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

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Sudden Cardiac Arrest Measures

Pilot Test Training

November 10, 2011

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What You Need to Write Down

http://manual.jointcommission.org

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Training Objectives

To provide participants the information needed to begin testing of the sudden cardiac arrest performance measures– Understand the measure specifications– Become familiar with the data collection

tool

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WebEcho availability

Recorded and available for later viewing– Available for 2 months on Conference

America server– TJC will make link available

Can also be downloaded to one’s computer

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Toll of Sudden Cardiac ArrestSudden cardiac arrest accounts for

approximately 350,000 deaths in the United States annually with a survival rate of 5-7%.

Many people affected have a history of cardiac disease, countless others have no cardiac history and are unaware of any risk factors

There are no formal, evidence-based guidelines or standards that are uniformly recognized and employed

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Sponsors/Funders

Development of a monograph and performance measures is sponsored by the Medtronic, Boston Scientific, and St. Jude Medical corporations– All sponsorships are through unrestricted

educational grants in which sponsors are at arms-length.

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Goals and Objectives of Pilot Test Phase

Test and implement standardized, evidence-based 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

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Measure Milestones and Timeline

Initial TAP Mtg

2/10

Public Comment

5/10

Specification Development

6/10-12/10

Alpha test

5/11 – 8/11

Pilot test

11/11-4/12

Final TAP Mtg

6/12

TAP meetings 9/10, 2/11 and

9/11

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What’s in a Pilot Test?

Data Collection and SubmissionOn-site Visits for reliabilityResource TrackingMonthly Conference Calls

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Pilot TestSix months in duration beginning for

discharges 11/1/11 and concluding for discharges through 4/30/12.

All 4 measures to be implemented and tested by participating sites

Data will be collected and transmitted monthly using a secure web-based collection tool

No sampling scheme applied

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Pilot Test Objectives

Determine Measure and Data Element Reliability

Gain an understanding of the issues related to implementation of sudden cardiac arrest measures

Gain an understanding of resources needed for implementation

Refine and enhance measure specifications

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Reliability Testing

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. – Two levels tested

–Measure level

–Data element level

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Reliability Testing 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

–Identify false negatives and false positives

–Code reasons for discrepancies

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On Site Reliability Visits

Focus Group Discussions– Discuss the measures and key

implementation issues– Gather site recommendations for solutions

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Reliability Site Visits

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.

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Tracking of Resources

Track once or twice during the testFocus

– Time spent in abstraction– Time spent in data entry – Time spent in implementation activities– Type of staff involved

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Monthly Conference Calls

Objectives– Provide Education and Support– Network

Schedule– Monthly

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Conference Call Schedule

Tuesday, Nov. 29, 2:00-3:00, Central Time

Friday, Dec.16, 2:00 – 3:00,Central Time

Invitations, agenda and call-in information will be sent via e-mail.

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Data Collection and Transmission Schedule

Patient Discharge Month 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

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Site Visit Schedule

Determined After 2-3 months of Data Submission

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ComponentsMeasure Information Forms

– Numerator and denominator, exclusions, populations

Data Dictionary/Data Elements (Chart Information to be Collected)

– Allowable values

– Notes for abstractionMissing & Invalid DataOnline Data EntryAccessing and Using the Data Collection Tool

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List of Measures

SCA-01 Timeliness of First Defibrillation Attempt

SCA-02 Confirmation of Endotracheal Tube Placement

SCA-03 Initiation of Therapeutic Hypothermia

SCA-04 Maintenance of Thermoregulation in Therapeutic Hypothermia

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SCA-01 Timeliness of First Defibrillation AttemptRationale

– 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.

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SCA - 01 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.

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

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SCA – 01 Exclusions Cardiac arrest events occurring prior to hospital arrival in the ED Cardiac arrest events occurring wherein the initial rhythm is not

ventricular fibrillation or pulseless ventricular tachycardia. Cardiac arrest events occurring in patients with a code status order

prior to the event 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).

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SCA – 01 Exclusions – cont’d

Cardiac arrest events occurring in patients with left ventricular assist devices (LVADs) or bilateral ventricular assist devices (BIVADs).

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.).

Age <18 years– Note that events in ED patients and inpatients are

included; events prior to ED arrival are excluded.

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Data Elements – SCA-01Denominator

– Arrival Date– Arrival Time– Birthdate– Cardiac Arrest– 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

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Data Elements – SCA - 01

Numerator– First Defibrillation Shock Date– First Defibrillation Shock Time

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SCA-02 Timely Confirmation of Correct Endotracheal Tube Placement

Rationale– 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.

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SCA-02 Denominator - The statement defining the population of interest

– Cardiac arrest events during which an endotracheal tube is placed.

Numerator - The statement defining the cases within the population of interest who have received the specific care being measured– 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 CO2 colorimetric monitor, or

– Revisualization with direct laryngoscopy

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ExclusionsCardiac arrest events occurring while

an endotracheal tube is in placeCardiac arrest events occurring prior to

hospital arrivalAge <18 years

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Data Elements – SCA-02Denominator

– Arrival Date– Arrival Time– Birthdate– Cardiac Arrest– Cardiac Arrest Date– Cardiac Arrest Event Number– Cardiac Arrest Time– Endotracheal Intubation Date– Endotracheal Intubation Time

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Numerator– Endotracheal Intubation Confirmation Date– Endotracheal Intubation Confirmation

Time– Methods of Intubation Confirmation

Data Elements – SCA-02

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SCA-03 Initiation of Therapeutic Hypothermia

Rationale:– Mild hypothermia is the only therapy applied in the post-

cardiac 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.

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SCA-03 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

Numerator - The statement defining the cases within the population of interest who have received the specific care being measured– 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.

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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

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SCA-03 Data ElementsDenominator:

– Admission Date– Admission Time– Birthdate– Cardiac Arrest– 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

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SCA-03 Data Elements

Numerator:–Arrival Date–Arrival Time–Date Therapeutic Hypothermia Initiated–Discharge Disposition–Reason for Transfer–Therapeutic Hypothermia Initiated–Time Therapeutic Hypothermia Initiated

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SCA-04 Maintenance of Thermoregulation in Therapeutic Hypothermia

Rationale– 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

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SCA - 04 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.

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.

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SCA – 04 Exclusions

– 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 in-hospital or out-of-hospital arrest are included

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SCA – 04 Data Elements Denominator

– Cardiac Arrest– 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– Code Status Order Date– Code Status Order Time– Therapeutic Hypothermia Initiated– Time Therapeutic Hypothermia Ended– Time Therapeutic Hypothermia Initiated

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SCA – 04 Data Elements

Numerator– Thermoregulation Maintained

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Diagnosis Codes

Cardiac Arrest ICD-9-CM Code– 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

– V12.53 - Sudden cardiac death successfully resuscitated

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Procedure CodesNot all CPT codes for hypothermia are

specific to cardiac arrest; therefore, use hypothermia records as a source to identify patients receiving therapeutic hypothermia.

Procedure codes for exclusionary procedures in SCA-01 are given in the data element “Patient Location”.

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Questions

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Measure Set-Specific Data Elements

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Data Elements – SCA-01 Denominator

– Cardiac Arrest– 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

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Cardiac Arrest Absence of both pulse and breathing.

– Y The patient sustained a cardiac arrest– N The patient did not sustain a cardiac

arrest

Equivalent terms for cardiac arrest include Code Blue or cardiorespiratory arrest

The preferred source is the resuscitation (Code Blue) record.

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Cardiac Arrest Time

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.

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.

For times that include “seconds”, remove the seconds and record the time as is.

Example: 15:00:35 would be recorded as 15:00

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Cardiac Arrest Event Number 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.

A cardiac arrest event may be a single instance of cardiac arrest, or multiple arrests occurring within minutes of each other

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.

Allowable values are 1, 2, 3, 4, and 5.

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Implanted Device 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

Internal pacemaker/defibrillators are included; external or wearable devices, such as LifeVest, are not included as implanted devices

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Initial Rhythm 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

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Left Ventricular Assist Device/BIVAD A left ventricular assist device (LVAD) is an

implantable mechanical pump that helps pump blood from the left ventricle; a biventricular assist device; a biventricular assist device (BiVAD) is a mechanical pump implanted to assist both the right and left

ventricles.– Y (Yes) There is a documentation that the patient had either

an LVAD or BiVAD 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 BiVAD 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.

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Code Status Order

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.

Includes: DNR, MOLST/POLST, Comfort Measures, Hospice, etc.

Excluded:– Advance directive signed by patient or family with no

accompanying order– Living will signed by patient with no accompanying order

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Patient Location 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

– 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

– 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

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Patient Location – cont’d. 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.

Be as specific as possible 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.

The patient must be actively in the cardiac cath lab, electrophysiology suite, or on open heart bypass or ECMO bypass to answer Value 1. ICD9-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.

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Numerator– Endotracheal Intubation Confirmation Date– Endotracheal Intubation Confirmation

Time– Methods of Intubation Confirmation

Data Elements – SCA-02

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Methods of Intubation Confirmation The acceptable methods of confirmation of

intubation are:– 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 PetCO2, plus a number.

– Electronic Waveform Capnography – Graphic tracing of carbon dioxide content in exhaled air, abbreviated as ETCO2.

– 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 CO2 colorimetric monitor – measurement of exhaled carbon dioxide via infrared or other technology, abbreviated as ETCO2.

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Methods of Intubation Confirmation– 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, McGrath, 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.

Examples of Inclusions: PetCO2 (plus any number), ETCO2 (plus any number), Esophageal detection device, EDD, Capnometry, Capnography, Color Waveform, Cords re-visualized.

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

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SCA-03 Data ElementsDenominator:

–Comatose–Reason for Not Administering

Therapeutic Hypothermia–Return of Spontaneous Circulation

Numerator:– Reason for Transfer

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ComatoseComatose 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– Y (Yes) There is documentation the patient

was comatose.

– N (No) There is no documentation that the patient was comatose.

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Reason for Not Administering Therapeutic Hypothermia

Allowable Values:– 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.

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Reason for Not Administering Therapeutic Hypothermia

System reasons for not administering therapeutic hypothermia are: – Equipment-related (e.g., machine malfunction, ice

machine broken, power outage)– Staff-related (e.g., nursing staffed in numbers

inadequate for hypothermia)

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Return of Spontaneous Circulation 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.

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Reason for TransferAllowable 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.

Notes for Abstraction:.– 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).

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SCA – 04 Data ElementsDenominator

– Date Therapeutic Hypothermia Ended– Date Therapeutic Hypothermia Initiated– Reason for Early Discontinuation of Therapeutic

Hypothermia– Therapeutic Hypothermia Initiated

Numerator– Thermoregulation Maintained

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Date Therapeutic Hypothermia Ended– Use the date that re-warming began

Date Therapeutic Hypothermia Initiated– 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

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Reason for Early Discontinuance of Therapeutic Hypothermia

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

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

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Reason for Early Discontinuance of Therapeutic Hypothermia

System reasons for discontinuation are:– Equipment-related (e.g., machine malfunction, ice

machine broken, power outage)– Staff-related (e.g., nursing staffed in numbers

inadequate for hypothermia)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.)

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Therapeutic Hypothermia InitiatedDocumentation that therapeutic hypothermia was

begun.– 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.

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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: Was there a core temperature recording every hour that was between 32 and 34 degrees Celsius for a minimum of 12 continuous hours?

– Allowable Values:– Yes, No, UTD

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Thermoregulation Maintained

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

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Thermoregulation Maintained 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.

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.

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Thermoregulation MaintainedConversion chart for Fahrenheit to Celsius

given, as well as calculation formula If there is more than one temperature

recorded at the same time from different sources, use the temperature source in the following order:– 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

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How to Identify Patients Eligible for the Measures?

Code tables for cardiac arrest are in Appendix A-1; the hypothermia code is not exclusive to cardiac arrest and is not often used.

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.

For measure 04, use hypothermia administration records.

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http://manual.jointcommission.orgEnter data into the online formKeep a crosswalk of the patient

identification numbersFirst conference call is on Tuesday

November 29th.

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GET STARTED

Access the project website at: http://manual.jointcommission.org

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SUDDEN CARDIAC ARREST PROJECT PAGE

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

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YOUR HOSPITAL PAGE

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 re-abstraction

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View and update existing records

Click the Pencil icon to “Edit” an existing record

Click the UBCI number to “expand” an existing record

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Mark records as complete

Click the empty box to “Complete” and “Lock” a record

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Review records that have been completed

Click the “Complete” radio button and then click “Filter” to view completed records

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Identify records flagged for re-abstraction

The “Lock” icon means the record is complete. The blue flag icon means the record will be re-abstracted.

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ENTERING NEW RECORDSNote: 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.

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ENTERING NEW RECORDS

Once you have completed data entry for this record, save the data record.

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DATA ENTRY CASE SCENARIOS

general patient data elements

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.

The “:” colon needs to be added to all “time” fields – in the HH:MM time format.

if the patient was not admitted, leave the Admission Date and Time blank

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CARDIAC EVENT SECTION

If Code Status Order is “N”, enter UTD for date and time

If Tube Insertion is “N”, you can leave the remaining Intubation elements blank

Answer Therapeutic Hypothermia Initiated for each Cardiac Event entered

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THERAPEUTIC HYPOTHERMIA SECTION

Click “Save Data Record” when all data entry is finished for the patient

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FIND EXISTING RECORDS

To find a record by Unique Blinded Case Identifier (UBCI), enter the UBCI and ignore the “Complete” and “Incomplete”, then click “Filter” button.

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VIEW RECORD’S DETAILS

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.

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EDIT EXISTING RECORDS

To edit the “General and other patient-level data elements”, click on the pencil icon.

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VIEW EXISTING RECORDS

To view the complete records, check the “Complete” radio button then click “Filter” button.

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REVIEWING COMPLETED RECORDS

The completed records are LOCKED and can not be edited. The blue flag indicates that record will be re-abstracted.

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UNLOCK A RECORD

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).

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ASK A QUESTION

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.

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

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