Team D. Agreed to Focus

Team D. agreed to focus on the problem of central line associated blood stream infections (CLABSI). Our target / PICO question is: Is there decreased incidence of CLABSI when using an antimicrobial dressing such as biopatch in conjunction with the central line bundle?

The various entities and their attributes that will provide the appropriate outputs are:

Patient with the attributes of name, age, medical record number (MRN), diagnosis, central line; Central line with the attributes of medical record number, date of insertion, insertion site, date of removal, line days, inserting provider, the components Central Line Bundle compliance, antimicrobial dressing placement; and CLABSI infections with attributes of MRN, date of diagnosis, date and time of specimen, organism detected. Central Line Bundle compliance will be measured by the evidence-based standards determined by the Institute for Healthcare Improvement (IHI, n.d).

Each field name and field type.

The field names are the named units of information. These are: Patient; Central line; CLABSI infection. Field types are the SQL shorthand that will be used to illustrate and these will include: dates (as e.g. For the CLABSI infection; date of insertion of central line; date of removal; date and time of specimen); numbers (as e.g. MRN for pateint and CLABSI); radio buttons (as, for instance, by age in regards to patient; antimicrobial dressing palcement; organism detected; hand hygiene); text (e.g. Patient's name; diagnosis; insertion site; insertion provider; hand hygiene); Textarea can be used for longer pieces of text (e..g diagnoses; hand hygiene; and Maximal Barrier Precautions/Insertion); URL (e.g., the components Central Line Bundle compliance).

III. The master and detail tables.

The 'Masters' are all the attributes under Patient; Central Line; and CLABSI infections. 'Orders' pertain to the details of each. As elaboration: Patient name, age, medical record number (MRN), diagnosis, central line are all 'Master'. The details pertaining to these categories will be 'order'; Central line: medical record number, date of insertion, insertion site, date of removal, line days, inserting provider, the components Central Line Bundle compliance, hand hygiene, and Maximal Barrier Precautions/Insertion are all 'Master'. The details pertaining to these categories (such as Chlorhexidine Skin Antisepsis Antimicrobial Dressing Placement presumably for hand hygiene) will be 'order'; and CLABSI infections: attributes of MRN, date of diagnosis, date and time of specimen, organism detected are all 'Master'. The details pertaining to these categories wil be 'order'.

Each -- Patient, Central Line, and CLABSI infection -- are interrelated to one another, with the patient related to both Central Line and CLABSI infection, and CLABSI infection, in turn related to Central Line. This is due to the fact that the whole forms one model / problem with information in each area impacting the other area.

IV. Primary key fields and foreign key fields

The primary key of the Patient table will be the MRN (Medical Record Number), of the Central Line Table it will be Insertion site, and of the CLABSI infection it will be MRN.

Foreign key fields (i.e. The key that represents the value of a primary key in a related table) may exist in the case of CLEBSI speciment: date of diagnosis, date and time of specimen (where latter may replicate). Under 'Patient', CLEBSI line is a foreign key, too.

V. Atomic-level data

Atomic data would be the most reducible element of information (without elaboration). So for instance for hand hygiene it would be Chlorhexidine Skin Antisepsis Antimicrobial Dressing Placement

VI. Schemas of the database will be:

Patient with the attributes of name, age, medical record number (MRN), diagnosis, central line; Central line with the attributes of medical record number, date of insertion, insertion site, date of removal, line days, inserting provider, the components Central Line Bundle compliance, antimicrobial dressing placement; and CLABSI infections with attributes of MRN, date of diagnosis, date and time of specimen, organism detected. Central Line Bundle compliance will be measured by the evidence-based standards determined by the Institute for Healthcare Improvement (IHI, n.d).

In short, the data will be organized in the following way:

Patient, Central Line, CLABSI Infection will be the field names. The primary key of the Patient table will be the MRN, of the Central Line Table - the Insertion site, and of CLABSI infection -MRN.

Their attributes will be the 'master keys' with the relevant information (i.e., the details) being the 'order' keys. These 'order' keys will provide discrete / atomic-level data for each item. For presentation of these order keys see above under field types.