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Copyright: Helen Stevens 2004 Nosocomial Hospital Acquired Infections Surgical Site Infections An International Approach Jeanette Carlson, Hai Nguyen and.

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Presentation on theme: "Copyright: Helen Stevens 2004 Nosocomial Hospital Acquired Infections Surgical Site Infections An International Approach Jeanette Carlson, Hai Nguyen and."— Presentation transcript:

1 Copyright: Helen Stevens 2004 Nosocomial Hospital Acquired Infections Surgical Site Infections An International Approach Jeanette Carlson, Hai Nguyen and Eduardo Rotenberg University of Victoria, Canada

2 Copyright: Helen Stevens 2004 Project Purpose University of Victoria – Healthcare Messaging Standards course (HINF430) 4 th year undergraduate course, required component of Health Information Sciences program HINF430 Project requirements: Contribute to the Intellectual Property of an international Standards Development Organization Project proposal, presentation, and final report

3 Copyright: Helen Stevens 2004 Project Team Members Both Jeannette and Eduardo have completed co-op work terms as part of the University of Victoria Heath Information Sciences program. Hai will be completing his work terms in the USA in 2005. Jeannette Carlson New Brunswick Department of Health and Wellness, Medicare/Prescription Drug Program health information management officer responsible for retrieving, processing and presenting prescription drug data. UK National Health Service (NHS), National Patient Safety Agency (NPSA). Implementation analyst responsible for assisting the manager in an effective rollout of the National Reporting and Learning System. This system was responsible for tracking all adverse patient safety incidents and near misses occurring in the NHS in England, Scotland Northern Ireland and Wales. Eduardo Rotenberg BC Childrens and Womens Health Centre. Evaluated ISO 17799 (security) standard into the CHIPP Project, a project in which health information was to be electronically shared between facilities specialized in paediatric oncology. BC Centre for Disease Control. Collected, summarized and presented information on possible incidents of SARS outbreak in British Columbia

4 Copyright: Helen Stevens 2004 Deliverables & Stakeholders Deliverables Using international perspectives, design a storyboard representing a nosocomial case RMIM Diagram modeling the storyboard including a comprehensive diagram walkthrough Using HL7 RMIM Designer Following HL7 V3 RIM and modeling methodology Project Stakeholders: Rob Borotkanics – Project mentor Anita Benson – Project primary contact Ali Rashidee – Co-chair Patient Safety SIG Alan Flett – National Patient Safety Agency, UK HL7 Patient Safety SIG member with Clive Flashman Pamela Kibsey – VIHA Microbiologist Max Walker – Vocabulary Technical Committee member, HL7 Australia Dr. Richard Stanwick – Vancouver Island Chief Medical Health Officer Helen Stevens-Love, HINF 430 Professor

5 Copyright: Helen Stevens 2004 Project Outcomes Identified and provided additional documentation about nosocomial infections to committee members to assist in current work on dialysis incidents Developed base line storyboard and RIM compliant model for nosocomial infections

6 Copyright: Helen Stevens 2004 Storyboard: Presentation Mrs. Brown, a 56 year old women has been a marathon runner since she was 16. During the past few months she has discovered a slight clicking in her left knee as she goes down staircases, or bends her knee past 30 degrees. One day while simply standing up, Mrs. Browns knee locked in a 90 degree position. Mrs. Brown could not move her knee from this position. Mrs. Brown was taken to the County Down Hospital where she was admitted to the emergency department. Upon being seen by Dr. Pink, it was discovered that Mrs. Brown had a partially torn cartilage in her knee that would have to have the tear removed. Dr. Pink explained this surgery would be done by an endoscopic surgeon Dr. Mauve who would do a simple keyhole procedure in order to repair her knee. He explained that this surgery was very simple and had minimal risk associated with it. It would involved 4 incisions around her knee only about a centimetre wide to get the scopes thorough. The expected recovery would be overnight at a maximum but in all likelihood Mrs. Brown could go home the same day as the surgery on a set of crutches.

7 Copyright: Helen Stevens 2004 Storyboard: Incident After spending the night in the hospital, Mrs. Brown was admitted to surgery for 8 oclock the following morning. Upon completion of the surgery, Mrs. Brown was taken back into her ward for recovery and released later the same day. During the mandatory monitoring period of Mrs. Browns knee, she started complaining to Dr. Mauve that her knee was in pain. Three days later Mrs. Brown was readmitted to the hospital after Dr. Mauve observed redness and swelling in her knee around the surgical site. A sample of swelling fluid was taken from Mrs. Browns knee and sent to the laboratory for investigation. In the mean time, Mrs. Brown was given some pain killers to ease her symptoms.

8 Copyright: Helen Stevens 2004 Storyboard: Investigation After several other complaints of infections in people who had undergone endoscopic surgery at the County Down Hospital, a nosocomial infection investigation was launched. It was discovered the bacteria causing the swelling was one which could be found upon an improperly cleaned endoscope. The swelling fluid was examined along with the endoscope used in the procedure. It was found that the endoscope had been used in several surgeries without being replaced as it should be. Instead the scope was being cleaned. In accordance with County Down Hospitals reporting policies, Dr. Mauve was required to file an adverse incident report to the risk management department of the County Down Hospital. She was to include information about the patient, herself as the surgeon and about the type of bacteria and how it was acquired.

9 Copyright: Helen Stevens 2004 Storyboard Evaluation Storyboard uses a typical incident to demonstrate a possible occurrence of a nosocomial infection. Storyboard outstanding issues: Does not use HL7-defined names for entities (hospital, patient, doctors etc.) Helen to provide worksheet to committee to modify storyboard to conform to HL7 publishing guidelines. Does not explicitly identify messaging instances within the story

10 Copyright: Helen Stevens 2004 RMIM Diagram

11 Copyright: Helen Stevens 2004 Walkthrough: Act Classes NosocomialInfectionInvestigation Entry point for this model. This act is performing an investigation on all of the other acts. This act must be performed on all presenting nosocomial infections. SurgicalProcedure Models the actual procedure performed on the patient in which the infection was acquired. Contains pertinent encounter information as to when and why the patient was admitted to the hospital. In other models this may be another way of acquiring the initial infection. Readmission Models the event of the patient being readmitted to the hospital after acquiring symptoms of possible infections. This point starts off the identification of the infection and infecting pathogen to discover that a nosocomial infection has actually occurred. PathogenObservation This is the observation of the infecting pathogen. It describes the processes required to establish what the pathogen is and where/how it may have been contracted.

12 Copyright: Helen Stevens 2004 NosocomialInfectionInvestigation Act models the information gathered during a nosocomial investigation as well as the act of carrying out the investigation itself. Contains the entry point of the RMIM. When a nosocomial infection is suspected, the process will be entered through the nosocomial infection investigation. IncidentReport This act represents the report to be put together based on the nosocomial investigation and the events preceding it. SurgicalProcedure The act of the surgical procedure is stated here just for information pertaining to the incident report. Diagnosis diagnosis is an observation of the patient in which it was classified a nosocomial was present. EvidenceOfInfection observed evidence of infection which was the reason of classifying as a nosocomial infection case. SpontaneousDihiscesOrOpened observation of a spontaneous dihisces or opened wound that lead to classification of the infection as nosocomial. DrianageFromIncision observation of drainage from the surgical incision that lead to the classification of the infection as nosocomial. Act Relationship subjectOf - the subject of relationship, is intended to model the presence of one of the observations as a subject of the incident report. One of these conditions must be present to classify the infection as a nosocomial surgical site infection.

13 Copyright: Helen Stevens 2004 PathogenObservation This act represents the start of the entire process to discover the specific pathogen (and perhaps cause) of the infection within the patient. It also monitors any additional secondary blood infections that might have been caused from the initial surgical site infection. Culture The culture is the actual viral culture taken from the suspected infecting material (in this example the endoscope). Because viruses are antibiotic resistant, they must be cultured directly from the material. Check This act is the act of checking for a secondary bloodstream infection. AntimicrobialSusceptibility In order to deduce what bacteria caused the infection, an antimicrobial susceptibility test is performed on the bacteria to see which antibiotics the bacteria responds too. Because viruses are antibiotic resistant, they must be cultured directly from the material. LabTestResults This act is an act in fulfillment of the ordered test. It produces the results of the swelling fluid taken from the patient. TestOrder The test ordered due to the patients readmission into the hospital. Usually ordered by attending physician.

14 Copyright: Helen Stevens 2004 Readmission This act represents the act of readmitting the patient for treatment and investigation of the symptoms of infection they are currently showing. SubstanceAdministrationEvent Antibiotics must be administered in order to control the presenting symptoms (pain and swelling). The test order will not be completed at this point so this is not a cure, it is just a temporary measure to suppress the current symptoms.

15 Copyright: Helen Stevens 2004 SurgicalProcedure This is the act of the patients initial surgery on the knee. Encounter This act is the patients original surgical encounter. This is the encounter in which the suspected infection was obtained. MonitorSurgicalSite After each and every surgery, a monitoring period is required to take place. This act represents this period and in the example triggers the observed problem and eventual readmission of the patient. ObservedProblem The observed problem is that of the swelling of the knee and the patients complaint of pain. This problem is noted by the physician and prompts them to readmit the patient to hospital.

16 Copyright: Helen Stevens 2004 RMIM Evaluation Diagram is a representation of the information necessary to support the storyboard Diagram and walkthrough follow HL7 V3 guidelines RMIM successfully validates against RIM RMIM outstanding issues: RMIM is a starting point for the committee – it is not ballot ready. Vocabulary requirements have not been resolved Committee will need to request a Domain Identifier to support development of V3 ballot ready material Request from chair of HL7 V3 Publishing committee (Helen)

17 Copyright: Helen Stevens 2004 Conclusions The U-Vic students submit this work to the Patient Safety SIG for their consideration. It is hoped that this work is useful in helping the SIG accelerate development of HL7 standards in this area critical to patient safety The work submitted must be considered in the context of being work completed by under-graduate students and although comprehensive, it requires further development by the SIG and validation by industry experts.

18 Copyright: Helen Stevens 2004 Thank you and Questions?

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