)

Who fills out the TISS

• 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 discharged or passes away on their shift. TISS done on Day or Evening shift reflects the workload from midnight to time of discharge or death.

When and for how long is a TISS required

• 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 completed, 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 transferred to another ICU, do not sent the form to the other center.

• If a patient is transferred 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.

• See 2 Hour rule for patients admitted after 2200 or discharged before 0200

Quality Control

• Data collectors are required to do quality control for the first 10 days of TISS.

<dig up quality control guide an insert here> TOstryzniuk 15:23, 3 December 2008 (CST)

• the data processor runs internal consistency checks on the TISS data and will flag patients whose TISS information is inconsistent with their collected information. For a list of data consistency checks and rules, see the Data Integrity Rules Category.

TISS Item Guideline

• TISS mutually exclusive items
• TISS 2 hour rule
• TISS 48 hour rule
• TISS Neurological
• TISS Cardiovascular
• TISS Blood Products
• TISS Respiratory
• TISS Gastrointestinal
• TISS Genitourinary
• TISS Fluid Lytes bloodsample
• TISS Meds_IVs
• TISS General Care
• TISS Procedures Interventions

Background

• First introduced in 1974 by Cullen DJ, Civetta JM, Briggs BA, et al: Therapeutic scoring systems: A method of quantitative comparison of patient care. Crit Care Med 2:57-60, 1974) at the Massachusetts General Hospital. (TISS with 70 therapeutic variables).

• Modified in 1983. (TISS with 76 therapeutic variables).
• Modified version in 1994 for use for intermediate and floor care nursing units (iTISS).
• Modified version in 1996. (TISS with 28 therapeutic variables).

• ICU in the City of Winnipeg uses a locally modified version of the 1983 TISS-76 and has a list of 83 therapeutic variables.

• TISS is a method of quantifying nursing and medical care required by
• 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 (NOTE: this capability of TISS has lost its application with the appearance of more specific scoring systems in the 1980).
  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 integral part of the Acute Physiologic and Chronic Health Evaluation APACHE II

• The comparative scores of TISS and APACHE enables us to see trends in the type of nursing care (TISS) provided for certain acuity 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.

Discussion

• As LKolesar points out, there is variation in how the TISS is collected in different centers. Is this something we should look at? Ttenbergen 00:04, 27 May 2008 (CDT)