Скачать презентацию Sudden Cardiac Arrest Measures Copyright The Joint Скачать презентацию Sudden Cardiac Arrest Measures Copyright The Joint

b4834799df82009d6d2802c956486236.ppt

  • Количество слайдов: 105

Sudden Cardiac Arrest Measures © Copyright, The Joint Commission Pilot Test Training November 10, Sudden Cardiac Arrest Measures © Copyright, The Joint Commission Pilot Test Training November 10, 2011

What You Need to Write Down © Copyright, The Joint Commission zhttp: //manual. jointcommission. What You Need to Write Down © Copyright, The Joint Commission zhttp: //manual. jointcommission. org

Training Objectives z. To provide participants the information needed to begin testing of the Training Objectives z. To provide participants the information needed to begin testing of the sudden cardiac arrest performance measures © Copyright, The Joint Commission – Understand the measure specifications – Become familiar with the data collection tool

Web. Echo availability z. Recorded and available for later viewing z. Can also be Web. Echo availability z. Recorded and available for later viewing z. Can also be downloaded to one’s computer © Copyright, The Joint Commission – Available for 2 months on Conference America server – TJC will make link available

z Sudden cardiac arrest accounts for approximately 350, 000 deaths in the United States z Sudden cardiac arrest accounts for approximately 350, 000 deaths in the United States annually with a survival rate of 5 -7%. z Many people affected have a history of cardiac disease, countless others have no cardiac history and are unaware of any risk factors z There are no formal, evidence-based guidelines or standards that are uniformly recognized and employed © Copyright, The Joint Commission Toll of Sudden Cardiac Arrest

Sponsors/Funders – All sponsorships are through unrestricted educational grants in which sponsors are at Sponsors/Funders – All sponsorships are through unrestricted educational grants in which sponsors are at arms-length. © Copyright, The Joint Commission z. Development of a monograph and performance measures is sponsored by the Medtronic, Boston Scientific, and St. Jude Medical corporations

z Test and implement standardized, evidencebased performance measures for sudden cardiac arrest treatment among z Test and implement standardized, evidencebased performance measures for sudden cardiac arrest treatment among – Two measures address therapeutic hypothermia – patient selection and temperature maintenance – One measure addresses time to defibrillation – One measure addresses endotracheal tube placement confirmation © Copyright, The Joint Commission Goals and Objectives of Pilot Test Phase

Measure Milestones and Timeline Specification Development Alpha test 5/10 2/10 6/10 -12/10 Final TAP Measure Milestones and Timeline Specification Development Alpha test 5/10 2/10 6/10 -12/10 Final TAP Mtg 11/11 -4/12 6/12 5/11 – 8/11 Public Comment Pilot test TAP meetings 9/10, 2/11 and 9/11 © Copyright, The Joint Commission Initial TAP Mtg

What’s in a Pilot Test? © Copyright, The Joint Commission z. Data Collection and What’s in a Pilot Test? © Copyright, The Joint Commission z. Data Collection and Submission z. On-site Visits for reliability z. Resource Tracking z. Monthly Conference Calls

z. Six months in duration beginning for discharges 11/1/11 and concluding for discharges through z. Six months in duration beginning for discharges 11/1/11 and concluding for discharges through 4/30/12. z. All 4 measures to be implemented and tested by participating sites z. Data will be collected and transmitted monthly using a secure web-based collection tool z. No sampling scheme applied © Copyright, The Joint Commission Pilot Test

z. Determine Measure and Data Element Reliability z. Gain an understanding of the issues z. Determine Measure and Data Element Reliability z. Gain an understanding of the issues related to implementation of sudden cardiac arrest measures z. Gain an understanding of resources needed for implementation z. Refine and enhance measure specifications © Copyright, The Joint Commission Pilot Test Objectives

Reliability Testing – Two levels tested –Measure level –Data element level © Copyright, The Reliability Testing – Two levels tested –Measure level –Data element level © Copyright, The Joint Commission z. Definition: The extent to which a measurement instrument yields consistent, stable, and uniform results over repeated observations or measurements under the same conditions each time.

Reliability Testing –Identify false negatives and false positives –Code reasons for discrepancies © Copyright, Reliability Testing –Identify false negatives and false positives –Code reasons for discrepancies © Copyright, The Joint Commission z Test Activities – On-site visits of a subset of participating hospitals – Re-abstraction of a sample of records previously transmitted to The Joint Commission – Compare results between the two abstractions

On Site Reliability Visits z. Focus Group Discussions © Copyright, The Joint Commission – On Site Reliability Visits z. Focus Group Discussions © Copyright, The Joint Commission – Discuss the measures and key implementation issues – Gather site recommendations for solutions

z. Since we will be re-abstracting the same records as those submitted, please keep z. Since we will be re-abstracting the same records as those submitted, please keep a crosswalk of the blinded numbers under which you submit a case online and the actual medical record number so it can be re-located and re-abstracted. © Copyright, The Joint Commission Reliability Site Visits

Tracking of Resources z. Track once or twice during the test z. Focus © Tracking of Resources z. Track once or twice during the test z. Focus © Copyright, The Joint Commission – Time spent in abstraction – Time spent in data entry – Time spent in implementation activities – Type of staff involved

Monthly Conference Calls z. Objectives – Provide Education and Support – Network z. Schedule Monthly Conference Calls z. Objectives – Provide Education and Support – Network z. Schedule © Copyright, The Joint Commission – Monthly

Conference Call Schedule Tuesday, Nov. 29, 2: 00 -3: 00, Central Time Friday, Dec. Conference Call Schedule Tuesday, Nov. 29, 2: 00 -3: 00, Central Time Friday, Dec. 16, 2: 00 – 3: 00, Central Time © Copyright, The Joint Commission Invitations, agenda and call-in information will be sent via e-mail.

Data Collection and Transmission Schedule Data Submission Date November 2011 12/15/11 December 2011 1/15/12 Data Collection and Transmission Schedule Data Submission Date November 2011 12/15/11 December 2011 1/15/12 January 2012 2/15/12 February 2012 3/15/12 March 2012 4/15/12 April 2012 5/15/12 © Copyright, The Joint Commission Patient Discharge Month

Site Visit Schedule © Copyright, The Joint Commission Determined After 2 -3 months of Site Visit Schedule © Copyright, The Joint Commission Determined After 2 -3 months of Data Submission

z Measure Information Forms – Numerator and denominator, exclusions, populations z Data Dictionary/Data Elements z Measure Information Forms – Numerator and denominator, exclusions, populations z Data Dictionary/Data Elements (Chart Information to be Collected) – Allowable values – Notes for abstraction z Missing & Invalid Data z Online Data Entry z Accessing and Using the Data Collection Tool © Copyright, The Joint Commission Components

z. SCA-01 Timeliness of First Defibrillation Attempt z. SCA-02 Confirmation of Endotracheal Tube Placement z. SCA-01 Timeliness of First Defibrillation Attempt z. SCA-02 Confirmation of Endotracheal Tube Placement z. SCA-03 Initiation of Therapeutic Hypothermia z. SCA-04 Maintenance of Thermoregulation in Therapeutic Hypothermia © Copyright, The Joint Commission List of Measures

– Early defibrillation is critical in optimizing survival outcomes from sudden cardiac arrest (SCA) – Early defibrillation is critical in optimizing survival outcomes from sudden cardiac arrest (SCA) due to ventricular fibrillation (VF) or pulseless ventricular tachycardia – NRCPR investigators confirmed that, for patients who arrest in the hospital with an initial rhythm of ventricular fibrillation or pulseless ventricular tachycardia (VT), defibrillation within 2 minutes (compared to greater than 2 minutes) was associated with a higher likelihood of survival to discharge. © Copyright, The Joint Commission SCA-01 Timeliness of First Defibrillation Attempt z. Rationale

z Denominator - The statement defining the population of interest – Cardiac arrest events z Denominator - The statement defining the population of interest – Cardiac arrest events occurring after the time of arrival in patients with an ICD-9 -CM Principal or Other Diagnosis Code of cardiac arrest as described in Appendix A-1 in whom the initial rhythm is either ventricular fibrillation or pulseless ventricular tachycardia. z Numerator - The statement defining the cases within the population of interest who have received the specific care being measured – First defibrillation shock delivered within 2 minutes (under 3 minutes) of cardiac arrest time © Copyright, The Joint Commission SCA - 01

z Cardiac arrest events occurring prior to hospital arrival in the ED z Cardiac z Cardiac arrest events occurring prior to hospital arrival in the ED z Cardiac arrest events occurring wherein the initial rhythm is not ventricular fibrillation or pulseless ventricular tachycardia. z Cardiac arrest events occurring in patients with a code status order prior to the event z Cardiac arrest events occurring during a specified ICD-9 -CM principal or other procedure (during cardiac catheterization, during cardiac electrophysiology testing, while on cardiac bypass during open heart surgery, or while on extracorporeal membrane oxygenation (ECMO). © Copyright, The Joint Commission SCA – 01 Exclusions

z Cardiac arrest events occurring in patients with left ventricular assist devices (LVADs) or z Cardiac arrest events occurring in patients with left ventricular assist devices (LVADs) or bilateral ventricular assist devices (BIVADs). z Events occurring in patients with any device implanted prior to cardiac arrest that is designed to deliver a defibrillation shock in the event of cardiac arrest (intra-cardiac defibrillators, defibrillator/pacemakers, etc. ). z Age <18 years – Note that events in ED patients and inpatients are included; events prior to ED arrival are excluded. © Copyright, The Joint Commission SCA – 01 Exclusions – cont’d

Data Elements – SCA-01 – – – – Arrival Date Arrival Time Birthdate Cardiac Data Elements – SCA-01 – – – – Arrival Date Arrival Time Birthdate Cardiac Arrest Date Cardiac Arrest Event Number Cardiac Arrest Time Implanted Device Initial Rhythm Left Ventricular Assist Device, Biventricular Assist Device Code Status Order Code Status Oder Date Code Status Order Time Patient Location © Copyright, The Joint Commission z Denominator

Data Elements – SCA - 01 z. Numerator © Copyright, The Joint Commission – Data Elements – SCA - 01 z. Numerator © Copyright, The Joint Commission – First Defibrillation Shock Date – First Defibrillation Shock Time

SCA-02 Timely Confirmation of Correct Endotracheal Tube Placement – Unrecognized esophageal intubation is the SCA-02 Timely Confirmation of Correct Endotracheal Tube Placement – Unrecognized esophageal intubation is the most serious complication of tracheal intubation and is potentially catastrophic – Chest X-Ray is not an acceptable method of verification; other methods, such as auscultation of the chest and fogging in the tube, likewise are not reliable – NRCPR database: 18% = no confirmation, 26% = auscultation alone. Capnography or EDD = increased ROSC and higher survival rates. © Copyright, The Joint Commission z. Rationale

SCA-02 – Cardiac arrest events during which an endotracheal tube is placed wherein confirmation SCA-02 – Cardiac arrest events during which an endotracheal tube is placed wherein confirmation of endotracheal tube placement is documented within one minute of intubation by a specified method : – – – Capnometry, or Electronic waveform capnography, or Esophageal detection devices, or Exhaled CO 2 colorimetric monitor, or Revisualization with direct laryngoscopy © Copyright, The Joint Commission z Denominator - The statement defining the population of interest – Cardiac arrest events during which an endotracheal tube is placed. z Numerator - The statement defining the cases within the population of interest who have received the specific care being measured

Exclusions © Copyright, The Joint Commission z. Cardiac arrest events occurring while an endotracheal Exclusions © Copyright, The Joint Commission z. Cardiac arrest events occurring while an endotracheal tube is in place z. Cardiac arrest events occurring prior to hospital arrival z. Age <18 years

Data Elements – SCA-02 – Arrival Date – Arrival Time – Birthdate – Cardiac Data Elements – SCA-02 – Arrival Date – Arrival Time – Birthdate – Cardiac Arrest Date – Cardiac Arrest Event Number – Cardiac Arrest Time – Endotracheal Intubation Date – Endotracheal Intubation Time © Copyright, The Joint Commission z Denominator

Data Elements – SCA-02 z. Numerator © Copyright, The Joint Commission – Endotracheal Intubation Data Elements – SCA-02 z. Numerator © Copyright, The Joint Commission – Endotracheal Intubation Confirmation Date – Endotracheal Intubation Confirmation Time – Methods of Intubation Confirmation

SCA-03 Initiation of Therapeutic Hypothermia – Mild hypothermia is the only therapy applied in SCA-03 Initiation of Therapeutic Hypothermia – Mild hypothermia is the only therapy applied in the postcardiac arrest setting that has been shown to increase survival rates. – Of benefit in overall survival rates and neurological outcome when used for survivors of out-of-hospital sudden cardiac arrest – Use of therapeutic hypothermia remains limited, with recent estimates suggesting that approximately 2300 (range 300 to 9500) additional comatose patients with cardiac arrest annually would achieve good neurological outcomes if hypothermia were fully implemented in US hospitals – Current evidence supports use only for out-of-hospital arrest survivors. © Copyright, The Joint Commission z. Rationale:

SCA-03 z Denominator - The statement defining the population of interest – Patients who SCA-03 z Denominator - The statement defining the population of interest – Patients who sustain a cardiac arrest prior to hospital admission, and who meet all of the following criteria: – Ventricular fibrillation or pulseless ventricular tachycardia is the initial rhythm at cardiac arrest, and return of spontaneous circulation, and comatose – Patients for whom therapeutic hypothermia is initiated either prior to or after hospital arrival, or who are transferred to another acute care facility for therapeutic hypothermia. © Copyright, The Joint Commission z Numerator - The statement defining the cases within the population of interest who have received the specific care being measured

SCA – 03 Exclusions Patients without return of spontaneous circulation Patients not comatose Cardiac SCA – 03 Exclusions Patients without return of spontaneous circulation Patients not comatose Cardiac arrest occurring after hospital admission Expired after therapeutic hypothermia ordered but prior to initiation of hypothermia – Age < 18 years – Documented reason for not administering therapeutic hypothermia © Copyright, The Joint Commission – –

SCA-03 Data Elements – – – – Admission Date Admission Time Birthdate Cardiac Arrest SCA-03 Data Elements – – – – Admission Date Admission Time Birthdate Cardiac Arrest Date Cardiac Arrest Time Comatose Date Therapeutic Hypothermia Ordered Discharge Date Discharge Disposition Discharge Time Initial Rhythm Reason for Not Administering Therapeutic Hypothermia Return of Spontaneous Circulation Time Therapeutic Hypothermia Ordered © Copyright, The Joint Commission Denominator:

SCA-03 Data Elements – Arrival Date – Arrival Time – Date Therapeutic Hypothermia Initiated SCA-03 Data Elements – Arrival Date – Arrival Time – Date Therapeutic Hypothermia Initiated – Discharge Disposition – Reason for Transfer – Therapeutic Hypothermia Initiated – Time Therapeutic Hypothermia Initiated © Copyright, The Joint Commission z. Numerator:

SCA-04 Maintenance of Thermoregulation in Therapeutic Hypothermia – The Advanced Life Support Task Force SCA-04 Maintenance of Thermoregulation in Therapeutic Hypothermia – The Advanced Life Support Task Force of the International Liaison Committee on Resuscitation (ILCOR) in 2003 recommended that unconscious adult patients with spontaneous circulation after out-of-hospital cardiac arrest should be cooled to 32 degrees C to 34 degrees C for 12 to 24 hours when the initial rhythm was ventricular fibrillation – This recommendation was repeated by the American Heart Association in the 2010 Guidelines for Cardiopulmonary Resuscitation © Copyright, The Joint Commission z. Rationale

z Denominator - The statement defining the population of interest – Patients with an z Denominator - The statement defining the population of interest – Patients with an ICD-9 -CM Principal or Other Diagnosis Code of cardiac arrest as described in Appendix A-1 for whom therapeutic hypothermia is initiated after sudden cardiac arrest. z Numerator - The statement defining the cases within the population of interest who have received the specific care being measured – Patients for whom thermoregulation is maintained. (There is at least one core temperature recording every hour between 34 and 32 degrees C for a minimum of 12 continuous hours. z © Copyright, The Joint Commission SCA - 04

– Code Status order enacted after initiation of therapeutic hypothermia – Expired during therapeutic – Code Status order enacted after initiation of therapeutic hypothermia – Expired during therapeutic hypothermia – Transferred out within 12 hours after initiation of therapeutic hypothermia – Non-system reason for early discontinuance of therapeutic hypothermia – Note that patients receiving therapeutic hypothermia after inhospital or out-of-hospital arrest are included © Copyright, The Joint Commission SCA – 04 Exclusions

SCA – 04 Data Elements – – – – Cardiac Arrest Date Cardiac Arrest SCA – 04 Data Elements – – – – Cardiac Arrest Date Cardiac Arrest Time Date Therapeutic Hypothermia Ended Date Therapeutic Hypothermia Initiated Discharge Date Discharge Disposition Discharge Time Reason for Early Discontinuation of Therapeutic Hypothermia Code Status Order Date Code Status Order Time Therapeutic Hypothermia Initiated Time Therapeutic Hypothermia Ended Time Therapeutic Hypothermia Initiated © Copyright, The Joint Commission z Denominator

SCA – 04 Data Elements z. Numerator © Copyright, The Joint Commission – Thermoregulation SCA – 04 Data Elements z. Numerator © Copyright, The Joint Commission – Thermoregulation Maintained

Diagnosis Codes – 427. 5 - Cardiorespiratory arrest – 668. 10 through 668. 14, Diagnosis Codes – 427. 5 - Cardiorespiratory arrest – 668. 10 through 668. 14, inclusive -Cardiac arrest or failure following anesthesia or other sedation in labor and delivery – 997. 1 - Cardiac arrest during or resulting from a procedure, Cardiac insufficiency during or resulting from a procedure, Cardiorespiratory failure during or resulting from a procedure, Heart failure during or resulting from a procedure – V 12. 53 - Sudden cardiac death successfully resuscitated © Copyright, The Joint Commission z Cardiac Arrest ICD-9 -CM Code

z. Not all CPT codes for hypothermia are specific to cardiac arrest; therefore, use z. Not all CPT codes for hypothermia are specific to cardiac arrest; therefore, use hypothermia records as a source to identify patients receiving therapeutic hypothermia. z. Procedure codes for exclusionary procedures in SCA-01 are given in the data element “Patient Location”. © Copyright, The Joint Commission Procedure Codes

© Copyright, The Joint Commission Questions © Copyright, The Joint Commission Questions

© Copyright, The Joint Commission Measure Set-Specific Data Elements © Copyright, The Joint Commission Measure Set-Specific Data Elements

z Denominator – Cardiac Arrest Date – Cardiac Arrest Event Number – Cardiac Arrest z Denominator – Cardiac Arrest Date – Cardiac Arrest Event Number – Cardiac Arrest Time – Implanted Device – Initial Rhythm – Left Ventricular Assist Device, Biventricular Assist Device – Code Status Order – Code Status Oder Date – Code Status Order Time – Patient Location © Copyright, The Joint Commission Data Elements – SCA-01

Cardiac Arrest z Equivalent terms for cardiac arrest include Code Blue or cardiorespiratory arrest Cardiac Arrest z Equivalent terms for cardiac arrest include Code Blue or cardiorespiratory arrest z The preferred source is the resuscitation (Code Blue) record. © Copyright, The Joint Commission z Absence of both pulse and breathing. –Y The patient sustained a cardiac arrest –N The patient did not sustain a cardiac arrest

z The time of cardiac arrest for a patient NOT on a cardiac monitor, z The time of cardiac arrest for a patient NOT on a cardiac monitor, or on a monitor that is not recording, is the time a Code Blue is called. z The time of cardiac arrest for a patient on a recording cardiac monitor is the time documented on the rhythm strip that the cardiac arrest occurred. For patients on a recording monitor, this time supersedes the time a Code Blue was called. z For times that include “seconds”, remove the seconds and record the time as is. Example: 15: 00: 35 would be recorded as 15: 00 © Copyright, The Joint Commission Cardiac Arrest Time

z The number used to identify the numerical sequence of the cardiac arrest event z The number used to identify the numerical sequence of the cardiac arrest event for which data are being abstracted. You may record data for up to 5 arrest events. z A cardiac arrest event may be a single instance of cardiac arrest, or multiple arrests occurring within minutes of each other z If the time elapsed between cardiac arrests is more than one hour, they are separate Cardiac Arrest Event Numbers. If the time elapsed between arrests is less than one hour, both arrests are part of the same Cardiac Arrest Event Number. z Allowable values are 1, 2, 3, 4, and 5. © Copyright, The Joint Commission Cardiac Arrest Event Number

z An implanted device is one inserted into the patient, either temporarily or permanently, z An implanted device is one inserted into the patient, either temporarily or permanently, that is designed to deliver a defibrillation shock at the time of a cardiac arrest. – Y (Yes) There is a documentation that the patient had an implanted device in place prior to the date and time of cardiac arrest – N (No) There is no documentation that the patient had an implanted device in place prior to the date and time of cardiac arrest z Internal pacemaker/defibrillators are included; external or wearable devices, such as Life. Vest, are not included as implanted devices © Copyright, The Joint Commission Implanted Device

z The first cardiac rhythm recorded during a cardiac arrest on a cardiac monitor z The first cardiac rhythm recorded during a cardiac arrest on a cardiac monitor or automated external defibrillator strip, or the first rhythm recorded on the resuscitation record (code sheet). – 1 The initial rhythm recorded during a cardiac arrest via electronic interpretation on a cardiac monitor or automated external defibrillator strip, or recorded on the code sheet, was ventricular fibrillation or pulseless ventricular tachycardia. – 2 The initial rhythm recorded during a cardiac arrest via electronic interpretation on a cardiac monitor or automated external defibrillator strip, or recorded on the resuscitation record (code sheet) was asystole or some other rhythm. – 3 Unable to determine (UTD) the initial rhythm © Copyright, The Joint Commission Initial Rhythm

Left Ventricular Assist Device/BIVAD – Y (Yes) There is a documentation that the patient Left Ventricular Assist Device/BIVAD – Y (Yes) There is a documentation that the patient had either an LVAD or Bi. VAD in place prior to the date and time of cardiac arrest – N (No) There is no documentation that the patient had either an LVAD or Bi. VAD in place prior to the date and time of cardiac arrest – NOTE: the device must be in place prior to cardiac arrest to answer Yes. © Copyright, The Joint Commission z A left ventricular assist device (LVAD) is an implantable mechanical pump that helps pump blood from the left ventricle; a biventricular assist device (Bi. VAD) is a mechanical pump implanted to assist both the right and left ventricles.

z A code status order is a physician order directing actions to be taken z A code status order is a physician order directing actions to be taken or treatment approaches for a patient in the event that his or her condition deteriorates, in the event of cardiac or respiratory arrest, or for patients who are or will become terminal. Orders to terminate life support are also considered code status orders. z Includes: DNR, MOLST/POLST, Comfort Measures, Hospice, etc. z Excluded: – Advance directive signed by patient or family with no accompanying order – Living will signed by patient with no accompanying order © Copyright, The Joint Commission Code Status Order

Patient Location z Location of the patient at the time of cardiac arrest – Patient Location z Location of the patient at the time of cardiac arrest – 1 – In the electrophysiology department/lab, in the cardiac catheterization suite, on cardiac bypass during open heart surgery, or while on extracorporeal membrane oxygenation bypass. – 2 - cardiac arrest occurred prior to arrival in the ED – 6 – in the general operating room – 7 – in a general hospital area, such as lobby, elevator, hallway, or during transport – 8 – in a diagnostic testing or therapy area, such as diagnostic imaging, nuclear imaging, or physical therapy – 9 - in the ED 10 – other © Copyright, The Joint Commission – 3 – In a monitored patient bed in a patient care unit, including observation units – 4 – in an unmonitored patient bed in a patient care unit, including observation units – 5 – in the dialysis suite

z When determining location, if there is a procedure record, such as electrophysiology lab z When determining location, if there is a procedure record, such as electrophysiology lab or ambulatory surgery, refer to the recorded times of arrival and departure from those areas that are recorded on the procedure note. z Be as specific as possible z When more than one choice is possible, choose the lowest applicable number. For example, if an outpatient comes for physical therapy and experiences a cardiac arrest in physical therapy and is subsequently transported to the ED for treatment, although Value 8 is applicable, Value 2 is also applicable and you would choose value 2, cardiac arrest occurred prior to arrival in the ED. z The patient must be actively in the cardiac cath lab, electrophysiology suite, or on open heart bypass or ECMO bypass to answer Value 1. ICD 9 -CM codes are given to assist abstraction, but their presence does not automatically require Value 1 to be chosen; the patient must be undergoing the bypass or in the specialty suites at the time of arrest. © Copyright, The Joint Commission Patient Location – cont’d.

Data Elements – SCA-02 z. Numerator © Copyright, The Joint Commission – Endotracheal Intubation Data Elements – SCA-02 z. Numerator © Copyright, The Joint Commission – Endotracheal Intubation Confirmation Date – Endotracheal Intubation Confirmation Time – Methods of Intubation Confirmation

Methods of Intubation Confirmation – Capnometry – Measurement of the partial pressure of carbon Methods of Intubation Confirmation – Capnometry – Measurement of the partial pressure of carbon dioxide in exhaled air, usually via a device attached to the endotracheal tube. Such measurements are abbreviated as Pet. CO 2, plus a number. – Electronic Waveform Capnography – Graphic tracing of carbon dioxide content in exhaled air, abbreviated as ETCO 2. – Esophageal Detection Devices – Mechanical devices used to check for tube placement that rely on the anatomy of the larynx and esophagus, more commonly used outside the hospital by EMS systems. – Exhaled CO 2 colorimetric monitor – measurement of exhaled carbon dioxide via infrared or other technology, abbreviated as ETCO 2. z. © Copyright, The Joint Commission z The acceptable methods of confirmation of intubation are:

– Revisualization with direct laryngoscopy – use of the laryngoscope to revisualize the endotracheal – Revisualization with direct laryngoscopy – use of the laryngoscope to revisualize the endotracheal tube insertion point. – Video-assisted laryngoscopy – Use of a video cable or camera in a rigid laryngoscope blade to visualize the glottis; images may be displayed on a LCD monitor. Common names for this equipment are Glidescope, Laryflex, Mc. Grath, Airtraq, Macintosh, and others. This includes fiberoptic visualization Note: Begin abstracting at the time of endotracheal intubation and look for any inclusion term within 30 minutes of intubation. z Examples of Inclusions: Pet. CO 2 (plus any number), ETCO 2 (plus any number), Esophageal detection device, EDD, Capnometry, Capnography, Color Waveform, Cords revisualized. z Exclusions: Bilateral breath sounds, Chest OK, Tube placed OK, No gurgling, Chest X-Ray (CXR) for tube placement, Chest PA and lateral, Abdomen negative for air © Copyright, The Joint Commission Methods of Intubation Confirmation

SCA-03 Data Elements Denominator: – Comatose – Reason for Not Administering Therapeutic Hypothermia – SCA-03 Data Elements Denominator: – Comatose – Reason for Not Administering Therapeutic Hypothermia – Return of Spontaneous Circulation © Copyright, The Joint Commission Numerator: – Reason for Transfer

Comatose – Y (Yes) There is documentation the patient was comatose. – N (No) Comatose – Y (Yes) There is documentation the patient was comatose. – N (No) There is no documentation that the patient was comatose. © Copyright, The Joint Commission z. Comatose patients are those patients documented as lacking purposeful movement or lacking response to painful stimuli or those patients for whom the term “comatose” has been entered into the clinical record

Reason for Not Administering Therapeutic Hypothermia – 1 - There is a system reason Reason for Not Administering Therapeutic Hypothermia – 1 - There is a system reason documented for not administering therapeutic hypothermia. – 2 – There is another reason documented for not administering therapeutic hypothermia – 3 -There is no reason documented for not administering therapeutic hypothermia, or unable to determine from medical record documentation. © Copyright, The Joint Commission z. Allowable Values:

Reason for Not Administering Therapeutic Hypothermia z System reasons for not administering therapeutic hypothermia Reason for Not Administering Therapeutic Hypothermia z System reasons for not administering therapeutic hypothermia are: © Copyright, The Joint Commission – Equipment-related (e. g. , machine malfunction, ice machine broken, power outage) – Staff-related (e. g. , nursing staffed in numbers inadequate for hypothermia)

z Patients with a return of spontaneous circulation are those patients who have a z Patients with a return of spontaneous circulation are those patients who have a detectable pulse without human or mechanical assistance, such as chest compressions or ventricular assistance devices, after a period of pulselessness. – Y Yes – there was return of spontaneous circulation – N No - there was no return of spontaneous circulation Note: Begin abstraction at the Cardiac Arrest Time and end 2 hours after cardiac arrest, looking for a pulse rate recording by any method (apical, Doppler, etc. ) at the same time that there are no chest compressions or mechanical assistance. © Copyright, The Joint Commission Return of Spontaneous Circulation

Reason for Transfer z Allowable Values: – 1 –Transferred for therapeutic hypothermia – 2 Reason for Transfer z Allowable Values: – 1 –Transferred for therapeutic hypothermia – 2 – Transferred for some other reason not related to therapeutic hypothermia – 3 – Unable to determine reason for transfer, or no reason stated. – The specific reason for transfer must be stated; if there is no reason stated, select value 3, unable to determine the reason for transfer. – If the reason stated is “Cardiac Care”, “Cardiac ICU’, or a similar term select value 2. – If the reason for transfer is “consider hypothermia”, or “for hypothermia administration”, select value 1. – If the transfer occurs more than 24 hours after the time of cardiac arrest, select N (No). © Copyright, The Joint Commission z Notes for Abstraction: .

SCA – 04 Data Elements z Denominator – Date Therapeutic Hypothermia Ended – Date SCA – 04 Data Elements z Denominator – Date Therapeutic Hypothermia Ended – Date Therapeutic Hypothermia Initiated – Reason for Early Discontinuation of Therapeutic Hypothermia – Therapeutic Hypothermia Initiated – Thermoregulation Maintained © Copyright, The Joint Commission z Numerator

z. Date Therapeutic Hypothermia Ended – Use the date that re-warming began – If z. Date Therapeutic Hypothermia Ended – Use the date that re-warming began – If therapeutic hypothermia is being given via a machine that uses cooling catheters or endovascular probe attached to a machine, and the catheter or probe is inserted in advance of the machine being turned on or activated, use the date the machine was turned on. If the date the machine was turned on is not documented, use the date the catheter or probe was inserted. – In some cases, this date may be the date before arrival © Copyright, The Joint Commission z. Date Therapeutic Hypothermia Initiated

Reason for Early Discontinuance of Therapeutic Hypothermia discontinuation of therapeutic hypothermia – 2 There Reason for Early Discontinuance of Therapeutic Hypothermia discontinuation of therapeutic hypothermia – 2 There is any other reason documented for discontinuation of therapeutic hypothermia – 3 There is no reason documented for discontinuation of therapeutic hypothermia © Copyright, The Joint Commission z Documentation of a reason for discontinuation of therapeutic hypothermia before the achievement of twelve continuous hours of temperature between 32 degrees and 34 degrees Celsius – 1 There is a system reason documented for

Reason for Early Discontinuance of Therapeutic Hypothermia System reasons for discontinuation are: If a Reason for Early Discontinuance of Therapeutic Hypothermia System reasons for discontinuation are: If a system or staff-related reason is given for discontinuance, select value 1, there is a system reason. If there is a medical reason documented for discontinuance of hypothermia before the achievement of 12 continuous hours of temperature in the range of 32 to 34 degrees Celsius, select value 2, any other reason. (An example of this might be uncontrollable shivering. ) © Copyright, The Joint Commission – Equipment-related (e. g. , machine malfunction, ice machine broken, power outage) – Staff-related (e. g. , nursing staffed in numbers inadequate for hypothermia)

Therapeutic Hypothermia Initiated – Therapeutic hypothermia is a process of cooling a patient to Therapeutic Hypothermia Initiated – Therapeutic hypothermia is a process of cooling a patient to a temperature range of 34 degrees to 32 degrees Centigrade following cardiac arrest. Cooling may be accomplished in a variety of ways that include administration of iced or refrigerated saline, application of cooling blankets, application of ice bags to various points of the body simultaneously, or by use of therapeutic hypothermia systems that use indwelling central venous cooling catheters and endovascular probes. In some cases, therapeutic hypothermia may be initiated prior to hospital arrival. © Copyright, The Joint Commission z Documentation that therapeutic hypothermia was begun.

Thermoregulation Maintained – Definition: Maintenance of thermoregulation in therapeutic hypothermia occurs when there is Thermoregulation Maintained – Definition: Maintenance of thermoregulation in therapeutic hypothermia occurs when there is at least one core temperature recording between 32 and 34 degrees Celsius every hour for a minimum of twelve continuous hours. – Suggested Data Collection Question: – Allowable Values: – Yes, No, UTD © Copyright, The Joint Commission Was there a core temperature recording every hour that was between 32 and 34 degrees Celsius for a minimum of 12 continuous hours?

z Begin assessing temperature when the first temperature recorded is between 34 and 32 z Begin assessing temperature when the first temperature recorded is between 34 and 32 degrees Celsius. Since SCA-04 assesses the maintenance of appropriate temperature for a minimum of 12 continuous hours, there must be a temperature recording between 32 and 34 degrees Celsius as the first temperature recorded in each of the eleven hours after the first hour in which that temperature range is reached © Copyright, The Joint Commission Thermoregulation Maintained

z If there is an hour within those next eleven hours in which there z If there is an hour within those next eleven hours in which there is no first temperature recording between 32 and 34 degrees Celsius, look at the next hour in which a temperature is recorded within 32 to 34 degree Celsius and count that as the first hour of another 12 hour period. z If there is no continuous 12 hour period in which the first temperature recorded each hour was within the range of 32 to 34 degrees Celsius, select value 2, No. © Copyright, The Joint Commission Thermoregulation Maintained

Thermoregulation Maintained – Any probe inserted in the cardiovascular system, such as pulmonary artery Thermoregulation Maintained – Any probe inserted in the cardiovascular system, such as pulmonary artery catheter or endovascular probe – Any temperature probe inserted in the bladder or rectum – Tympanic (ear) temperature – Axillary © Copyright, The Joint Commission z Conversion chart for Fahrenheit to Celsius given, as well as calculation formula z If there is more than one temperature recorded at the same time from different sources, use the temperature source in the following order:

z Code tables for cardiac arrest are in Appendix A-1; the hypothermia code is z Code tables for cardiac arrest are in Appendix A-1; the hypothermia code is not exclusive to cardiac arrest and is not often used. z Especially if you are collecting data while patients are still hospitalized, use Code Blue Records to identify patients for measures 01, 02, and 03. Also, check ED records, especially for Measure 03, looking for cardiac arrest and intubations. z For measure 04, use hypothermia administration records. © Copyright, The Joint Commission How to Identify Patients Eligible for the Measures?

© Copyright, The Joint Commission zhttp: //manual. jointcommission. org z. Enter data into the © Copyright, The Joint Commission zhttp: //manual. jointcommission. org z. Enter data into the online form z. Keep a crosswalk of the patient identification numbers z. First conference call is on Tuesday November 29 th.

© Copyright, The Joint Commission Questions © Copyright, The Joint Commission Questions

79 © Copyright, The Joint Commission Navigating the Sudden Cardiac Arrest Project Data Collection 79 © Copyright, The Joint Commission Navigating the Sudden Cardiac Arrest Project Data Collection Tool

GET STARTED 80 © Copyright, The Joint Commission Access the project website at: http: GET STARTED 80 © Copyright, The Joint Commission Access the project website at: http: //manual. jointcommission. org

81 © Copyright, The Joint Commission LOG IN TO THE PROJECT SITE 81 © Copyright, The Joint Commission LOG IN TO THE PROJECT SITE

82 © Copyright, The Joint Commission SUDDEN CARDIAC ARREST PROJECT 82 © Copyright, The Joint Commission SUDDEN CARDIAC ARREST PROJECT

From this page you can: § Access your hospital page § Access the Measure From this page you can: § Access your hospital page § Access the Measure and Data Element info § Find data submission dates § Submit questions and provide feedback § Find news, tools and other resources that may become available during the project © Copyright, The Joint Commission SUDDEN CARDIAC ARREST PROJECT PAGE

YOUR HOSPITAL PAGE 84 © Copyright, The Joint Commission From this page you can: YOUR HOSPITAL PAGE 84 © Copyright, The Joint Commission From this page you can: § Add or update your hospital information § Enter new records § View and update existing records § Mark records as “complete” § Review records that have been completed § Identify records that have been flagged for reabstraction

85 © Copyright, The Joint Commission Updating Hospital Demographic Information 85 © Copyright, The Joint Commission Updating Hospital Demographic Information

86 © Copyright, The Joint Commission Updating Hospital Demographic Information 86 © Copyright, The Joint Commission Updating Hospital Demographic Information

87 © Copyright, The Joint Commission Entering New Records 87 © Copyright, The Joint Commission Entering New Records

View and update existing records Click the Pencil icon to “Edit” an existing record View and update existing records Click the Pencil icon to “Edit” an existing record 88 © Copyright, The Joint Commission Click the UBCI number to “expand” an existing record

Mark records as complete 89 © Copyright, The Joint Commission Click the empty box Mark records as complete 89 © Copyright, The Joint Commission Click the empty box to “Complete” and “Lock” a record

Review records that have been completed 90 © Copyright, The Joint Commission Click the Review records that have been completed 90 © Copyright, The Joint Commission Click the “Complete” radio button and then click “Filter” to view completed records

Identify records flagged for re-abstraction 91 © Copyright, The Joint Commission The “Lock” icon Identify records flagged for re-abstraction 91 © Copyright, The Joint Commission The “Lock” icon means the record is complete. The blue flag icon means the record will be re-abstracted.

ENTERING NEW RECORDS 92 © Copyright, The Joint Commission Note: hovering over the green ENTERING NEW RECORDS 92 © Copyright, The Joint Commission Note: hovering over the green “i” next to a data element will show you the question and allowable values associated with that data element as well as a link to the data element page.

ENTERING NEW RECORDS 93 © Copyright, The Joint Commission Once you have completed data ENTERING NEW RECORDS 93 © Copyright, The Joint Commission Once you have completed data entry for this record, save the data record.

DATA ENTRY CASE SCENARIOS general patient data elements The “: ” colon needs to DATA ENTRY CASE SCENARIOS general patient data elements The “: ” colon needs to be added to all “time” fields – in the HH: MM time format. 94 © Copyright, The Joint Commission if the patient was not admitted, leave the Admission Date and Time blank Discharge Date, Birthdate, and Admission Date have the format locked in place, but for Arrival Date, you will need to add the “-“ dashes to the MM -DD-YYYY format.

CARDIAC EVENT SECTION If Tube Insertion is “N”, you can leave the remaining Intubation CARDIAC EVENT SECTION If Tube Insertion is “N”, you can leave the remaining Intubation elements blank Answer Therapeutic Hypothermia Initiated for each Cardiac Event entered © Copyright, The Joint Commission If Code Status Order is “N”, enter UTD for date and time

Click “Save Data Record” when all data entry is finished for the patient 96 Click “Save Data Record” when all data entry is finished for the patient 96 © Copyright, The Joint Commission THERAPEUTIC HYPOTHERMIA SECTION

FIND EXISTING RECORDS 97 © Copyright, The Joint Commission To find a record by FIND EXISTING RECORDS 97 © Copyright, The Joint Commission To find a record by Unique Blinded Case Identifier (UBCI), enter the UBCI and ignore the “Complete” and “Incomplete”, then click “Filter” button.

VIEW RECORD’S DETAILS 98 © Copyright, The Joint Commission To view an existing record, VIEW RECORD’S DETAILS 98 © Copyright, The Joint Commission To view an existing record, click on the UBCI number. You can contract the drop down by clicking on the ‘-’or expand by clicking on the ‘+’ before the different sections.

EDIT EXISTING RECORDS 99 © Copyright, The Joint Commission To edit the “General and EDIT EXISTING RECORDS 99 © Copyright, The Joint Commission To edit the “General and other patient-level data elements”, click on the pencil icon.

100 © Copyright, The Joint Commission MARKING RECORDS AS “COMPLETE” 100 © Copyright, The Joint Commission MARKING RECORDS AS “COMPLETE”

VIEW EXISTING RECORDS 101 © Copyright, The Joint Commission To view the complete records, VIEW EXISTING RECORDS 101 © Copyright, The Joint Commission To view the complete records, check the “Complete” radio button then click “Filter” button.

REVIEWING COMPLETED RECORDS 102 © Copyright, The Joint Commission The completed records are LOCKED REVIEWING COMPLETED RECORDS 102 © Copyright, The Joint Commission The completed records are LOCKED and can not be edited. The blue flag indicates that record will be re-abstracted.

UNLOCK A RECORD 103 © Copyright, The Joint Commission To send an e-mail request UNLOCK A RECORD 103 © Copyright, The Joint Commission To send an e-mail request to unlock a record, click on the “lock” icon and an e-mail form will appear. In the e-mail, please briefly explain why the record needs to be unlocked (e. g. , Accidentally clicked the “Complete” checkbox).

ASK A QUESTION 104 © Copyright, The Joint Commission On the SCA project page ASK A QUESTION 104 © Copyright, The Joint Commission On the SCA project page – the very bottom has a link to ask a clinical or technical question. The FAQ table also will display the common questions.

105 © Copyright, The Joint Commission QUESTIONS? 105 © Copyright, The Joint Commission QUESTIONS?