1. Why use an online intubation procedure note?  

2. Who created this site?  What's going on here?  What's this all about?

3. I don't get one of the questions on the form?  What information am I supposed to supply?

4. Specific Help information.

5. Contact the originators of this site and these forms.

FAQ

1. Why use an online line intubation procedure note? 

There are two goals behind providing this procedure note.  First, we wanted to provide a quick way to document an intubation completely and legibly, in order to improve our overall documentation in the hospital, and to assist anyone who is trying to intubate the same patient in the future.  Plus, after you use the form a couple of times, it is actually quicker than writing out a note by hand.

The other reason this form was created is to assist in data collection regarding intubation in our hospital.  There are several efforts being undertaken to intubation associated complications, but before we know what can be addressed, we need to know how, where, and by whom patients are being intubated in our hospital.  By using this form, your responses are collected automatically (and anonymously) and incorporated into a database that will help us to address quality improvement efforts appropriately.  In the end, you are helping to improve patient safety in our hospital.

2. Who created this site?  What's going on here?  What's this all about?

This form was created by a team of ICU fellows and intensivists, in collaboration with the VGH ICU staff, as part of a quality improvement initiative aimed at improving patient safety in the ICU.  Intubations have been well documented to be one of the major risks critically ill patients face in any hospital, and we would like to reduce the risk in our facility.  Thanks for helping us achieve this goal, by using this online form.

3. I don't get one of the questions on the form?  What information am I supposed to supply?

Check out the help tips below. There is a tip explaining each of the questions on the form.  You can also link directly to the individual tips by clicking the relevant link on the form itself.

Help

MRN - please enter the 8 digit patient MRN, including leading zeros if necessary.  This is the only required field on the page.

Primary indication for intubation - what was the main reason the patient required intubation.  If it was a procedure, or "other" indication, please write a few words describing either one.

Location of intubation - i.e. where in the hospital was the intubation performed, not where on the patient.  If it was on a ward, please note which ward (eg: T4A), or if it was somewhere else, please note where (eg. radiology, CT scanner).

Physicians - Please indicate the level of training and the specialty of the primary operator.  If a supervisor was present, please indicate that, and also their specialty and level of training.

Airway exam - Document any findings noted on airway exam prior to intubation.  If you did not do part of the exam due to time constraints, oversight, or whatever, don't worry about; just document that too.  This is primarily useful for anyone repeating the intubation in the future.

Bag-mask ventilation - Document findings related to bag-mask ventilation.  This will assist future intubators in avoiding difficulties with bag-mask seal or saturations that were encountered on a prior intubation.

Intubation attempts - for each intubation attempt, please indicate who made the attempt, and what tools they used.  Just fill this out for the attempts that were made; don't worry about the extra spaces.

Intubation specifics - these questions are pretty self explanatory.  I know, it would be nice if the form could automatically fill out the number of attempts based on your answer to the previous question, but we're not smart enough to make it do that. 

Please indicate if the tube was an evac tube; if you're not sure, you can ask the RT, but as a general rule if the intubation took place in the VGH ICU, it was an evac tube.  If it was in emerg. or on the ward, it might not have been.

Medications - select the drugs used, and fill out the dosage and the dose measurement (i.e. mg or mcg). 

Vasopressors - check the appropriate box if the patient was on vasopressors prior to the intubation, and/or if the dose was changed or vasopressors were initiated after the intubation.  Also indicate how much phenylephrine you used, if any.

Glottic view - how well did you see the cords?  Select one.

Vitals - this one is a bit of a pain, but if you can do your best to fill out the vitals before, during, and 5 minutes after the intubation, it would really help with our research project.  Really.  Thanks.

Complications - if any of the common complications listed occurred, please check them.  If there were other complications, you can indicate those too, or you can fill out other valuable information in the comments box.

Comments - anything else about the intubation you would like to document?  For example - "Difficult to visualize cords; quite anterior."  Or maybe - "Patient required significant amounts of midazolam to achieve appropriate procedural sedation".  Pretty much anything else that you think should be documented, especially if it will be helpful to anyone trying to intubate this patient in the future.

Generate printable procedure note button - clicking on this button does two things.  First, it takes your responses on the form and turns them into a custom procedure note that you can print and place in the chart.  This takes the place of the usual procedure note that you would normally write.  It is automatically updated with the date and time, it is detailed, and it is legible.

The second thing it does is e-mail your responses to an independent data collector to facilitate research on intubation in our hospital.  The data does not carry any identifying information from the person filling out the form, so you can feel comfortable in being honest with your responses.  It does carry the patient's MRN, so that we can track back and see if anything we are doing as a team is having an impact on the rate of intubation complications.  All data is strictly confidential, and no information collected on the form will ever be released or commented on without being de-identified first.

Reset button - clicking on this button erases your responses, and returns the form to it's default state.

Contact us at coolresearchers@icunotebook.com if you have any questions, comments, or suggestions on how to improve this form or our research efforts in general.  Thanks for taking the time to help us out!