Example template for documenting significant bloodstream infections

Suggested format for documenting significant BSI for later analyses.  Sub documents with key definitions will be provided soon. Print this sheet onto a single A4 page and maintain a records folder. Include documentation of the clinical liaison process as below.  Definitions for significance will be discussed in a future posting. 

Significant BSI Event Sheet

Patient medical record number
Patient name
Age or DOB
Sex
Date first positive culture
Lab number
Organism 1 species
Organism 2 species
Organism 3 species
Antibiotic susceptibility

 

MSSA  MRSA

Other

 

Healthcare-associated infection status (circle) HCA-inpatient    HCA-noninpatient       Community
Principle clinical manifestation

(select from this list)

IV device associated with event N/A    Periph IV    Central IV
Service Med    Surg    Paed    O&G   ICU   Neonatal    ED
Comments

 

 

 

 

Isolate(s) storage coordinate Box number:                     Coordinate:
Record of clinical liaison calls (dates, person called, contact details and summary of recommendations

About mdjkf

Microbiologist and Infectious Diseases Physician
This entry was posted in Module - Blood cultures, Quality management, Statistics and tagged . Bookmark the permalink.

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