Center for Performance Sciences, 2001...Vagin al H y sterectomy So urce: IQIP W e i gh t e d M ea n...

Center for Performance Sciences, 2001

International Quality Indicator Project®

Acute Care Indicator Set

Implementation Manual

Implementation Manualν Each indicator chapter contains…

θ Table of Performance Measuresθ Overviewθ Glossary of Termsθ Implementation Rulesθ Formulasθ Displaying Your Dataθ Optional Patient-Level Variablesθ Data Collection Tools

Some Key Concepts

Acute care inpatients

ν Unless otherwise specified, indicators do only apply to acute care inpatients

ν Excluded areθ Patients on psychiatric units/wardsθ Outpatientsθ Emergency room patientsθ Observation status patientsθ Patients in long-term care beds

Indicator and measures

ν Indicators can comprise multiple measuresν A measure is either a rate or a ratioν Submeasures are percentage breakdown of

“parent” measures and one therefore has to participate in all submeasures belonging to a parent measure

Acute Care Indicators

1a. Device-Associated Infections in the ICU

1a. Device-Associated Infections in the ICUν Measures explore

θ Central-line associated bloodstream infectionsθ Ventilator-associated pneumoniasθ Indwelling urinary catheter-associated UTIs

ν May report forθ APICU (all purpose ICU)θ Or

ν CCU (coronary care unit)ν MICU (medical ICU)ν M/S ICU (medical/surgical ICU)ν SICU (surgical ICU)

1a. Device-Associated Infections in the ICUν Device-associated infection

θ An infection in an ICU patient who has had the device in use within 48 hours of onset of the infectionν Must be compelling evidence of association if > 48 hours

θ Infection not present or incubating at time of admission to the ICU

1a. Device-Associated Infections in the ICUν Infection is counted in the month in which it

occursν Measures exclude post-discharge infectionsν Use Centers for Disease Control (CDC)

criteria for infectionsν Facility determines time of count each day

1a. Device-Associated Infections in the ICUν Patient populations not exclusive

θ APICU-mixed population of critically illθ CCU-primarily cardiac, non-surgicalθ MICU-primarily medical, non-cardiacθ M/S ICU-mixed population with medical and/or

surgical conditionsθ SICU-primarily surgical

ν PCUs (progressive care units) are not ICUs

1a. Device-Associated Infections in the ICUν Measures are reported by unit

θ Numerator—number of device-associated infections

θ Denominator—number of device days for that specific device

D ev ice-A s s o ciat ed In fect io n s in t h e A P IC U

O c t 0 3 D e c 0 3 F e b 0 4 A p r 0 4 Jun 0 4 A ug 0 4

So ur c e : I Q I P

C en t ral L in e-A s s o ciat ed

V en t ilat o r-A s s o ciat ed

C at h et er-A s s o ciat ed

APICU CCU MICU MSICU SICUSource: IQIP, 3Q 2004

Symptomatic Indwelling Urinary Catheter-Associated UTIs

Ventilator-Associated Pneumonia

1b. Device Use in Intensive Care Units

ν Measures exploreθ Central line useθ Ventilator useθ Indwelling urinary catheter use

ν May report forθ APICU orθ CCU, MICU, M/S ICU, and/or SICU

ν Central line day, ventilator day, or indwelling urinary catheter dayθ Counted if the device is in use at the time of the

ν Patient daysθ The sum of the number of days all patient stayed

in an individual ICU during the month ~ same as census days

ν Device “X” use in the “Y”θ Numerator— number of device days for that

specific deviceθ Denominator— number of patient days for that

specific ICU

D e v ic e U se in t h e A P I C U

So ur c e : I Q I P

C e n t r a l L in e

Ve n t ila t o r

I n dwe llin g U r in a r y C a t h e t e r

Indwelling Urinary Catheter Use

Ventilator Use

2a. Surgical Site Infections

ν Measures explore site infections forθ CABG ~ chest incision onlyθ CABG ~ chest and donor siteθ Hip arthroplastyθ Knee arthroplastyθ Abdominal hysterectomy

ν Risk-stratified using NNISθ Score of 0 to 3 based on

ν ASA class assignment > P3?ν Wound dirty or contaminated?ν Operation lasting more the “T” hours?

ν Measures reported by procedure and NNIS score

Elements Patient X Patient Y

ASA Class III (1 point) IV (1 point)

Operation > “T” hours

No (0 point) Yes (1 point)

Wound Class Clean (0 point) ______________

Dirty (1 point) ______________

Risk Index Category

ν Surgical site infections for procedure “X” with NNIS Risk Index score “Y”θ Numerator— number of surgical site infections for

“X” procedures with NNIS Risk Index “Y”θ Denominator— number of “X” procedures with

NNIS Risk Index “Y”

0 20 40 60 80 100Source: IQIP, 3Q 2004

Infection Rates per 100 Inpatients w/NNIS Risk Index 1, Hip Arthroplasty

2b. Antiobiotic Prophylaxis for Surgical Proceduresν Measures explore prophylaxis for

θ CABG ~ chest incision onlyθ CABG ~ chest and donor siteθ Hip arthroplastyθ Knee arthroplastyθ Appendectomyθ Abdominal hysterectomyθ Vaginal hysterectomy

2b. Antiobiotic Prophylaxis for Surgical Proceduresν Antiobiotic prophylaxis

θ Prophylaxis within 30 minutes prior to incisionθ Prophylaxis within 1 hour prior to incisionθ Prophylaxis within 2 hours prior to incisionθ Prophylaxis for 24 hours or less

2b. Antiobiotic Prophylaxis for Surgical Proceduresν Prophylactic antibiotic

θ Administered as a preventative with no prior knowledge or suspicion of infection

ν Therapeutic antibioticθ Administered to treat an infection

2b. Antiobiotic Prophylaxis for Surgical Proceduresν Measures apply to both inpatients and

outpatients who undergo any of the specified procedures

ν Patients who die perioperatively and who received prophylaxis should be counted in numerator and denominator for the specified procedure

ν Measures reported by procedure

2b. Antiobiotic Prophylaxis for Surgical Proceduresν Prophylaxis for procedure “X”

θ Numerator— number of “X” procedure patients receiving prophylaxis

θ Denominator— number of patients undergoing “X” procedure

2b. Antiobiotic Prophylaxis for Surgical Proceduresν Prophylaxis within 30 minutes, 1 hour, or 2

hours prior to incisionθ Numerator— number of “X” procedure patients

who received prophylaxis within 30 minutes or 2 hours prior to incision

θ Denominator— number of “X” procedure patients receiving prophylaxis

2b. Antiobiotic Prophylaxis for Surgical Proceduresν Prophylaxis for 24-hours or less

θ Numerator— number of “X” procedure patients who received prophylaxis for 24 hours or less perioperatively

θ Denominator— number of “X” procedure patients receiving prophylaxis

2b. Antiobiotic Prophylaxis for Surgical Procedures

A n t ibio t ic P r o p h y la x is f o r Sur gic a l P r o c e dur e s

So ur c e : I Q I P

C A B G H ip A r t h ro p las t yK n ee A rt h ro p las t y A p p en d ect o m yA b d o m in al H y s t erect o m y V agin al H y s t erect o m y

A n t ib io t ic P ro p h y laxis fo r Su rgical P ro ced u res fo r a D u rat io n < = 2 4 H o u rs , 3 Q 2 0 0 4

C A B G H ip A r t h r o p la st y K n e eA r t h r o p la st y

A p p e n de c t o m y A bdo m in a lH y st e r e c t o m y

Va gin a lH y st e r e c t o m y

So ur c e : I Q I P

A n t ib io t ic P ro p h y laxis fo r Su rgical P ro ced u res 3 0 M in u t es P rio r t o In cis io n , 3 Q 2 0 0 4

C A B G H ip A r t h r o p la st y K n e eA r t h r o p la st y

A p p e n de c t o m y A bdo m in a lH y st e r e c t o m y

Va gin a lH y st e r e c t o m y

So ur c e : I Q I P

3. Inpatient Mortality

ν Measures exploreθ Total inpatient mortalityθ Inpatient mortality by specific DRG category

ν Encouraged but not required to report inpatient deaths in all eleven DRG categories

ν DRG 014 CVAν DRG 079 Respiratory infectionsν DRG 088 COPDν DRG 089 Pneumoniaν DRG 127 Heart failure/shockν DRG 174 GI hemorrhage

ν DRG 316 - Renal failureν DRG 416 – Septicemiaν DRG 475 – Respiratory diagnosis/ ventilatory

supportν DRG 489 - HIV/major related conditionν XXX - All other DRGs

ν Availability of crosswalk for DRGs toθ ICD-9 codesθ ICD-10 codes

ν Should be address in manual and software translations

ν Total inpatient mortalityθ Numerator— number of inpatient deathsθ Denominator— number of inpatient discharges

ν Total inpatient mortality by DRGθ Numerator— number of inpatient deaths for the

specified DRGθ Denominator— number of inpatient discharges for

the specified DRG

T o t al A cu t e C are In p at ien t M o rt alit y

A p r 0 3 Jun 0 3 A ug 0 3 O c t 0 3 D e c 0 3 F e b 0 4 A p r 0 4 Jun 0 4 A ug 0 4

So ur c e : I Q I P

U SA E u ro p e A s ia

DRG 14 79 88 89 127 174 316 416 475 489Source: IQIP, 3Q 2004

sInpatient Mortality by DRG

4. Neonatal Mortality

ν Measures exploreθ Neonatal mortality of direct admissionsθ Neonatal mortality of transfers-in (your facility

provides a higher level of care)

ν Risk-stratified by birth weight categoriesν Neonate— live birth through day 28

ν Birth weight categoriesθ < 750 gramsθ 751 to 1,000 gramsθ 1,001 to 1,800 gramsθ > 1,801 grams

ν Direct admissions includeθ Live birthsθ Inpatient neonatal admissionsθ Neonatal admissions of births out of asepsis

ν Direct admissions includeθ Neonatal readmissionsθ Neonates transferred from a facility with a higher

level of care to your facility

ν Death is counted in the month in which it occurs

ν Measures are reported by birth weight category

ν Neonatal mortality for direct admissionsθ Numerator— number of neonatal deaths of direct

admissions by birth weight “X”θ Denominator— number of neonatal direct

admissions with birth weight “X”

ν Neonatal mortality for transfers-inθ Numerator— number of neonatal transfers-in

deaths with birth weight “X”θ Denominator— number of transfers-in with birth

weight “X”

4. Neonatal MortalityNeonatal Mortality by Admission Status and Birth Weight, 3Q 2004

4.1 4.2 4.3 4.4 4.5 4.6 4.7 4.8

Source: IQIP

Measure ID

5. Perioperative Mortality

ν Measures exploreθ Total perioperative mortality for all ASA classesθ Perioperative mortality for a specific ASA class—

P1 through P5

ν Perioperative mortalityθ Death of any patient who has had an inpatient

anesthesia episode and dies at the same hospital within 48 hours of time noted in medical record for induction of anesthesia

ν Inpatient anesthesia episode is an occasion when an inpatientθ is assigned an ASA classθ receives anesthesia from Anesthesia staffθ undergoes one or more inpatient operative

procedures within the ICD-9-CM ranges of 01.0 to 86.99

ν At the time of death, individuals having undergone an inpatient anesthesia episode may beθ Inpatientsθ Outpatientsθ ED patients

ν Individuals receiving sedation and analgesia are excluded

ν Individuals who die during the inpatient anesthesia episode should be included if they satisfy definitions and rules

ν Neonates and obstetrical inpatients should be included if they satisfy definitions and rules

ν Total perioperative mortality for all ASA classesθ Numerator— number of perioperative deaths for all

ASA classesθ Denominator— number of inpatient anesthesia

episodes for all ASA classes

ν Perioperative mortality by ASA classθ Numerator— number of perioperative deaths for

ASA class “X”θ Denominator— number of inpatient anesthesia

episodes for ASA class “X”

P erio p erat iv e M o rt alit y , A SA 3 an d A SA 4

So ur c e : I Q I P

A SA 3

A SA 4

ASA 1 ASA 2 ASA 3 ASA 4 ASA 5Source: IQIP, 3Q 2004

Perioperative Mortality by ASA Class

6. C-Sections and Management of Labor

ν C-sectionθ The removal of a fetus by means of an incision

into the uterus

ν VBACθ A vaginal birth after previous C-section

ν Trial of laborθ An instance when a purposeful attempt is made to

allow active labor to develop and proceed so that a vaginal delivery can take placeν Drugs may or may not be usedν Active labor does not have to be established

ν Multiple deliveries count as a single birthν Multiple deliveries involving both vaginal and

C-section are counted as C-sectionsν Stillborns are excluded— whether delivered

vaginally or by C-section

ν Primary C-sectionθ Numerator— number of primary C-sectionsθ Denominator— number of deliveries minus

(number of repeat C-sections + number of VBACs)

ν Repeat C-sectionθ Numerator— number of repeat C-sectionsθ Denominator— (number of repeat C-sections +

number of VBACs)

ν Total C-section frequencyθ Numerator— number of C-sectionsθ Denominator— number of deliveries

ν VBACsθ Numerator— number of VBACsθ Denominator— (number of VBACs + number of

repeat C-sections)

ν Trial of labor successθ Numerator— number of VBACs resulting from a

successful trial of laborθ Denominator— number of previously C-sectioned

women who underwent a trial of labor

Repeat C-Section

Apr 03 Jun 03 Aug 03 Oct 03 Dec 03 Feb 04 Apr 04 Jun 04 Aug 04

Source: IQIP

USA Project-Wide

Europe Asia

Asia Europe USASource: IQIP, 3Q 2004

Repeat Cesarean Section

Vaginal Birth After Cesarean Section (VBAC)

Trial of Labor Success

7. Unscheduled Readmissions

ν Unscheduled readmissionsθ An inpatient readmission to the same facility for

the same or a related condition that was not scheduled at the time of the previous discharge

ν DRG 079-Respiratory infections & inflammations

ν DRG 088-COPDν DRG 089-Simple pneumoniaν DRG 127-Heart failure & shockν DRG 140 to143-Angina, chest pain

ν Readmission intervalsθ 0 to 15 daysθ 0 to 31 days

ν HCFA DRGs are usedν DRGs represent five of the most frequent

reasons for unscheduled readmission

ν Availability for crosswalks from DRGs toθ ICD-9θ ICD-10

ν Translations should be addressed in manual and software translation

ν Time frames are not mutually exclusiveν Chronic conditions are included within the

scope of these measuresν Neonates discharged as a normal newborn

should be included in the denominatorν Day count begins with the day of discharge

ν Unscheduled readmissions within 15 and/or 31 daysθ Numerator— number of unscheduled

readmissions within “X” daysθ Denominator— number of inpatient discharges

ν Unscheduled readmissions within “X” days for DRG “Y”θ Numerator— number of unscheduled

readmissions within “X” days for DRG “Y” or a related condition

θ Denominator— number of discharges for DRG “Y”

Oct 03 Dec 03 Feb 04 Apr 04 Jun 04 Aug 04

Source: IQIP

sUnscheduled Acute Care Readmissions within 31 Days

DRG 79 88 89 127 140/143Source: IQIP, 3Q 2004

sUnscheduled Readmissions Within 31 Days by DRG

8. Unscheduled Admissions Following Ambulatory Proceduresν Unscheduled admission

θ An admission to the same facility either as an inpatient or for observation that was not scheduled at the time of the procedureν Must occur within 48 hours of the elective procedure

performed at facility or freestanding surgical center that is facility-owned or operated

8. Unscheduled Admissions Following Ambulatory Proceduresν Ambulatory procedure patient

θ An outpatient undergoing an elective operative procedure within the ICD-9-CM code range of 01.0 to 86.99 in . . .ν An ambulatory surgery suiteν Another designated area of a facilityν A freestanding surgical center that is hospital-owned or

operated

8. Unscheduled Admissions Following Ambulatory Proceduresν Admission following an ambulatory procedure

may result from procedure findingsθ Considered unscheduled unless it is documented

prior to the procedure that an admission might occur

ν Individuals undergoing multiple procedures are counted only once

8. Unscheduled Admissions Following Ambulatory Proceduresν Ambulatory procedure categories

θ Cardiac catheterization proceduresθ Digestive, respiratory, and urinary system

diagnostic endoscopic proceduresθ All other general operative procedures 01.0

through 86.99 except those above

8. Unscheduled Admissions Following Ambulatory Proceduresν Unscheduled admissions following procedure

“X”θ Numerator— number of unscheduled admissions

(inpatient and observation) following procedure “X”

θ Denominator— number of ambulatory procedure patients undergoing procedure “X”

8. Unscheduled Admissions Following Ambulatory Proceduresν Unscheduled inpatient admissions following

procedure “X”θ Numerator— number of unscheduled inpatient

admissions following procedure “X”θ Denominator— number of unscheduled

admissions (inpatient and observation) following procedure “X”

8. Unscheduled Admissions Following Ambulatory Proceduresν Unscheduled observation admissions

following procedure “X”θ Numerator— number of unscheduled observation

admissions following procedure “X”θ Denominator— number of unscheduled

admissions (inpatient and observation) following procedure “X”

8. Unscheduled Admissions Following Ambulatory Procedures

U n s ch ed u led A d m is s io n s F o llo w in g D iagn o s t ic E n d o s co p y b y R egio n

So ur c e : I Q I P

U SA P ro ject -W id e

E u ro p e A s ia

8. Unscheduled Admissions Following Ambulatory Procedures

Source: IQIP

sUnscheduled Admissions Following Ambulatory Diagnostic Endoscopy

9. Unscheduled Returns to an Intensive Care Unitν Unscheduled return to an ICU

θ An unexpected return to an Intensive Care Unit during the same inpatient admissionν Unscheduled return may be to the same or to another

9. Unscheduled Returns to an Intensive Care Unitν Transfers-out

θ The movement from an ICU to a lower level of careν PCUν General med/surg, OB, or pediatric bedν PACUs (post anesthesia care unit)

9. Unscheduled Returns to an Intensive Care Unitν Excluded are

θ NICUs (neonatal ICU)θ Burn ICUsθ Neurotrauma ICUsθ PICUs (pediatric ICU)

ν Units serve a specialized subpopulation— not typical of the general critically ill population

9. Unscheduled Returns to an Intensive Care Unitν Exclude patients who die in an ICU from the

denominatorν Exclude returns from non-acute care beds

from the numerator

9. Unscheduled Returns to an Intensive Care Unitν Unscheduled returns to ICUs

θ Numerator— number of unscheduled returns to ICUs

θ Denominator— number of transfers-out from ICUs

9. Unscheduled Returns to an Intensive Care Unit

Source: IQIP

sProject-Wide - Unscheduled Returns to Intensive Care Units

9. Unscheduled Returns to an Intensive Care Unit

Source: IQIP

sEurope- Unscheduled Returns to Intensive Care Units

10. Unscheduled Returns to the Operating Roomν Unscheduled return

θ A return to the OR during the same inpatient admission for complications or untoward outcomes related to a prior inpatient operative procedure performed in the OR

θ Return not scheduled at the time of the prior operative procedure

10. Unscheduled Returns to the Operating Roomν Inpatient trip to the OR

θ Any trip to the OR where one or more procedures within ICD-9-CM code range of 01.0 through 86.99 are performed on an inpatient

10. Unscheduled Returns to the Operating Roomν It is assumed operative procedures are not

undertaken without some expectation of success and that additional or staged surgical procedures would be identified at the time of the prior procedureθ This measure doesn’t address likelihood for

complications or possibility of failure

10. Unscheduled Returns to the Operating Roomν Count the number of inpatient returns rather

than the number of inpatientsν Returns for organ procurement are not

included

10. Unscheduled Returns to the Operating Roomν Unscheduled returns during which the patient

dies are only counted in the numeratorν One trip to the OR may include multiple

procedures done at the same time

10. Unscheduled Returns to the Operating Roomν Unscheduled returns to the OR

θ Numerator— number of unscheduled inpatient returns to the OR

θ Denominator— number of inpatient trips to the OR

10. Unscheduled Returns to the Operating Roomν Unscheduled returns to the operating room with prior peripheral

vascular proceduresθ 38.12 Endarterectomy – head or neckθ 38.44 Resection of vessel with replacement – aorta abdominalθ 38.7 Interruption of vena cavaθ 39.29 Other (peripheral bypass)θ 39.49 Other revision of vascular procedureθ 39.50 Angioplasty or artherectomy of non-coronary vesselθ 39.71 Endovascular implantation of graft in abdominal aorta

10. Unscheduled Returns to the Operating Roomν Unscheduled returns to the operating room with prior cardio-thoracic procedures

θ 35.22 Other replacement of aortic valveθ 36.01 Single vessel percutaneous transluminal coronary angioplasty or coronary

atherectomy without mention of thrombolytic agentθ 36.05 Multiple vessel percutaneous transluminal coronary angioplasty or coronary

atherectomy performed during the same operation, with or without mention ofthrombolytic agent

θ 36.11 Aortocoronary bypass of one coronary arteryθ 36.12 Aortocoronary bypass of two coronary arteriesθ 36.13 Aortocoronary bypass of three coronary arteriesθ 36.14 Aortocoronary bypass of four or more coronary arteriesθ 36.15 Single internal mammary-coronary artery bypassθ 37.94 Implantation or replacement of automatic cardioconverter/defibrillator, total

system [AICD]

10. Unscheduled Returns to the Operating Room

Source: IQIP

mProject-Wide - Unscheduled Returns to the Operating Room

10. Unscheduled Returns to the Operating Room

Source: IQIP

mEurope- Unscheduled Returns to the Operating Room

11. Isolated CABG PerioperativeMortalityν Isolated CABG perioperative death

θ The death of any patient who has undergone an isolated CABG procedure and who dies within 48 hours of induction of anesthesia during the same inpatient admission

11. Isolated CABG PerioperativeMortalityν Isolated CABG procedure

θ A CABG procedure during which no other cardiac-associated procedure is performed

11. Isolated CABG PerioperativeMortalityν Facilities must report on all ASA classes to

participate in this measureν Heart-port access CABG surgery is included

even though there is, at present, no associated ICD-9-CM code

11. Isolated CABG PerioperativeMortalityν Facilities report observed perioperative

mortality for each ASA classθ QI Project® calculates the expected perioperative

mortality for each ASA class

11. Isolated CABG PerioperativeMortalityν Observed isolated CABG perioperative

mortality for ASA class “X”θ Numerator— number of ASA class “X”

perioperative deathsθ Denominator— number of ASA class “X” isolated

CABG surgeries

12. Physical Restraint Use

ν Restraintθ A process that restricts an individual from having

free, unimpeded access to their body or which prevents them from moving freely at will within their environment

ν Physical restraint eventθ A discrete instance in which physical restraint is

ν Restraint event begins when an individual is first restrained and ends when the use of restraint ceases— regardless of the number of orders or renewalsθ Individuals may experience multiple events in a

24-hour periodθ Individuals may experience a single restraint

event that lasts 24-hours or more

ν Trial release of restraint may not exceed 60 minutes

ν Releases for circulation checks, toileting, or range of motion don’t constitute new events

ν Bed rails not considered restraintν Chemical restraint not recognizedν Neonates are excluded

ν Physical restraint eventsθ Numerator— number of physical restraint eventsθ Denominator— number of patient days

ν Physical restraint events by durationθ Lasting 1 hour or lessθ Lasting > 1 hour but < 4 hoursθ Lasting > 4 hours but < 8 hoursθ Lasting > 8 hours but < 16 hoursθ Lasting > 16 hours but < 24 hoursθ Lasting > 24 hours

ν Physical restraint events by durationθ Numerator— number of physical restraint events

for a specified interval of timeθ Denominator— number of physical restraint events

ν Physical restraint events by reasonθ Cognitive disorderθ Risk of fallingθ Disruptive behaviorθ Facilitate treatmentθ All other reasons

ν Physical restraint events by reasonθ Numerator— number of physical restraint events

by reasonθ Denominator— number of physical restraint events

ν Physical restraint events by time restraint initiatedθ Day (7 a.m. – 2:59 p.m.)θ Evening (3:00 p.m. – 10:59 p.m.)θ Night (11:00 p.m. – 6:59 a.m.)

ν Physical restraint events by time restraint initiatedθ Numerator— number of physical restraint events

initiated between the times of day specifiedθ Denominator— number of physical restraint events

ν Inpatients with one or more physical restraint eventsθ Numerator— number of inpatients experiencing

one or more physical restraint eventsθ Denominator— number of inpatients

ν Patients with two or more physical restraint eventsθ Numerator— number of inpatients experiencing

two or more physical restraint eventsθ Denominator— number of inpatients experiencing

one or more physical restraint events

ν Physical restraint hoursθ Numerator-Number of acute care physical hoursθ Denominator-Number of acute inpatient care days

(converted into hours by the software)

U s e o f P h y s ical R es t ra in t b y D u rat io nP ro ject -W id e W eigh t ed M ean R at es (So u rce: IQ IP , 3 Q 2 0 0 4 )

> 8 an d < = 1 6 H o u rs> 2 4 H o u rs

> 1 6 an d < = 2 4 H o u rs

> 4 an d < = 8 H o u rs

> 1 an d < = 4 H o u rs

< = 1 H o u r

U s e o f P h y s ical R es t ra in t b y R eas o nP ro ject -W id e W eigh t ed M ean R at es (So u rce: IQ IP , 3 Q 2 0 0 4 )

t o facilit a t e t reat m en t

co gn it iv e d is o rd er

r is k o f fa llin g

d is ru p t iv e b eh av io r

all o t h er reas o n s

U s e o f P h y s ical R es t ra in t b y T im e o f In it ia t io nP ro ject -W id e W eigh t ed M ean R at es (So u rce: IQ IP , 3 Q 2 0 0 4 )

7 :0 0 A M t o 2 :5 9 P M

3 :0 0 P M t o 1 0 :5 9 P M

1 1 :0 0 P M t o 6 :5 9 A M

13. Documented Falls

ν Fallsθ An unplanned movement of a patient to the

ground or from one plane to another

ν Documented fallsθ A fall that is recorded in the patient’s medical

record, in an incident report, a risk management report, or in some other official organizational record

ν Documented fallsθ Numerator— number of documented fallsθ Denominator— number of patient days

ν Documented falls by reasonθ Patient’s health statusθ Response to treatment, medication, or anesthesiaθ Environmental hazardθ Other causes

ν Documented falls by reasonθ Numerator— number of documented falls by

specific reasonθ Denominator— number of documented falls

ν Injuryθ A disruption of structure or function of some part

of the body that is the result of a fall

ν Falls resulting in injuryθ Numerator— number of documented falls that

resulted in injuryθ Denominator— number of documented falls

ν Documented falls resulting in injury by severity scoreθ Severity Score 1 (little or no care)θ Severity Score 2 (some med or nursing

intervention)θ Severity Score 3 (clearly require medical

intervention or consultation)

ν Falls resulting in injury by severity scoreθ Numerator— number of documented falls by

specific Severity Scoreθ Denominator— number of documented falls that

resulted in injury

ν Repeat fallsθ Numerator— number of patients with two or more

documented fallsθ Denominator— number of patients with one or

Center for Performance Sciences, 2001...Vagin al H y sterectomy So urce: IQIP W e i gh t e d M ea n...

Documents

Transcript of Center for Performance Sciences, 2001...Vagin al H y sterectomy So urce: IQIP W e i gh t e d M ea n...

Ohm’s Law + - R E I E = I * R I = E / R R = E / I E = Voltage I = Current R = Resistance.

P R O C E E D I N G S · Методология искусственного интеллекта в многоуровневом управлении.....74 Eremeev A.P., Vagin V.N.

R 18 E R 19 E R 20 E R 21 E R 22 E ... - Hillsborough County

R E F E R E N C E S

G r e a t B a r r i e r R e e f

R e t r i e v e r N e w s l e t t e r - AACPS

GILA COUNTY SURFACE MANAGEMENT RESPONSIBILITY · E a s t Ve rd e Ri v e r T o n t o C r e e k R y e C r e e k C h e r r y C r e e k S p r i n g C r e e k G r e n b a c k C r e e k

J R C R E F E R E N C E R E P O R T - Europa

Hémorragies génitales de l’adolescente€¦ · Adénocarcinome à cellules claires du vagin ...

City of Winnipeg · A s in b o n e R i v e r City of Winnipeg R e d R i v e r S e i n e R i v e r R50M L a S a l l e R v e r S t u r g e o n C r e e k R e d R i v e r F l o o d w

P e e r - 2 - P e e r

M E M B E R S H I P P A R T N E R R E F E R R A L

R e s p o n s e to th e R e v i e w e r s R e v i e w e r # 1

movep - LoopNet€¦ · Mississauga, ON 5090 Explorer Drive ... Veloce Italian Kitchen and more. E W E W R R R D E D E D D E E D R R R R R R R 1 7 Toronto Pearson International Airport

R e f e r e n c e A r c h i t e c t u r e - Cloudera

D e a r R e a d e r - files.myprimitive.cloud

City of North Pole, Alaska · p p r t e r y r e y t e t y t e p e r e r t t y y y y y e t p minuteman lp y e y y e t y t y r r r r e e e e t d d d t e e r n n r r e e t p e r r d

v r w e s iet r e vh e NAviGAtiNG ChANGes FrOM COrDrAY’s ... · march 2012 THE review REVERSE t h e r e v e r s e r e v i e w e t h e h r e v e r s e r e v ie w t h e r e v e rs

Fitting EM maps into X-ray Data Alexei Vagin York Structural Biology Laboratory University of York.

-R XI VZ I R XMS R E X ' ) ' 2 E XMS R E P ' I R XI V S R -R ......2 E XMS R E P ' I R XI V S R -R XI R W MZ I-R XI VZ I R XMS R E X ' ) ' IEP Goal S e tting Got You Down? We 'v e