TISS28 collection Survey January 7, 2013

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TISS28 collection Survey January 7, 2013 LEGACY

Also see: TISS28 collection & scanning Survey April 16, 2013

Please do not post here anymore. Will start new Survey. Thank you those of you who have taken the time to post very helpful feedback here!! Continue to keep your nursing educators and managers up to date in regards to issues observed with the completion of TISS28. I will continue to pass this information back to nursing administration (Jodi) and nursing education so that we get support for this form.

Met with Basil Evan today the ICU QA officer for the Region. He has taken note of key issues and will discuss with Regional Education team. He will also be going to sites to do some TISS QA checks. He will contact data collector on day he may go to site. Next Survey will be done first week of March. ALL ICU STAFF from EACH ICU UNIT MUST post TISS items that they have observed in their unit to be the most problematic at their site.

The plan is to have collector stop doing such detailed QA checking on TISS at end of March. -Trish Ostryzniuk 15:46, 2013 February 7 (EST)

Compliance Question TISS 28 January 7, 2013

How is the new TISS28 is going at your site in terms of compliance etc? I know first week Jan may be a bit dicey, but let me know by the end of the month or sooner in regards to what you are seeing at your site with the new forms I will provide some feedback to Jodi Walker Tweed and nursing education & quality officer (Basil Evan).Trish Ostryzniuk 11:55, 2013 January 7 (EST)

  • Collection Staff: Please email the unit manager in the area you are assigned to keep them posted in regards to some of the issues you are observing with new TISS28 forms. This will allow them to help address some of the problems collectors are observing.

OAK

  • Nights continues to complete the form and I expect that this will be an old habit that will take a long time to fade. I thought we had switched over to the new forms but found old ones appearing on all new admissions. The problem was that there were admissions bundles made up that included the old forms. I worked a shift in ICU as a bedside nurse this weekend and assisted the unit clerk in switching out all the bundles so that problem should correct itself. I will have to go back and do the TISS on the days that were not done now that all forms have been switched over. I am finding it a little more time consuming to complete as we are getting used to the new form. Lorri Pruden

STB

  • STB_MICU - So far it seems well received and the nurses are completing it fairly well. The only thing so far I have seen being missed consistently is:
  • #28-planned extubations which is a new item so they are not used to it being there yet. There will be a learning curve. I will update you later in the month as well. Laura Kolesar. Jan 4.13.
  • STB_CCU - It’s a little early for me to tell how the new TISS will work out. My nurses are overwhelmed with “new” stuff right now and I think they just “gave up trying” between Christmas and New Years. There were an abnormal number of TISS missing and the ones that were accounted for, were sorely lacking in data. I will gently remind and coax for another week before I become worried about the new forms. Marla Penner. Jan 9.13

HSC

  • MICU and my IICU patients only I have the following comments:
  • The staff of MICU are doing the TISS for the most part. They have always been pretty good but miss certain elements. The educators Joanne Hutton and Maurita Keisman have been really supportive.
  • DISCHARGE DAY- the last day in unit continues to often not be filled in.
  • #31 Diuretics are missed completely or they are counting oral doses. Staff are filling in diuretics that are not at the listed doses.
  • DAY 1 TISS - I had a few patients that came in between 22:00 and 24:00 and the staff used the old 2 hour rule.
  • Some confusion seems to be occurring regarding the CRN's filling in the line counts. Some think they don't need to do it anymore, some think they do.I will try to go this week to check IICU and follow up on who their educator is. On December 31 a staff member told me they do not have an educator anymore. Their educator is Sarah from SICU. Dave was not sure why the staff would say they don't have and educator.
    • CRN's are to continue with line count form until they are notified by their manager to stop. I have email the managers today. -Trish Ostryzniuk 17:38, 2013 January 9 (EST)
  • 4 Meds any route -oral meds only are missed occasionally as a medication any route.GHall 17:26, 2013 January 10 (EST)
  • #9-CAM + is new and perhaps I need more education. Here is some valuable info I got from Maurita
    • Yes, should be done/documented every shift, or q12h.
    • There's a CAM tool (laminated) that RNs were provided. There are tools on the bulletin boards in the front and back of the units.
    • Is supposed to be charted on the neuro section of the flowsheet and the systems review. It should be CAM +, CAM - or unable to assess (due to therapeutic sedation etc).
  • Can we get some education on how the staff determine this scale and how it is supposed to be charted? Or maybe I will see what they got for info and post it
  • #2 - people are counting points for ONLY intake and output when the patients did not have vital signs for 2 hours.
  • #46-49 - The 23:00 hour questions are often missed,it's almost like they think they answered the questions already on the form. So far I have corrected them.
  • DISCHARGE DAY: The no tiss elements were not being filled in when a patient was transfer ready because of the description on the guidelines given to staff. They thought because the patient was transfer ready the tiss elements did not count.
  • #6-dressing for lines are missed
  • #6-dressings for decubitus are missed
  • #8- Drainage tubes: foley is not being included as a drainage tube.
  • #39 - emergency surgery is being double counted for gi scope/embolization
  • staff are writing on the form still, I'm constantly erasing.
  • #39 emerg surgery- staff are counting angios as emergency surgery
    • thank you Gail. Better yet, please email observations to Shelley, Basil Evan & Maurita.-Trish Ostryzniuk 19:28, 2013 January 25 (EST)
  • #9 CAM ve+ HSC_SICU - The charting of the # 9-CAM is not in a consistent place on the flowsheet. Sometimes it is in the IPN. It is generally being done inconsistently. I think it is then incorrectly interpreted by the TISS since an incomplete would appear the same as CAM –ve. Joyce Peterson Jan 14.13.

GRA

Spoke with Lily today and she said she thinks the nureses like the form better. I have not used it yet as ICU is backlogged and have been working on Dec discharges but I am looking forward to using them. - Mary Lou Waschuk. Jan 9.13

CON

I am just starting to look at Jan admit/discharges. I have not done the Tiss quality checks for any of these charts but for the 6 pts discharged the bedside nurses' incompletion of the TISS is still an issue--5 of 6 charts had 0-35% of the TISS days filled in.

  • Jan 22-Completion of the TISS is improving at the CON; but still issues of missed days (ex.first day on the TISS is the pt's fourth day in ICU --not done for the first three days,last day missed,etc.)
    • The educator, Jason Trottier, is drafting a memo addressing this issue.
  • I am finding that the quality checks are difficult for some of the items:
  • #9 CAM +ve- is being filled in as present with no documentation on the chart if pt CAM +/- or unable to do.
  • #25 Incentive spirometry being filled in-no documentation on the chart if done or not.
    • IF we find that the documentation is not there to validate the entry; do we leave the entry while doing our quality checks? Do we assume the nurse who filled in the TISS item did indeed do the task/assessment?Mlaporte 11:54, 2013 January 22 (EST)
      • Hi, good you are checking and providing feedback to educator so that they can inform & educate staff however, the expectation is not for the data collector to check and make sure every single item marked on the TISS is also in chart for every single patient. Random intermittent spot checks on fields like this are okay to do. You have to assume if they marked it, it is correct, don't want to to verify every single item. Will have to discuss to what degree QI checking should be done so it is done the same at each site.Trish Ostryzniuk 13:29, 2013 January 22 (EST)
  • Concordia is having many of the same TISS issues that Gail noted to be occurring at HSC.
  • #6 or 7 missed dressings
  • #46-49 missed 2300 hrs items
  • #8 missed drains /foley
  • FIRST DAY TISS & LAST DAY TISS: missed first and last day,etc)-Mlaporte 16:03, 2013 January 30 (EST)

VIC

As above stated nurses are forgetting to mark

  • #9 CAM positive
  • #8 drainage tubes are being missed
  • #6&7 - dressings
  • generally this new TISS is much more user friendly for the staff and for the data collector.