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Thank you for joining our session. The presentation will begin momentarily.
BORN Ontario: NICU/SCN Encounter Enhancements`
Coming April 7, 2014
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Making Improvements for You!
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Objectives
1. Review Enhancement
Process and Principles
2. Review NICU/SCN
Encounter Updates
3. Questions/Discussion
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Enhancements
New Data Elements
New Validation
Rules
New Pick-list Values
• BORN Information System (BIS) enhancements will
occur annually • Implementation date - April 7, 2014
TOTALLY REDESIGNED NICU/SCN ENCOUNTER
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Enhancement Process
Feedback
Technical Team:
● Reviews issue
● Proposes potential solutions
Ensures alignment with best practice
Assesses impact on: data elements, encounters, data quality, reports etc.
Estimates time required to implement change
Performs cost analysis
Clinical implications are reviewed by:
● Data Collection Review Committee
● BORN MNOC Committee
● Neonatal Sub-committee
● Subject matter experts
Technical team works with software developers to develop and test changes
Coordinators
Test changes
Plan rollout strategies & provide training
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Enhancement Principles
• Defects and issues that impact data entry and quality are
addressed as soon as possible
• Major enhancements are reviewed annually and
prioritized for implementation
• Timing of enhancement release coincides with end of
fiscal period so it is important to keep data entry current
• Feedback is welcome at any time
– Contact your local BORN Coordinator
– Email: [email protected]
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Current state
• Single NICU/SCN encounter
• Created in 2008 (Niday)
• 45 Level 2 SCN - manual and upload
• 3 Level 3 NICU entering manually
• 2 Level 3 NICU’s using a CNN upload
• NICU profile report
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Why so many changes?
• Changes to neonatal care
• Requests from members and Neonatal
Subcommittee of MNOC (subject matter experts)
• Level 3 already entering into multiple databases
• Program created to upload from Canadian
Neonatal Network (CNN)
• Provincial QI – e.g. breast feeding, skin to skin,
hyperbilirubinemia QBP
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Enhancements
• New tabs
• New data elements
• New pick lists
• Removed SNAP/TRIPS* and a few other
redundant data elements
Remains a single NICU/SCN encounter
* SNAP = Score for Neonatal Acute Physiology TRIPS = Transport Risk Index of Physiologic Stability
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Admission and Demographics Tab
Data Elements to Review
• NICU/L3 SCN/L2
• Transferred From
• Admission Temperature
• Admission Weight
• Admission Head
Circumference
• Transport Personnel (In)
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“NICU/L3 SCN/L2”
• Visibility of data elements is based on the
organizational level of care
• If the organization only has an SCN/L2 or an
NICU 3, the field will be automatically set to the
applicable value
• If the organization has both an NICU and an
SCN, a manual selection is required
NEW !
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“Transferred From”
Pick list clarifications:
• Labour & Birth Unit same hospital
• Mother/Baby unit (Post Partum)
same hospital
• Paediatric unit same Hospital
Pick list additions:
• Non-medical facility (e.g. taxi,
ambulance, parking lot )
• PICU/PCCU same Hospital
• Clinic same Hospital
• Operating room same Hospital
• Unknown
Pick list items unchanged:
• Other hospital
• NICU/SCN same Hospital
• Admitted from Emergency
Department
• Home
• Birth Centre (added Sept 2013)
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Admission Information
• Temperature
• Weight
• Head Circumference
NEW !
On Admission
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“Transport Personnel (In)”
• MD
• RN
• RRT
• Transport Team
Required if Neonatal Transport
From = ‘Other Hospital”
Multi-select
• CNS/NP
• Paramedic
• Other
NEW !
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Admissions & Demographics Tab - overview
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Health Status Tab
Data Elements to Review
• Neonatal Resuscitation
• Birth Complications
• Neonatal Health Conditions
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“Neonatal Resuscitation”
Changed to align with newest NRP (2010)
“Neonatal Resuscitation”
“Neonatal Resuscitation: Initial Gas Used”
● Air ● Supplemental Oxygen ●100% Oxygen ●Unknown
“Neonatal Resuscitation: Maximum of Oxygen in %
provided during resuscitation”
If “Initial Gas Used” = 100% oxygen, field
will automatically be set to 100 Mandatory if “Initial Gas Used” =
Supplemental Oxygen or if “Neonatal Resuscitation” contains at least one of the following values: CPAP, PPV, CPAP + O2,
FF02, PPV + O2.
• None
• FFO2
• CPAP + Air
• CPAP + O2
• CPAP
• PPV + Air
• PPV +O2
• PPV
• Laryngeal mask airway (LMA)
• Intubation for tracheal suction
• Intubation for PPV
• None
• Chest compression
• Epinephrine
• Narcan
• Volume Expander
• Unknown
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Newborn Conditions and Complications
Renamed “Birth Complications”
• Birth injury - intracranial hemorrhage
• Birth injury - subarachnoid hemorrhage
• Birth injury - subdural hemorrhage
• Birth injury - unspecified
• Birth injury – other
• Other
• None
NEW !
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Neonatal Health Problems renamed
“Neonatal Health Conditions”
• None
• PDA
• Pneumothorax
• HIE
• Seizures
• Respiratory
• Cardiovascular
• Gastrointestinal
• Sepsis/Infections
• CNS
• Other
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Health Status tab - overview
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Interventions Tab
Data Elements to Review
• Neonatal Therapies/Intervention
• Pain Management
• Neonatal Surgery
• Highest Mode of Respiratory Support
• Respiratory Support in Hospital
• Feeding Methods in Hospital
• Nutritional Support in Hospital
• Reason For Breast Milk Substitute in Hospital
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“Neonatal Therapies/Interventions”
Pharmacological Support in
Hospital:
• Methylxanthines
• Antibiotics for GBS
• Antibiotics-Other
• Surfactant Corticosteroids
• Inotropes
• Paralytic Agents
• Anticonvulsants
Blood Products in Hospital
• Packed Red Blood Cells
(pre-2014: Packed Red
Blood Cell Transfusion)
• Whole Blood
• Platelets
• Fresh Frozen Plasma
• Cryoprecipitate
• Albumin
• Immuniglobulin
• Other Blood products
New pick list values with all pick lists grouped in new sub-headings
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“Neonatal Therapies/Interventions”
Intravascular Devices in
Hospital
• PIV (pre-2014: I.V.)
• PICC Line
• Surgical CVL
• UAC
• UVC
• PAL
Other Interventions in
Hospital:
• Phototherapy
• Exchange Transfusions
• Therapeutic Hypothermia
(pre-April 2014: HIE
Cooling)
• None
• Other
• Unknown
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“Pain Management”
Sedative use | Ketamine
Sedative use | Benzodiazepines
Sedative use | Other
Oral analgesics including
acetaminophen
Unknown
NEW !
None
Opioid analgesic use – Morphine
Opioid analgesic use – Fentanyl
Sedative Use – Midazolam
Sedative Use – Chloral Hydrate
Mandatory Multi-select (throughout stay)
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“Neonatal Surgery”
New pick list values:
• Cardiac surgery
• ECMO
• Other chest surgery
• Other abdominal surgery
• Other surgery
• Cryo/laser treatment renamed
“ROP treatment”
• Craniotomy/CNS renamed
“Neurosurgery/ Central
Nervous System Surgery”
• None
• PDA ligation
• NEC surgery
• Unknown
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Highest Mode of Respiratory Support
Pick list ordered from highest to lowest
Select one value (highest mode)
Invasive High Frequency Ventilation [1-highest]
Intermittent Positive Pressure Ventilation [2]
Non-Invasive Ventilation [3]
Oxygen [4]
Other [5-lowest]
None
Unknown
NEW !
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“Respiratory Support”
• Invasive High Frequency
Ventilation
• Nitric Oxide
• Intermittent Positive
Pressure Ventilation
• Non-Invasive Ventilation
• Oxygen
• Other
• Unknown
Mandatory if “Highest Mode of
Respiratory Support” ≠ None and
NICU/SCN Type = NICU (Level III)
Optional for Level II
Multi-select
If oxygen, invasive ventilation
(IPPV),or non-invasive ventilation is
selected, you must enter the number
of days
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“Feeding Methods in Hospital”
• None
• Breast
• Bottle
• Enteral
• Supplementation
• Device on Breast
• Supplementation Device not
on Breast i.e., finger feed,
cup, other
• NPO
• Gavage tube
• Supplementary feeding
systems
• Gastrostomy tube
• Mucus Fistula Re-feed
• Other
• Not Applicable
• Unknown
Same pick list values as Feeding Methods (on day of discharge)
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“Nutritional Support in Hospital”
• None
• Breast Milk
• Formula
• Donor Milk
• Study Milk
• Human Milk Fortifier
• TPN
• NPO
• Other Additives
• Unknown
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“Reason for Breast Milk Substitute in Hospital” Same pick list values as Reason for Breast Milk Substitute (on day of discharge).
Infant Medical
• Hypoglycemia
• Inborn Errors of Metabolism
• Pre-term (<32 weeks)
• Very low birth weight (<1500 gms)
• Significant weight loss in the
presence of clinical indications
• Other
Maternal Medical
• Active herpes
• Additional Health Concerns
• Contraindicated maternal
medication
• HIV infection
• Severe maternal illness
• Birth mother not involved in care
• Informed Parent Decision to use Any Breast Milk Substitute
• Parental Consent not obtained
• Unknown
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Interventions tab - overview
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Screening Tab
Data Elements to Review
• Bilirubin Measured Within 72 Hours of Birth
• Hyperbilirubinemia Requiring Treatment
• Pain Relief Measures During Newborn Screening or Serum
Bilirubin
• ROP Eye Screening Performed; ROP Treatment
• Neuroimaging
• RSV Prophylaxis Eligible; RSV Prophylaxis Administered
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Bilirubin & Hyperbilirubinemia
Bilirubin Measured Within 72
Hours of Birth
Transcutaneous bilirubin (TCB)
Total Serum Bilirubin (TSB)
Newborn Transferred Out
Not Done
Declined
Unknown
Allow multi-select only for TSB and TCB
Mandatory
Hyperbilirubinemia requiring
treatment
Hyperbilirubinemia Requiring
Treatment
●Yes ●No ●Unknown
Mandatory if “Neonatal Health
Conditions” = hyperbilirubinemia
NEW
Hyperbilirubinemia
Treatment
• Phototherapy
• IVIG administration
• Exchange transfusion Multi-select Mandatory if “Hyperbilirubinemia Requiring Treatment” = Yes
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“Highest Serum Bilirubin”
Highest Serum Bilirubin
>340 mmol/l
• Yes
• No
• Unknown
Optional if “Bilirubin Measured
Within 72 hours of Birth” = Total
Serum Bilirubin (TSB)
Highest Serum Bilirubin
>425 mmol/l
• Yes
• No
• Unknown
Optional if “Highest Serum
Bilirubin >340” = Yes
NEW !
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BORN supports Quality Based Procedure
• The hyperbilirubin data elements were added to support Ontario’s Quality
Based Procedure (QBP) on hyperbilirubinemia in Term and Late-Preterm
Infants (≥ 35 weeks)
• Health Quality Ontario – to improve evidence-based standards of care,
recommend best practices, monitoring and public reporting on quality of care
• Added data fields will allow for evaluation of this QBP (i.e. all babies should
receive bilirubin testing in the first 72 hours of life; percent of infants with
critical hyperbilirubinemia; percent of infants who require phototherapy etc.)
• A copy of the Clinical Handbook for Hyperbilirubinemia in Term and Late
Pre-Term Infants (≥ 35 weeks) is posted on the Ministry of Health and
Long-Term Care Website and can be downloaded: http://health.gov.on.ca/en/pro/programs/ecfa/funding/hs_funding_qbp.aspx
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“Pain Relief Measures During Newborn
Screening or Serum Bilirubin”
• Sucrose
• Breastfeeding
• Skin to skin
• None
• Other
• Unknown
Mandatory if “Newborn Screening (NSO) Offered” = Obtained or if “Bilirubin
Measured Within 72 Hours” = TSB Serum
Multi select
NEW !
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ROP (screening)
Retinopathy of Prematurity (ROP) Screening renamed “ROP Eye Screening
Performed”
• Yes/No/Unknown (same pick list values)
Mandatory if Gestational Age At Birth < 32 Weeks and Birth Weight < 1500g
“ROP Worst Stage”: Left eye/ Right eye/ Both eyes
• None, I II III IV V , Immature, Unknown
Mandatory if “ROP Screening” = Yes and “NICU Type” = (Level III)
Single select
“ROP Eye Screening Type”
Physical exam
RetCam
Unknown
NEW !
NEW !
Mandatory if “ROP Eye Screening Performed” = Yes
Select all that apply
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“ROP Treatment”
• None
• Left eye – Cryotherapy
• Left eye - Laser Therapy
• Left eye - Anti-VEGF injections
• Left eye - Other eye surgery
• Right eye – Cryotherapy
• Right eye - Laser Therapy
• Right eye - Anti-VEGF injections
• Right eye - Other eye surgery
• Unknown
NEW !
Mandatory if “ROP Screening” = Yes, and “NICU/SCN Type” = NICU L3 Multi-select
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“Neuroimaging Screening”
Neuroimaging Screening Performed • Yes
• No
• Unknown
Neuroimaging Screening Results Left/Right • No abnormalities found
• Blood in Germinal Matrix
• Blood in Ventricles
• Ventricular Enlargement Mild
• Ventricular Enlargement Moderate
• Ventricular Enlargement Severe
• Intraparenchymal lesion
• Periventricular Leucomalacia
• Infarct
• Cerebellum Hemorrhage
• Other Brain Lesions
• Unknown
NEW !
Mandatory if “Neuroimaging Screening Performed” = Yes & “NICU/SCN Type” = NICU 3 Multi select
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RSV (Screening)
Meets Respiratory Syncytial Virus (RSV) Prophylaxis Criteria renamed
“RSV Prophylaxis Eligible”
• Yes/No/Unknown
“RSV Prophylaxis Administered”
• Yes
• No
• Unknown
“RSV Prophylaxis
Criteria”
Infant < =32 6/7 weeks and less than or equal to 6 months at the start of RSV season
RSV Risk Assessment Tool score > 49 for infants 33 0/7 to 35 6/7
Confirmed Downs syndrome
Confirmed Bronchopulmonary dysplasia
Confirmed hemodynamically significant congenital heart disease
Special Consideration with physician letter and medical justification
Birth Sibling qualifies
Unknown
Mandatory if RSV Prophylaxis Eligible= Yes. Multi select
NEW
Mandatory if RSV Prophylaxis Eligible = yes
NEW
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“Neonatal Growth and Development Follow-up” Renamed “Meets Neonatal Follow-up Criteria”
New pick list values:
• Yes
• No
• Unknown
Pick list values removed:
• Not required
• Refused by parents
• Regional Centre
• Tertiary Centre
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Screening tab - overview
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Discharge Tab
Data Elements to Review
• Feeding Type on Day of Discharge
• Reason for Breast Milk Substitute on day of discharge
• Discharge Interventions
• Neonatal Discharged/Transferred to
• Transfer Personnel (Discharge)
• Corrected Age at Discharge
• Days of Age at Discharge
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Infant Feeding
Feeding Type on Day of D/C
Same pick list as “Nutritional Support
in Hospital”
Reason for Breast Milk Substitute on
day of discharge
Same pick list values as Reason for
Breast Milk Substitute in Hospital
Newborn Feeding at D/C removed
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Infant Feeding Method renamed
“Feeding Methods (on day of discharge)”
New pick list values
• None
• NPO
• Gavage tube
• Supplementary feeding
systems
• Gastrostomy tube
• Mucus Fistula Re-feed
• Other
• Unknown
Pick list values unchanged:
• Breast
• Bottle
• Enteral
• Supplementation Device
on Breast
• Supplementation Device
not on Breast
(i.e. finger feed, cup, other)
• Not Applicable
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Discharge Interventions
• None
• Oxygen
• Ostomy
• Tracheostomy
• Gastrostomy
• Ventilation
• CPAP
• Phototherapy
• Unknown
On day of discharge
Multi select
NEW !
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“Neonatal Discharge Or Transfer To”
• Home
• Transfer to other hospital
• Transfer to Mother / Baby unit, same hospital
• Transfer to Paediatric unit same hospital
• Transfer to Labour & Birth unit, same hospital
• Transfer to Level II, same hospital
• Transfer to Level III, same hospital
• Transfer to PICU/PCCU, same hospital
• Transfer to Emergency department, same hospital
• Transfer to clinic, same hospital
• Transfer to operating room, same hospital
• Transfer to same hospital, other
• Transfer to Palliative Care
• Child and Family Services Apprehension
REVISED
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“Transport Personnel (Discharge)”
Added to Pick List
• CNS/NP
• Paramedic
• Other
Pick list values unchanged
• MD
• RN
• RRT
• Transport team
Same Pick list as “Transport Personnel In” Must be provided if “Newborn discharged or transferred to” =
Transfer to other hospital
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Other Discharge Data Elements….
Discharge Weight
Mandatory
Discharge Head Circumference
Mandatory
Corrected Age at Discharge – Renamed “Gestational Age at Discharge”
Modified calculation. Days of age at discharge (DOD-DOB)/7 + GA at birth = GA
in weeks and days (38 weeks + 6 days).
“Days of Age at Discharge”
Mandatory
Date of Discharge – DOB
NEW !
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Discharge tab - overview
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Retired
• SNAP, TRIPS
• D/C to Health Care
Professional
• Reason for admission
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Reports Under Construction
• NICU profile Report, NICU Cube
• BIS enhancements have a significant impact on
reporting.
• Over 55 clinical reports to be examined to see if anything needs to
change as a result of the enhancements/changes
• This process will not be completed by go-live on April 7th, 2014.
• An impact analysis and report corrections is underway
• The prioritization of which ones to correct first is mainly based on
reports having the highest volume of use in the BIS.
• We’ll have an ‘under construction’ note on the BIS home page during
the report repair period
• The Clinical reports page, will also display a temporary note next to
each affected report indicating that the report can be run only for data
up to April 6th, 2014
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Resources
• Downtime forms – email, BIS, website
• Pick list resource sheet for health conditions
• Field level help
• Data dictionary
• Webinar on Website
• Coordinators
