Present on admission

1. Present on admission Expert reference group Presented by Paul Croft and Steve Bowring

2. Agenda

3. Actions and notes

4. Actions and notes

5. Meeting objectives

6. Meeting Objectives • Agree and sign-off Terms of Reference • Agree and sign-off Inclusion Criteria • Discuss candidate conditions: • Sign off if ready • Suggest changes • Suggest contacts • Recommend POA removal

7. Scope re-cap

8. Scope recap • Define and publish a clinically validated list of Present on Admission (POA) conditions including associated business definitions and rules, clinical coding mappings and user guidance • Establishment of an Expert Reference Group (ERG), comprising representatives from key stakeholders organisations, including clinicians • Development of a process and associated templates to support requests for the consideration, and potential mandation, of further POA conditions in the future

9. POA Project Out of Scope • Implementation of changes to CDS 6.2 within SUS R12 to support the national reporting of POA indicators • Undertaking piloting of the collection and reporting of POA indicators and submission of these through CDS 6.2 • Information Standards Board (ISB) submission to seek approval for the mandation of POA reporting across the healthcare system

10. Terms of reference

11. Terms of Reference - updated • Updated to include comments from last meeting • Objectives • Activities • Deliverables • Stakeholders • Method of operation • Confidentiality

12. Inclusion criteria

13. Inclusion criteria - updated

14. First-pass assessment by the ERG

15. Scenarios

16. Scenarios – Admission Episode

17. Scenarios – Subsequent Episodes

18. Condition review

19. Condition review

20. Condition review

21. Condition questions

22. Condition review - Venous Thromboembolism Many DVT are not clinically detectable and impossible to ‘date’ in order to say with confidence it was not present on admission.

23. Condition review - MRSA Should we include other organisms, MSSA equally important – there should be an abilityto vary the category depending on future developments? What about incidents that only become obvious two days after admission? Is there a duplication with HPA data collection and reporting?

24. Condition review – C Diff Can a patient have C Diff infection for a period of time without showing sumptoms? Will collection of this data be a duplication with HPA data already collected?

25. Condition review – Pressure ulcers Does the removal of the 72 hour rule make sense? Does the 2, 3, 4 and unclassifiable update make sense? Is specialist knowledge required? Are the business rules clear enough to cover all circumstances?

26. Condition review – Injury from falls What happens if there is a POA fall and hospital acquired fall in the same episode? Are the current reporting processes through NRLS adequate?

27. Condition review – Acute kidney injury Is AKI too often associated with acute admission? i.e. is AKI almost always community acquired rather than hospital acquired? Does the strict definition make it impossible to diagnose on admission?

28. Condition review – Malnutrition MUST screening process often quoted in consultation responses What happens if malnutrition is POA and hospital acquired in the same episode? Which conditions should lead to exclusion? i.e. End of life conditions and cancer Are there any timing elements to take on?

29. Condition review – Pneumonia Suggested condition – no consultation feedback Often recorded as hospital acquired

30. Condition review – Poor glycaemic control Requires re-write

31. Next Steps • Further work to define final definitions including review by clinical experts • Develop Implementation Guidance • Assess POA definitions against Inclusion Criteria • Ensure the ERG is in a position to sign-off the POA conditions and guidance • Develop on-going arrangements for POA Next meeting: TBC Venue: TBC

32. Thank You!