TISS28 collection & scanning Survey April 16, 2013
Hi everyone. The new TISS28 has now been in place for 3.5 month. We would like feedback once again from data collectors and from data processing in regards to these forms. Feedback from the data collection & processing front lines is helpful for continued bedside nursing education and also for the main database office to assess for applicable QA checks that could be automated in data processing (see: TISS28 Scanning quality checks), where possible. Beside commenting on compliance in your unit here, I need specific details in regards to items you observe done well or not on new forms.
The last survey done Jan 7.13 was very helpful and the information went back to QA officer, nursing education, ICU TASK team and managers. Also provided main office with important observation when interpreting TISS data and also some tweeking of wording on form.
Dats, thank you in advance for taking the time to comment here.
NOTE; when referring to any items on the TISS28 form, please indicate the TISS28 item number you are referring to. For example, if Hourly vital sign is missed or done well, refer to TISS #2. Thanks again.
Site
HSC
MICU/CCU Same issues as STB MICU plus:
- #2-Vital signs are occasionally counted for OH1 when all elements of monitoring are not met
- #9-CAM positive is not accurate on the TISS form
- #17 & #46-vascaths that dialysis patients have even prior to admission are not counted occasional as central lines
- LAST DAY - not done most of the time but the form is never missing.That I'm very grateful for!
- Compliance at filling in the form except for the last day is very good.
- Accuracy is improved since form has been changed to better language and it's easy to check
- line through bubble rather than filling in dot (HSC_MICU). Can't ID individual doing this.
SICU
STB
MICU
I find that there is more overall compliance with completing the new form. The problem spots are as follows:
- #9-Cam + is sometimes marked when it is not documented on the flow sheet and sometimes it is missing when it is documented
- #12-more than 5L per day IV fluids is usually missed as people are not going back to check if this amount of volume was given
- #24-chest physio is often missed
- #26-inhalation therapy is often missed
- #28 & #29-I always ensure when the extubations are marked as this is sometimes missed
- #40 to #44 -I always ensure when the specific interventions and
- #45-trips out of the ICU I always check to make sure they are done because this area has commonly missed items
- #46-49-Need to also check the 2300 hr items as these are sometimes done wrong
Overall, I find this tiss much easier to trouble shoot and check and compliance is much better. --LKolesar 10:17, 2013 April 16 (EDT)
CCU
In CCU,compliance with the new TISS is much improved since the last "audit". Problematic for my unit remain:
- #8 Drains - Foleys are seldom documented
- #20 O2 nasal prongs...Frequently missed
- #26 Puffers, nebulizers....Frequently missed
- #31 IV Lasix more than 30mg/day....Frequently missed
- #39 Emergency surgery E1 - Code "Stemi" Angiocath intervention certainly qualify as "EMERGENCY" surgery and yet this is frequently missed as well
- (Note to Marla: code stemi angios are not E1 surgery and should not be included in the tiss item # 39 Emergency Surgery. This was previously clarified.) --LKolesar 15:48, 2013 April 16 (EDT)
I have mentioned these "omissions" and compliance has much improved but not yet "stellar". Marla Penner
CICU
- I find the same problem areas as Laura noted above
- compliance is still only fair
- worst compliance is during weekends
- they often do not get another TISS sheet when the first one is full. Lois
CON
- Overall compliance has improved but with the following issues persist: Short stays of 1-2 days are on occasion left blank. The last day frequently not completed. Some forms appear to be "ripped" out of the chart so that all punch-holes have to be re-inforced.
- #3 Lab spec: miss when sending labs such as urine, ETT, etc.
- #5 Two IV meds or more: like the OAKS-not counting PRNs
- #6 Dressings: Counting the total sites not dressing changes/complexity
- #9 CAM +ve: Entered incorrectly-pt comatose, RASS -4/-5, confused only and not documented on flowsheets
- #12 >5L missed or entered incorrectly by including pre-ICU volumes
- #20 Supplemental Oxygen-missed on the day of extubation
- #25 Incentive spirometry: PRN puffers missed, incentive spirometry not charted
- #27 Intratracheal suctioning--missed on pts who are orally suctioned
- #46-#49 2300 hour items: entered on day of D/C and not present at 2300 hr
OAK
I find compliance rates with filling out the form to be similar to the old form.
- #2 hourly VS- not always documented properly eg) not a full set of VS done ( missing RR ) and this will still be blacked out
- #4 IV meds - 2 or more - nurse does not think to include prns
- #8 drainage tubes- an issue initially but was mentioned to staff and compliance has improved greatly
- #9 CAM +- poor documentation on flow sheet therefore rarely blacked out
- #5 Chest physio- I have to read PT charting to know if it was done, or notice them doing it- rare to have this filled out by nurse
- 46-49 - 2300 hr section is frequently not accurate. It seems as if the blacking out just continues, even if device is not longer in use.
- ADMIT DATE: Another occasional concern is that the admission date is not always accurate on the TISS, the first nurse to notice it then starts with the date that he/she is working with the patient and I have to backtrack the form.
GRA
I am impressed with the compliance in filling out the form. There just seems to be a rare occasion when one or two days are totally not filled in. ?one individual
- #2 Vital signs not done hourly yet filled in as such
- #3 specimen collection by RN missed on rare occasion
- #5 Two or more IV meds - missed frequently takes time to go through all med sheets to check
- 6&7 Dressing, sometimes confused
- #8 Drains - missed for foleys hopefully revised form will correct this
- #9 CAM + is seldom marked. Also marked incorrectly when a pt is sedated
- #12 > 5L fluids - missed on couple occasions
- #24 Chest physio - rarely documented as ever being done
- #31 substantial IV diuries - missed frequently
- LAST DAY is occasionally missed
- One TISS form totally missing
VIC
There is better compliance with the new TISS .I found like Laura, the following get missed:
- #9 Cam +
- #12 more than 5L IV fluid in ICU
- #24 Chest Physio
- #26 Inhalation therapy
- #45 RN accompanied trips - will be filled out yet the transport team goes only not the ICU nurse this depends if the test/procedure is done in the hospital or out of the hospital so you have to check whether the transport team went or the nurse.
April 17/13 {{The following seem to get missed frequently:
- #3 Lab specimen collection
- #4 Drainage tubes
- #9 -CAM + - discrepancy in having heavily sedated pts (rass -4 to -5) as CAM positive, and not marking it when the nurses notes indicate that there was cam + activity later in the day
- #24 - db&c is rarely if ever marked
- #26 and #31 (#35 -not used often here)- meds are almost always missed)
- #45 RN trips out of icu - people will mark when pt is accompanied by wrha transport team and not the nurse
Main office - Data Processing observations
- missing last day TISS - very common. (not marked with no Treatment or acutal last day in ICU NOT DONE).
- incorrect first date on form (admission date different than registry date)
- dates not sequential. Example: March 1, 3, 4 5,
- VERY faint (anemic) pencil marks to fill in bubbles on form
- bubble not clearly filled in (half filled or bubble is circled outside)
- BLUE pen used to fill out form
- incorrect unit recorded