Tips to help with frequently found errors when entering data


The latest tip looks at COVID-19 Patient Monitoring and which patients should be reported in this module. Scroll down for the previous tip where we take a look at some common inaccuracies found when entering data for a haemodialysis event as well as surgical antibiotic prophylaxis.  Look out for more tips on other modules in future eBulletins.


Tip for December 2021 - COVID-19 Patient Monitoring – which patients should be included?

 

Which patients should be included in the COVID-19 patient monitoring?

All patients that meet confirmed COVID-19 case definition and are admitted to this facility.

Do I include admitted patients with a COVID19 test result of ‘indeterminate’ or ‘low positive’?

Yes, COVID-19 tests reported as ‘indeterminate’ or ‘low positive’ are equivalent to confirmed positive and should be reported via VICNISS webform. If the patient is later found to be negative, i.e. false positive, the case should be deleted from the VICNISS database.

Do I include confirmed COVID-19 cases that present to outpatients, emergency department, etc?

No, unless this patient is later admitted to the facility

Do I include patients that did not have their COVID-19 specimen collected at my facility (e.g. GP clinic)?

Yes, report all confirmed COVID-19 cases admitted to your facility regardless where the initial specimen was collected.

Is HITH patients included?

Yes, include HITH patients that are confirmed COVID-19. Patients in the HITH program are considered admitted. This is applicable to the ‘traditional’ HITH programs.

Do I include patients in the COVID-19 Positive Care Pathways Program?

There are several public health units across the state that are delivering the COVID-19 Positive Care Pathways program.  It appears each public health unit has their own system of delivering these programs.  The description of the program by the Department of Health includes: “each case is triaged into one of three pathways (low, medium, or high severity) based on clinical risk, severity of illness and social needs… Care is generally provided in the home through telehealth or other remote monitoring platforms. If clinical care needs are higher, care is provided through the local hospital, either in your home or as an inpatient.”

The VICNISS Patient Monitoring Module aims to capture those patients with COVID-19 that are accessing the hospital for the higher care either through HITH or as an inpatient.  Patients (e.g. low acuity), being monitored only via phone call/telehealth do not need to be reported to VICNISS. Please note there are numerous terms being used for this low level monitoring e.g. telehealth, virtual HITH, better at home, etc.































































Tip for October 2021 - Haemodialysis Event (HDE)

Be careful to enter the central lines correctly. Most central lines in the haemodialysis outpatient are tunnelled.  It is rare to have a non-tunnelled central line, e.g. vascath, in the outpatient. If you are unsure please contact VICNISS.

Surgical Antibiotic Prophylaxis (SAP) found in SAP & SSI modules

Differentiate and accurately record antibiotics given as surgical prophylaxis (SAP or Prophylaxis) or given for treatment of infection (Treatment).

What is the difference between antibiotics given for prophylaxis or treatment?

Prophylactic antibiotics are administered with intent of preventing infections at the surgical site and usually given just prior to surgery. Sometimes if the surgery is delayed or for antibiotics that have a long half-life (such as IV vancomycin), prophylactic antibiotics can be started 1-2 hours prior to procedure.

Treatment antibiotics are usually started some time (sometimes days before) prior to the procedure. They are also sometimes redosed  (especially if they are due to be given anyway) or commenced by the anaesthetist (e.g., in emergency procedures). Antibiotics given as part of ‘Treatment’ should not be recorded as SAP even if dose is given within 1 hour of surgery. There is a separate section on the web form to document non-SAP/treatment antibiotics received in the 24 hours of surgery. 

Why is it important to capture antibiotic in the correct part of the form

Both SAP & Non-SAP antibiotics are considered in assessment of SAP compliance – choice, dose, timing & duration.

Here is an example where capture of antibiotic in the “Prophylaxis” or “Treatment” table is important

Mr RJ underwent hip prosthesis implantation on 5 August 2021 at 0900. 

Scenario 1
On the SAP table, it was recorded that ceftriaxone 1g IV was given at 0830, and cefazolin 2g given at 0835.
It was recorded that ceftriaxone was continued for >24 hours post-procedure, but cefazolin ceased with no further doses given post-leaving theatre.
Compliance assessment
        • The antibiotic choice compliance assessment for this is “compliant” but the prescription is “adequate, too broad” (as SAP was deemed to have met adequacy with cefazolin alone and did not require additional coverage provided by ceftriaxone). Prior to July 1st 2021, VICNISS choice compliance had the following outcomes (1) optimal (2) adequate (3) non-compliant (4) non-assessable.  From July 1st 2021, “Adequate” will be divided into “Adequate, reasonable” and “Adequate, too broad”.  “Adequate, too broad” reflects prescriptions that provide excessive coverage against infection for the procedure which can contribute to antimicrobial resistance.
        • Although cefazolin duration was compliant, as ceftriaxone was continued after procedure, the overall assessment for duration was non-compliant

Scenario 2
On the SAP table, it was recorded that cefazolin 2g given at 0835.
On the Treatment table, it was recorded that ceftriaxone 1g IV was given at 0830.  The ICP noted in the documentation that the indication for ceftriaxone was for UTI treatment at the request of the surgeon. It was continued on return to ward.
Compliance assessment
        • Antibiotic choice compliance assessment for cefazolin is optimal.  No compliance assessment against prophylaxis for ceftriaxone is performed as it was prescribed for UTI treatment.
        • Antibiotic duration assessment is optimal.