Dependency Outpatient Activity

This topic is for IBID

Dependency Outpatient Activity

The Daily Dependency record is the patents care record while under the care of the Burns team.

Creating a Dependency Record

A new Daily Dependency record can be created by

• clicking New Dependency Record shown next to Open Dependency Record,
• by clicking on the New Dependency Record on the Navigation tab or
• selecting New on the tool bar and selecting New Dependency Record.

See also: Entering Dependency Data

See also: Data Grids

Daily Dependency Dependency records should be created for each interaction with an out-patient.

Dependency Header

Linking with iBID Record

 Please create the IBID record before creating Dependency records

It is vital from an information analysis perspective that the Dependency record is correctly linked with the associated iBID record. This is done automatically when the user updates the Record Date/Time field, free type or choose from drop down calendar.

If there is no iBID record to link to either:

Check that the dates are correct

Manually select the correct iBID record by clicking the blue <None> link.

This will open a drop down list of the patients Ibid records, click to insert relevant record.











Once the Ibid Record has been linked, details of the linked record will be displayed in the Linked Ibid Records box at the bottom of the Dependency Header. The Dependency Header will be displayed throughout the dependency record regardless of the dependency tab open.

The dependency record can be edited up to 24 hours after the record has been created, after that time the Dependency record will be opened in Un-editable mode, click the "Edit" button on the Dependency Tool bar to make an changes after this point.

• Status - Choose from drop down list the patients status at the time of the dependency record treatment, I.e In Patient, Ward Attender etc.

• Location - Choose from drop down list the location of the patient whilst treatment is received, i.e Hospital Ward, Residence etc.

• Bed Number - Choose bed number, ward or other Location for patient whilst treatment is received.

• Shift - Choose from drop down list the shift the procedure was carried out.

• Off Ward - Choose from drop down list the location the patient received treatment.

• Ward Attender for (hrs) - Box to enter the hours the patient has been on the ward.

Daily Dependency

Dependency Scoring

Made up of KPI Required fields the dependency scoring builds a score of patient dependency for analysis purposes.

Monitoring Requirements - Choose from the drop down list the patient's level of monitoring dependency required.

Procedure Complexity - Choose from the drop down list, the complexity level of procedures undertaken for the patient on this date. Ranging from small dressing or procedure to major op.

Psychosocial Support - Choose from the drop down list the level of Psychosocial Support the patient and NOK requires.

ADL Achievement - Choose from the drop down list the level of support the patient received provided by burn care staff to fulfil the activities of daily living on this date.

Mobility Limitation - Choose from the drop down list the menu item that best describes the level of input provided to the patient.

No Physical Therapy - Tickbox that hides the physical therapy fields 'Therapy Support' and 'Treatment Complexity' when no physical therapy was given.

Therapy Support - Choose from the drop down list the menu item that best describes the level of input provided to the patient.

Treatment Complexity - Choose from the drop down list the degree of complexity of care provided to the patient by the physical therapy staff.

Rehabilitation Complexity Score

Nursing staff to complete this section

Basic Care and Support Needs - (including washing, dressing, hygiene, toileting, feeding and nutrition, maintaining safety etc) **Ensure info correlates to the ADL Section** Choose from the drop down list the menu item that best describes the level of basic care and support requirements to the patient. This forms part of the rehabilitation complexity score for analysis purposes. Definitions as follows :-

C0 Largely independent - patient maintains their own safety and manages basic self-care tasks largely by themselves. May have incidental help just to set up or to complete eg, application of orthoses, tying laces etc

C1 Needs Help from 1 person for most basic care needs - for washing, dressing toileting etc. May have incidental from a 2nd person eg just for one task such as bathing

C2 Requires help from 2 people for most basic care needs -for washing, dressing toileting etc.

C3 Requires help from 2 people for basic care needs - OR requires constant 1:1 supervision eg to manage confusion and maintain their safety

Skilled Nursing Needs - Choose from the drop down list the menu item that best describes the level of The specialist nurse care requirements of the patient. This forms part of the rehabilitation complexity score for analysis purposes.

N0 No need for skilled nursing – needs can be met by care assistants only

For Ward Patient

N1 Requires intervention from a SRN - (eg medication, wound/stoma care, nursing obs, enteral feeding, IV infusion etc)

N2 Requires intervention from trained rehabilitation nursing staff - This level is for neuro rehab patients HDU or ICU

N3 Requires highly specialised nursing care - For very complex needs such as:-Patients management of tracheostomy or ventilation

Management of challenging behaviour/psychosis/complex psychological needs

Highly complex postural, cognitive or communication needs

Vegetative or minimally responsive states, locked-in syndromes

Therapists to complete this section

Therapy Intervention (describes the approximate level of input that is given from therapy disciplines. Includes individual or group based sessions. Run by therapists)

Therapy Intervention - Choose from the drop down list the menu item that best describes the level of physical therapy requirements of the patient on this date. This forms part of the rehabilitation complexity score.

T0 No therapy intervention (eg awaiting discharge)

T1 Total therapy intervention less than 4 hours per week (or less than 1 hr / day)

T2 total therapy intervention 4 – 9 hours per week (or approximately 1-2 hours / day)

T3 Total therapy intervention 10 – 15 hours per week (or approximately 2-3 hours / day)

T4 Total therapy intervention 16 – 20 hours per week (or approximately 3-4 hours / day)

T5 Total therapy intervention 21 – 25 hours per week (or approximately 4-5 hours / day)

T6 Total therapy intervention more than 25 hours per week (or More than 5 hrs / day)

Nursing staff to complete this section

Medical Intervention (describes the approximate level of medical care environment for medical/surgical management)

Medical Intervention - Choose from the drop down list the degree of medical support and intervention required by the patient on this date. This forms part of the rehabilitation complexity score.

M0 No active medical intervention - For patients being managed by GP

M1 Basic investigation/monitoring/treatment- For patients in non-specialised hospital setting or community eg intermediate care, normal ward)

All/most pts

M2 Specialist medical intervention - Requiring in-patient hospital care in specialised hospital setting ie; in-patient in burns service

Unwell ICU pts

M3 Acutely sick or potentially unstable medical condition -Requiring 24 hour on-site acute medical cover ie; requires Acute Medical/Surgical Care or potentially unstable requiring out-of-hours intervention – eg, for uncontrolled seizures, immune-compromised

Worst Mews Score - Box to enter the highest score for the medical early warnings score recorded on this date.

Dependency Notes

Enter in free text boxes as much information as possible regarding the patients care. Current Status Treatment Plan Other events

Once the Daily Dependency fields are completed the outpatient may have had a wound dressed, in this case a wound assessment load field will need to be completed.

Wound Assessment Load

Wound Assessment/Load Is designed to display the size of the wound dressed, types of wound treatments, grafts and skin substitutes used during the patients care episode.

Wound Assessment & Consumables

Wound Assessment

Donor Site Load - Enter the size of the donor site

SF/SD Load - Enter the Superficial or Superficial Mid-dermal surface load

DD/FT Load - Enter the Deep Dermal or Full Thickness load

Graft Failure Evident - Choose form drop down list the percentage of the graft failure evidence

Large Skin Area Dressings Today - Enter the percentage of the dressing area applied the day of the dependency record

95% Healed - Tick box indicating the wound is 95% healed

100% Healed - Tick box when the wound is 100 healed

Treatments for:TODAY

Tick boxes for each treatment the patient has received for the relevant dependency record

MR Bact Contamination

MR Bact Septicaemia

Non MR Bact Septicaemia

Fungal Contamination

Fungal Septicaemia

Strep A Contamination

Strep A Septicaemia

Pseudomonas Contamination

Pseudomonas Septicaemia

Skin Substitutes

To enter a new skin substitute Click the New Skin Substitute icon on the Skin Substitutes toolbar.

Multiple skin substitutes can be added for each Daily Dependency.

• Skin Substitute - Choose Skin Substitute from drop down list

• TBSA% - Enter percentage of Total Burn Surface Area

Click the save button and the skin substitute entered will be added to the Skin Substitute list, along with the date the information was entered and the users name. To add another Skin Substitute simply click the Skin Substitute button on the toolbar and the drop down list will appear once again.

To delete a skin substitute click the Delete button on the Skin Substitutes toolbar.

Outpatient Activity

• Patient Attendance - Choose the relevant option from the drop down list.

• Re Arranged - Tickbox if patient did not attend and appointment has been rearranged

Assessments

Tick Box if patient has been assessed by any of the following.

Surgeon Assessment

Nurse Assessment

Therapy Assessment

Psychology Assessment

Pressure Gmt Assessment

Other Assessment

Assessment Information

Once the relevant boxes have been ticked further information fields will appear

Enter grade of each speciality that has seen the patient and choose assessment time from drop down list.

Tick boxes for Follow up, Discharge or Listed

Referrals

Tick box if patient has been referred to any of the following specialities

Referral to Dermatology

Referral to Cosmetic Camouflage

Referral to Psychiatrist

Psychological Scoring Data

These fields are to be found with the Physiotherapy Scoring fields on the Psych & Physio Tab.

Psychological Scoring Data

These fields are to be found with the Physiotherapy Scoring fields on the Psych & Physio Tab.

PREM/PROM

PREM - Enter the Patient Reported Experience Measures in the free type box

PROM - Enter the Patient Reported Outcome Measures in the free type box

CALM

Communication and Low Mood scale

Compliance (0 - 4)- Enter patients compliance score ranging from 0 to 4

Adherence (0 -4) - Enter the Adherence score ranging from 0 to 4

Lability (0 - 4) - Enter patients Lability score ranging from 0 to 4

Motivation - Enter patients Motivation score ranging from 0 to 4

Recovery Barriers

Tick box if patient suffers from the following recovery barriers.

BioMedical

Employment

Finance

Psychosocial/Sex

Psychiatric

Paediatric Psychology

PedsQL Family Impact Module (0-100) - Enter the pediatric quality of life inventory score for Family Impact from 0-100

PedsQL Parent Report (0-100 )- Enter the pediatric quality of life inventory score for Parent Report from 0-100

PedsQL Child Report (0-100) - Enter the pediatric quality of life inventory score for Child Report from 0-100

CRIES-8 (0-40) - Enter the Children's Revised Impact of Event Scale from 0 to 40

Satisfaction with Appearance (0-100) - Enter the patients satisfaction with appearance from 0 to 100

Burn Spec. Health Scale (Brief)

Enter Score 0 (Extremely) to 4 (None) in the following fields using the Burn Specific Health Scale

Abilities

Hand Function

Work

Body Image

Affect

Interpersonal

Sexuality

Heat Sensitivity

Treatment Regimens

BHS -B Total Score - Automatically adds the above Burns Specific Health Scale score

Once the Psychological Scoring Data is completed, the Physiotherapy Fields will need to be filled in. For further information regarding the Physiotherapy fields please follow link to Physio Scoring

Physiotherapy Scoring Data

Rehab Screening Performed

Rehab Screening Performed- Tick box when the rehab screening has taken place, only one patient screening is necessary. This is a KPI field and will be displayed in the Patient Summary.

Patient Specific Functional Scale (PSFS)

The patient has to identify up to 3 activities that have been impacted by their injury/problem.

Score marks out of 10 for each activity as follows

0 = Unable to perform

10 = Able to perform activity at the same level as before the injury took place

Activity boxes - Enter name of activity

Score (0-10) - Enter activity score

PSFS% - Enter the percentage score of the Patient Specific Functional Scale

Scar Site - Free type the place the scar is located on the patient

Patient & Observer Scar Assessment Scale

This section aims to measure the Patient's scar quality

Observer Score

Mark out of 10 as follows:-

1 = Normal Skin

10 = Worst Scar Imaginable

Vascularity

Pigmentation

thickness

Relief

Pliability

Surface Area

Observation Overall

Patient Score

This section aims to assess the patients feelings on their scar.

Mark out of 10 as follows:-

1 = Not at all

10 = Yes Very Much

Pain

Itch

Colour

Stiffness

Thickness

Irregularity

Patient Overall - To be scored as follows:-

1 = Feels Normal

10 =Feels Very Different

Therapy Outcome Measures (AusTOMS)

Mark the following fields using the AusTOMs scores as follows:-

5 = Normal

0 = unable or extreme problem

Impairment

Skin

Functional Mobility

Upper Limb Use

Self Care

Pain

Respiratory

Musculoskeletal

Domestic Life

Activity Limitation

Skin

Functional Mobility

Upper Limb Use

Self Care

Pain

Respiratory

Musculoskeletal

Domestic Life

Participation Restriction

Score

Wellbeing

Score

FA4B (Functional Assessment 4 Burns) Score

Score range from 7 to 35

FA4B Score (7-35)= The Functional Assessment for Burns (FAB) score is an objective measure of burn patients' physical function. It is used to facilitate discharge planning, measure progress of a patient's physical rehabilitation, set rehabilitation goals and motivate patients".

Pain Overall VAS

Score lowest and highest pain experienced to a value of 1 to 10 as follows:-

0 = No Pain

2 = Mild, annoying pain

4 = Nagging uncomfortable pain

6 = Distressing, Miserable Pain

8 = Intense, dreadful Pain

10= Unbearable Pain

• Lowest Pain Score in 24 Hours

• Highest Pain Score <24 Hours

Pain Neuropathic

Mark the Neuropathic pain in the boxes below using the LANSS Pain Scale, marks from 0 -24

LANSS (0-24)

Self LANSS (0-24)

Editor Types

Date Editor

Can free type date or select from drop down calender. Enter "Today" or press "Clear to exit without entering data.

Time Editor

Can free type time or use scroll bars at the right of data field.

Date & Time Editor

Free type date dd/mm/yyy and time 00.00, or drop down list. Choose "today" button if event was day of inputting data or "Clear to exit field without data entered.

Drop Down / Lookup List

The Lookup List is a collection of common names, places, catagorys, or other types of information that can help you choose a required field. Click on the down arrow to the right of the data field, highlight the relevant information to enter.

Staff Drop Down / Lookup List

Populated by staff names entered as "Users" in Administration.

'Yes/No/(Don't Know Drop Down

A special kind of drop down list to allow a clearer selection of yes, no & don't know when compared to the tick box. Used predominantly in the iBID editors, but due to roll out to all data-entry fields. Input via keyboard can be acheived by pressing Y or N on the keyboard.

Tickbox

Checked - Positive with a known value = 1.

Unchecked - Negative with a known value = 0.

Gray - Don't know with a value = null.

Please note: Check boxes are grey (Unknown) by default.

Postcode Editor (2 part)

Free type 1st part of postcode letters and numbers.

Free type 2nd part of postcode numbers and letters.

Text Field

A free type field to enter as much detail as possible.

(Note: Max 255 characters)

Memo Field

A free type field to enter as much detail as possible (Unlimited chars)

Automatically Filled in Fields

Sometimes shaded, Aquila will fill in these fields automatically from the data entered in previous fields.