2014 CPQCC Manual of Definitions Final

APPENDICES Appendix A Data Submission Timeline Appendix B Logs Appendix C Bacterial Pathogens Appendix D Birth Defect Codes for Item 49 Appendix E Surgery Codes for Item 43 Appendix F OSHPD FACILITY CODES Appendix G Calculation Charts for Date of Day 28 Appendix H Calculation Charts for Date of Week 36 (please use new calculator tool) Appendix I Day Number Chart Appendix J Farenheit to Centrigrade Conversion Table *Appendices G-J was adapted from a log developed by Vermont Oxford Network* 2014 CPQCC, Stanford University, MSOB, 1265 Welch Road, Stanford, CA 94305. (650) 721-1844 Page 103 of 166 APPENDIX A - DATA SUBMISSION TIMELINE (Please see 2014 Finalization Guidelines for more details) January 1, 2015 Start using new on-line form for infants born in 2015. Centers who submit electronically, start following the 2015 format of the EDS specs. January 8, 2015 Deadline for submitting data to be included in the Fourth Quarter Report for 2014. January 2015 Fourth Quarter Report for 2014 available on-line (www.cpqccdata.org). February 2015 CPQCC/VON Contact Report posted on the www.cpqcc.org site for all participating Database Members. April 1, 2015 Deadline for submitting the following: 1) Submit all data into the CPQCC Database for ALL eligible infants born in 2014 and Still-In-House infants born in 2013. Only the minimum data items need to be submitted for infants that have not yet been discharged. 2) Deadline for submitting ALL Finalization documents. 3) Deadline for submitting 2014 CCS Supplemental Forms and confirming the Draft CCS Report. April 1, 2015 CPQCC Data Center Deadline for completing finalization of all data to be included in the VON Database and the Annual NICU Quality Management Report for 2014. April 8, 2015 Deadline for submitting data to be included in the First Quarter Report for 2015. April 2015 First Quarter Report for 2015 available on-line (www.cpqccdata.org) June 1, 2015 Deadline for submission of the following finalized data: 1) All records for 2014 and prior years are complete and 100% error free to be included in ALL CPQCC, CCS and VON Annual Reports. 2) CCS Final Report finalized and confirmed for completeness and accuracy. Jun 2 – 7, 2015 Deadline to confirm the CCS Final Report for completeness and accuracy. July 8, 2015 Deadline for submitting data to be included in the Second Quarter Report for 2015. July 2015 Second Quarter Report for 2015 available on-line (www.cpqccdata.org) September 2015 Annual NICU Quality Management Report for 2015 available for Centers that completed the 2015 data. October 8, 2015 Deadline for submitting data to be included in the Third Quarter Report for 2015. October 2015 Third Quarter Report for 2015 available on-line (www.cpqccdata.org) January 8, 2016 Deadline for submitting data to be included in the Fourth Quarter Report for 2015. 2015 CPQCC, Stanford University, MSOB, 1265 Welch Road, Stanford, CA 94305. (650) 721-1844 APPENDIX B - LOGS Page 105 of 166 OPTIONAL: CPQCC PENDING ELIGIBILITY LOG 2015 ELIGIBILITY LOGS INCLUDE PROTECTED HEALTH CARE INFORMATION FOR YOUR INTERNAL USE ONLY DO NOT SUBMIT TO CPQCC Center Number__________ Center Name____________________________________ Patient's Name Birth Date Admit Date Date of Day 28 Eligible at If infant is eligible, (MM/DD/YYYY) (MM/DD/YY) discharge? enter date below and SELECTION CRITERIA: To be eligible, infant MUST answer (Yes/No) enter the infant in the YES to at least one of the following criteria prior to infant Patient Log reaching Day 28 (MM/DD/YY) 401-1500 grams? (Yes/No) Gestational Age Greater than 1500g/31 wks 6/7 between 22/0 days AND MUST answer YES to at and 29/0? least one criteria: Acute Transport (Yes/No) in/out, Surgery, Death, Intubated Assisted Vent >4 continuous hrs., Early Sepsis, Previously discharged home and readmitted for Total Serum Bilirubin of =>25mg/dL and/or exchange transfusion OR Nasal IMV/XIMV (or any other form of non- intubated assisted vent) for >4 continuous hrs. *This form was adapted from a log developed by Vermont Oxford Network *Submit Items 58-60 for all transported infants when the Post Transfer Disposition is known. **Submit Items 61-62 for all readmitted infants when the Disposition After Readmission is known ***Submit Items 63 and 64 for all infants who were transferred more than once when the Ultimate Disposition is known. ****Submit Item 64 for all infants who were transferred when the Date of Final Discharge or Death is known. CPQCC PATIENT LOG 2015 PATIENT LOGS INCLUDE PROTECTED HEALTH CARE INFORMATION FOR YOUR INTERNAL USE ONLY DO NOT SUBMIT TO CPQCC Center Number________ Center Name____________________________________ CPQCC Network Patient's Name Medical Record Birth Date Eligibility: Admission/Discharge Form Date DR Death Form Transport Form ID Number Number (MM/DD/YYYY) A. 401-1500g OR Sent (MM/DD/YYYY) Date Sent Required? (Y/N) B. GA 22/0-31/6 OR (MM/DD/YYY) C. >1500g and one of the following: Death, Surg, Intubated Assisted Vent >4 continuous hrs, Early Sepsis, Acute Transport in/out, Previously discharged home and readmitted for Total Serum Bilirubin of =>25mg/dL and/or exchange transfusion OR Nasal IMV/SIMV (or any other form of non-intubated assisted vent) for >4 continuous hours. *This form was adapted from a log developed by Vermont Oxford Network CPQCC TRANSPORT LOG 2015 ELIGIBILITY LOGS INCLUDE PROTECTED HEALTH CARE INFORMATION FOR YOUR INTERNAL USE ONLY DO NOT SUBMIT TO CPQCC Center Number__________ Center Name____________________________________ CPQCC Network Patient's Name Birth Date Transfer Date Transfer Hospital CPQCC Items 58-60 Items 61-62 Items 63-64 Item 64 ID Number (MM/DD/YY) (MM/DD/YY) Name Member? Sent* Sent** Sent*** Sent**** (Yes/No) (MM/DD/YY) (MM/DD/YY) (MM/DD/YY) (MM/DD/YY) Required for Required for all Transfers all Transfers *This form was adapted from a log developed by Vermont Oxford Network *Submit Items 58-60 for all transported infants when the Post Transfer Disposition is known. **Submit Items 61-62 for all readmitted infants when the Disposition After Readmission is known ***Submit Items 63 and 64 for all infants who were transferred more than once when the Ultimate Disposition is known. ****Submit Item 64 for all infants who were transferred when the Date of Final Discharge or Death is known. APPENDIX C- BACTERIAL PATHOGENS 1. Achromobacter species [including Achromobacter xylosoxidans (also known as Alcaligenes xylosoxidans) and others] 2. Acinetobacter species 3. Aeromonas species 4. Alcaligenes species [Alcaligenes xylosoxidans and others] 5. Bacteroides species 6. Burkholderia species [Burkholderia capecia and others] 7. Campylobacter species [Campylobacter fetus, C. jejuni and others] 8. Chryseobacterium species 9. Citrobacter species [Citrobacter diversus, C. freundii, C. koseri and others] 10. Clostridium species 11. Enterobacter species [Enterobacter aerogenes, E. cloacae, and others] 12. Enterococcus species (Enterococcus faecalis (also known as Streptococcus faecalis), E. faecium, and other Enterococcus species] 13. Escherichia coli 14. Flavobacterium species 15. Haemophilus species [Haemophilus influenzae and others] 16. Klebsiella species [Klebsiella oxytoca, K. pneumoniae and others] 17. Listeria monocytogenes 18. Moraxella species [Moraxella catarrhalis (also known as Branhamella catarrhalis) and others] 19. Neisseria species [Neisseria meningitidis, N. gonorrhoeae and others] 20. Pasteurella species 21. Prevotella species 22. Proteus species [Proteus mirabilis, P. vulgaris and others] 23. Providencia species [Providencia rettgeri, and others] 24. Pseudomonas species [Pseudomonas aeruginosa and others] 25. Ralstonia Species 26. Salmonella species 27. Serratia species [Serratia liquefaciencs, S. marcescens and others] 28. Staphylococcus coagulase positive [aureus] 29. Stenotrophomonas maltophilia 30. Streptococcus species [including Streptococcus Group A, Streptococcus Group B, Streptococcus Group D, Streptococcus pneumoniae, Strep Milleri and other] Page 109 of 166 APPENDIX D - BIRTH DEFECTS CODES FOR ITEM 49 Code Other Lethal or Life Threatening Birth Defect 100 Other Lethal or Life-Threatening Birth Defect which is not listed below Code Central Nervous System Defects 150 Other lethal or life threatening CNS Defects (DESCRIBE) 101 Anencephaly 102 Meningomyelocele 103 Hydranencephaly 104 Congenital Hydrocephalus 105 Holoprosencephaly 106 Microcephaly 107 Hypopituitary 108 Septic Optic Dysplasia 109 Encephalocele Code Congenital Heart Defects 200 Other lethal or life threatening congenital heart defects (DESCRIBE) 201 Truncus Arteriosus 202 Transposition of the Great Vessels 203 Tetralogy of Fallot 204 Single Ventricle 205 Double Outlet Right Ventricle 206 Complete Atrio-Ventricular Canal 207 Pulmonary Atresia with intact ventircal septum 208 Tricuspid Atresia 209 Hypoplastic Left Heart Syndrome 210 Interrupted Aortic Arch 211 Total Anomalous Pulmonary Venous Return 212 Coarctation of the Aorta 213 Atrial septal defect (ASD) 214 Ventricular septal defect (VSD) 215 Arrythmias 216 Ebsteins Anomaly 217 Pericardial Effusion 218 Pulmonary Stenosis 219 Hypertrophic Cardiomyopathy 220 Penatalogy of Cantrell (Thoraco-Abdominal Ectopia Cordis) Code Gastro-Intestinal Defects 300 Other lethal or life threatening GI Defects (DESCRIBE) 301 Cleft Palate 302 Tracheo-Esophageal Fistula 303 Esophageal Atresia 304 Duodenal Atresia 305 Jejunal Atresia Page 110 of 166 306 Ileal Atresia 307 Atresia of Large Bowel or Rectum 308 Imperforate Anus 309 Omphalocele 310 Gastroschisis 311 Pyloric Stenosis 312 Annular Pancreas 313 Biliary

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