NUR Intervention Queries

1
NUR Intervention Queries

• Where is my data?
• Presented by Jenny Blue

2
Problem 1

• Nursing Intervention dataThe query responses use
  to appear on your NPR ReportBUT, they
  stopped!!!!
• CAN YOU RELATE?
• Your NPR report was accurately displaying query
  responses for an intervention.
• Historical data still appears, but recently
  entered data still appears in the EMR but NOT on
  the NPR report!!!!
• Why does this happen?Where is the data? How do
  you get the historical as well as the new data on
  your report?

3
Why does this happen?

• Query Responses
• for NUR interventionsare NOT stored in a single
  location.
• How you design the assessment screen and how you
  define the queries will decide where the data
  will be stored.
• When a query type and/or a repeat flag is
  changed, the new data is stored in a new
  location. This causes a loss of continuity
  between new data and previously entered data.

4
Changing Query Type

• Changing the Query Type from a single entry type
  such as Number to a multiple entry type like
  Several will change where new data will be
  stored.
• In later versions, MEDITECH has started
  restricting such changes in Query Type.

5
Changing Query Group Repeat Flag

• Changing the screen Query Group Repeat Flag from
  blank or N to Y will change where new data will
  be stored.

6
Where is the data?

• Where the response to a query is stored
• is based on the combination
• of 2 independent factors.
• The Query Type in the Query Definition
• The Query Group Repeat Flag in the Assessment
  Screen Definition
• There are 4 different storage locations for
• NUR intervention queries.

7
Four storage locations

• ASSESSMENT DATA
  SEGMENT
• QUERY TYPE REPEAT FLAG FOR RESPONSES
• single entry query Y
  td.repeat.results(nur.documented.results.repeat)
  such as N-numeric (N1)NPCWpatientIint.baseO
  int.urnTDtd.act.date,td.act.time,td.act.ctrRt
  d.repeat.ctrQtd.rep.query
• (N1)NPCWX123I5257777O3TD20080220,0910,1R
  1.1QT.GEN 5(N1)NPCWX123I5257777O3TD2
  0080220,0910,1R1.2QT.GEN 3
• blank
  td.results(nur.documened.results)
• (N1)NPCWpatientIint.baseOint.urnTDtd.act.d
  ate,td.act.time,td.act.ctrQtd.query(N1)NPCWX
  123I0500025O2TD20080123,0700,1QVS.PULS
  83
• multiple entry query Y
  td.repeat.results.mult (nur.documented.results.rep
  eat.mult)
• such as S-several (N1)NPCWpatientIint.baseOi
  nt.urnTDtd.act.date,td.act.time,td.act.ctrRtd.
  repeat.ctrQtd.rep.queryMtd.rep.query.q
• (N1)NPCWX123I5257777O3TD20080220,0910,1R
  1.1QT.NURM1 4
• (N1)NPCWX123I5257777O3TD20080220,0910,1R
  1.1QT.NURM2 14
• (N1)NPCWX123I5257777O3TD20080220,0910,1R
  1.1QT.NURM3 17
• blank
  td.results.mult (nur.documented.results.repeat)(
  N1)NPCWpatientIint.baseOint.urnTDtd.act.dat
  e,td.act.time,td.act.ctrQtd.queryMtd.query.q
• (N1)NPCWX123I0500025O2TD20080123,0700,1Q
  VS.RXPSM1 4
• (N1)NPCWX123I0500025O2TD20080123,0700,1Q
  VS.RXPSM2 6
• (N1)NPCWX123I0500025O2TD20080123,0700,1Q
  VS.RXPSM3 9

8
NUR data can be a moving target

• When one of the 2 factors changes for an
  intervention query, new responses are stored in a
  new location (different data segment/table).
• This change does not affect previously collected
  data. It is still in the same data segment where
  it was originally stored. Historical data does
  not move.
• Existing NPR reports will continue to report the
  historical data. But, the reports will fail to
  find new query responses until each report is
  modified to look in both old and new storage
  locations.

9
What to do???

• Unless the query type and assessment screenswill
  NEVER be changed
• which is unlikely in the real world,
• then reporting needs to search all 4 data
  segments/tables for the responses to queries in
  NUR.

10
Data Example 1

• Single answer to a single QUERY repeat flag set
  to N or blank
• DATA SEGMENT NUR.PC.WORK.td.results
• (N1)NPCWpatientIint.baseOint.urnTDtd.act.d
  ate,td.act.time,td.act.ctrQtd.query
• (N1)NPCWX123I0500025O2TD20080123,0700,1Q
  VS.PULS 83
• when the VS.PULS was edited from 83 to 84
• (N1)NPCWX123I0500025O2TD20080123,0700,1Q
  VS.PULS 83
• (N1)NPCWX123I0500025O2TD20080123,0700,1.01
  QVS.PULS 84

11
Data Example 2

• Multiple answers to a single QUERY repeat flag
  set to Y
• DATA SEGMENT NUR.PC.WORK.td.repeat.results
• (N1)NPCWpatientIint.baseOint.urnTDtd.act.d
  ate,td.act.time,td.act.ctrRtd.repeat.ctrQtd.re
  p.query
• (N1)NPCWX123I5257777O3TD20080220,0910,1R
  1.1QT.GEN 5
• (N1)NPCWX123I5257777O3TD20080220,0910,1R
  1.2QT.GEN 3
• When the entries were edited
• (N1)NPCWX123I5257777O3TD20080220,0910,1R
  1.1QT.GEN 5
• (N1)NPCWX123I5257777O3TD20080220,0910,1R
  1.2QT.GEN 3
• (N1)NPCWX123I5257777O3TD20080220,0910,1.01
  R1.1QT.GEN 5
• (N1)NPCWX123I5257777O3TD20080220,0910,1.01
  R1.2QT.GEN 6

12
Data Example 3

• Single answer to a multiple QUERY repeat flag
  set to N or blank
• DATA SEGMENT NUR.PC.WORK.td.results.mult
• (N1)NPCWpatientIint.baseOint.urnTDtd.act.d
  ate,td.act.time,td.act.ctrQtd.queryMtd.query.q
  
• (N1)NPCWX123I0500025O2TD20080123,0700,1Q
  VS.RXPSM1 4
• (N1)NPCWX123I0500025O2TD20080123,0700,1Q
  VS.RXPSM2 6
• (N1)NPCWX123I0500025O2TD20080123,0700,1Q
  VS.RXPSM3 9
• when the entries for VA.RSPX were edited from
  4,6,9 to 4,7,9
• (N1)NPCWX123I0500025O2TD20080123,0700,1Q
  VS.RXPSM1 4
• (N1)NPCWX123I0500025O2TD20080123,0700,1Q
  VS.RXPSM2 6
• (N1)NPCWX123I0500025O2TD20080123,0700,1Q
  VS.RXPSM3 9
• (N1)NPCWX123I0500025O2TD20080123,0700,1.01
  QVS.RXPSM1 4
• (N1)NPCWX123I0500025O2TD20080123,0700,1.01
  QVS.RXPSM2 7
• (N1)NPCWX123I0500025O2TD20080123,0700,1.01
  QVS.RXPSM3 9

13
Data Example 4

• Mulitple answers to a multiple QUERY repeat
  flag set to Y
• DATA SEGMENT NUR.PC.WORK.td.repeat.results.mult
• (N1)NPCWpatientIint.baseOint.urnTDtd.act.
  date,td.act.time,td.act.ctrRtd.repeat.ctrQtd.r
  ep.queryMtd.rep.query.q
• (N1)NPCWX123I5257777O3TD20080220,0910,1R
  1.1QT.NURM1 4
• (N1)NPCWX123I5257777O3TD20080220,0910,1R
  1.1QT.NURM2 14
• (N1)NPCWX123I5257777O3TD20080220,0910,1R
  1.1QT.NURM3 17
• When the entries were edited
• (N1)NPCWX123I5257777O3TD20080220,0910,1R
  1.1QT.NURM1 4
• (N1)NPCWX123I5257777O3TD20080220,0910,1R
  1.1QT.NURM2 14
• (N1)NPCWX123I5257777O3TD20080220,0910,1R
  1.1QT.NURM3 17
• (N1)NPCWX123I5257777O3TD20080220,0910,1.01
  R1.1QT.NURM1 4
• (N1)NPCWX123I5257777O3TD20080220,0910,1.01
  R1.1QT.NURM2 13

14
Problem 2

• Nursing Intervention dataEdited data appears
  multiple times on reports.
• The display includes the original
• as well as the final versions
• of the data.
• Why does this happen?
• How do you get only the latest/corrected version
  of the data on your report?

15
Why does this happen?

• Query Responses
• for NUR interventionsare NEVER changed or
  deleted.
• When a NUR query is changed, MEDITECH makes a new
  copy of the data that includes the changes.
• The original copy and the changed copy are
  differentiated by an activity counter field
  (td.act.ctr).

16
Why does this happen?

• Latest version of edited data is identified by
  the largest value for td.act.ctr.
• FOR EXAMPLE A query that has a single answer
  with the report flag set to N (or blank) will be
  stored in NUR.PC.WORK.td.results
• In C/S, the data structure for td.results is
  defined as (N1)NPCWpatientIint.baseOint.ur
  nTDtd.act.date,td.act.time,td.act.ctrQtd.query
  
• This is an example of a stored query and the
  response .
• (N1)NPCWX123I0500025O2TD20080123,0700,1Q
  VS.PULS 83
• The query VS.PULS was answered with the value
  83
• The td.act.ctr was entered by MEDITECH as 1
• This is an example after the response was
  edited.(N1)NPCWX123I0500025O2TD20080123,0
  700,1QVS.PULS 83
• (N1)NPCWX123I0500025O2TD20080123,0700,1.01
  QVS.PULS 84
• The original entry remains, and a new entry with
  a value of 84 has been created with a
  td.act.ctr value of 1.01

17
Why does this happen?

• In the following example from NUR.PC.WORK.times.do
  ne.repeat.mult , if you do NOT filter out earlier
  versions from the data, there will be 10 entries
  reported. Three of which have been replaced with
  edits therefore, they are duplicate or
  erroneous.
• (N1)NPCWX123I5257777O3TD20080220,0910,1R
  1.1QT.NURM1 4
• (N1)NPCWX123I5257777O3TD20080220,0910,1R
  1.1QT.NURM2 14
• (N1)NPCWX123I5257777O3TD20080220,0910,1R
  1.1QT.NURM3 17
• (N1)NPCWX123I5257777O3TD20080220,0910,1.01
  R1.1QT.NURM1 4
• (N1)NPCWX123I5257777O3TD20080220,0910,1.01
  R1.1QT.NURM2 13
• (N1)NPCWX123I5257777O3TD20080220,0910,1.01
  R1.1QT.NURM3 14
• (N1)NPCWX123I5257777O3TD20080220,0910,1.01
  R1.1QT.NURM4 17
• (N1)NPCWX123I5257777O3TD20080220,0910,1.01
  R1.1QT.NURM5 19
• (N1)NPCWX123I5257777O3TD20080220,0910,1.01
  R1.1QT.NURM6 23
• (N1)NPCWX123I5257777O3TD20080220,0910,1.01
  R1.1QT.NURM7 25

18
How do you fix it?

• The NPR report needs to filter for only the most
  recent version of the edited data.
• This can be accomplished in a Select field that
  filters out all except the highest value of
  td.act.ctr.

19
Problem 3

• Nursing Intervention dataAssessments that have
  had an undo
• still appear on reports.
• Why does this happen?
• How do you get undone assessments off your
  report?

20
Why does this happen?

• Query Responses
• for NUR interventionsare NEVER changed or
  deleted.
• When a NUR assessment is undone, MEDITECH flags
  the undo in the NUR.PC.WORK.activity data
  segment. This is a sibling data segment of
  the NUR.PC.WORK.times.done data segment. These
  two data segments can be addressed using the same
  subscripts.
• All queries and responses are maintained as they
  were entered and edited. The act.ctr field in
  the NUR.PC.WORK.activity data segment is flagged
  for an undone or deleted assessment.
• The act.ctr field has a .99 suffix added to it.

21
How do you fix it?

• The NPR report needs to filter out any queries
  that do not have the assessment flagged as
  undone
• This can be accomplished in a Select field that
  filters out all queries that have the assessment
  act.ctr recorded with ending characters of .99

22
Thanks for joining us today!Questions?
Comments?
Interface People, LP
214.222.1125   (Dallas area)866.539.2188
  (toll free)
info_at_ipeople.com
To Download a copy of this presentation go to
www.ipeople.com/muse