Infection Adjudication on REDCAP Module

Infection Adjudication on REDCAP Module

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Version: Feb 1st, 2012

Infection Adjudication

Based on the microbiology and antibiotic data entered, REDCAP will automatically trigger suspicions of newly acquired infectionsSuspicions MUST be adjudicated by Site Investigator or MD delegate REDCAP will generate a table that will guide and assist the Site Investigator/Research Coordinator through the various steps

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CRS Manual p 22

Log in to REDCAP using assigned username and passwordClick on the “My Database” tab, select TOP-UP. Click on the “Infection Adjudication” linkYou will be directed to the following window showing the patients that require adjudication and how many suspicions of infection each haveClick on the patient ID

How to Start?

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Adjudication Table: baseline, daily data

Infection adjudication table will show up listing:baseline/outcome information at the top daily data elements, micro and antibioticsSuspicions of infection (Newly Acquired Infections)

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Microbiology and Antibiotic Forms

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Click on the antibiotic or organism names to view the corresponding antibiotic/microbiology forms

Click to open a window with the Day 1 Antibiotic form for

Metronidazole

Click to open a window with the Day 3 Microbiology form for

Escherichia

s.p

. - coli

Adjudication Table: suspicions of infection

You will have 3 options to enter in the NEWLY ACQUIRED INFECTION column:This is a newly acquired infectionThis is not a newly acquired infectionThis is a previously adjudicated infection

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a) Newly acquired infection

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Pick this option if the clinical suspicion of infection is considered to be a newly acquired infection.

Assign a Category of Infection, then the degree of certainty of the infection using the definition from CRF Appendix 9For example, on study day 9 the patient is febrile, has an elevated WBC, CXR reveals a new infiltrate. An endotracheal aspirate specimen was sent for culture, S. aureus is identified. The infection should be adjudicated as follows:

Click to open a window describing the categories and the degrees of certainty

b) NOT a newly acquired infection

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Pick this option if the clinical suspicion of infection is not considered to be an infection.Assign the degree of certainty of the infection using CRF Appendix 10For example, On study day 17 a blood culture indicates the presence of Staph Epidermis. There are no other clinical indicators of infection (i.e. SIRS). A repeat culture is negative. The initial positive culture is thought to be a contaminant. The infection should be adjudicated as follows:

Click to open a window describing the degrees of certainty

c) Previously adjudicated infection

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Pick this option if this clinical suspicion of infection is associated with an infection already adjudicated.

Indicate the day and the suspicion # of the associated previously adjudicated infection.

Infections that occur within the first 72 hrs of ICU admission are

not

to be considered newly acquired infections, however, these may be related to suspicions later.

If the suspicion of infection was due to an infection that occurred in the first 72 hours after ICU admission, select “Baseline Infection”.

c) Previously adjudicated infection

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For example, on study day 19 the patient is febrile, has an elevated WBC and CXR reveals a new infiltrate. An endotracheal aspirate specimen was sent for culture, S. aureus is identified.

On study day 20 an antibiotic was initiated to treat the S. aureus. The clinical suspicion triggered on study day 20 with the initiation of an antibiotic is related to a previously adjudicated infection.

How to clear responses?

To change your response, click on the CLEAR RESPONSE

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To change your response, click on the CLEAR RESPONSE

To change your response, click on the CLEAR RESPONSE

Infection ID #’s

All suspicions of infection will be assigned unique infection identification number followed by the study day it was entered onInfection ID #s will never be repeatedInfection identification numbers will be sequential unless a microbiology and/or antibiotic form was changed/added AFTER adjudications have been saved

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Site: infection responses completed

When done click SAVE & COMPLETED at bottom of page if you have completed ALL the infection adjudication for this chartSAVE if wish to returnBoth buttons will initiate data checksThere will be a confirmation for either a “save” or a “save and complete” at the top of the table

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Stages of Data Entry:After initial adjudication

After completion of the adjudication, the patient will be in stage 3.

CRS Manual page 28

Site Initial Adjudication done: Stage 3

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Stage 2

Complete

initial site adjudication

Stage 3

Complete 3 & 6 month follow-up

Stage 4a

Central

adjudicator reviews each adjudication and either agrees or disagrees with each suspicion of infection

Stage 4b

Both adjudicators agree on all suspicions of infection

Stage 5

Patient chart closed

Investigators Confirmation

Site adjudicator reviews each adjudication and either agrees or disagrees with centrals adjudicators changes

If the site disagrees with any of the central changes or has made any changes

If the central adjudicator agrees with

all

of the site adjudicators

Central disagrees with at least one adjudication

3 & 6 month follow up

Complete the 3 and 6 month follow-up forms and click on the bottom of the REDCap gridYou will now be in stage 4a

3 & 6 month follow up done: Stage 4a

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Stage 2

Complete

initial site adjudication

Stage 3

Complete 3 & 6 month follow-up

Stage 4a

Central

adjudicator reviews each adjudication and either agrees or disagrees with each suspicion of infection

Stage 4b

Both adjudicators agree on all suspicions of infection

Stage 5

Patient chart closed

Investigators Confirmation

Site adjudicator reviews each adjudication and either agrees or disagrees with centrals adjudicators changes

If the site disagrees with any of the central changes or has made any changes

If the central adjudicator agrees with

all

of the site adjudicators

Central disagrees with at least one adjudication

Central Adjudicator

At stage 4a, the central adjudicator will review each suspicion of infection and determine if s/he agrees or disagrees with the site’s suspicion of infections

Central adjudicator is assigned by CERU

Site response to Central adjudication

Every

few weeks

, an email on adjudications requiring your attention (including those that have been centrally adjudicated) will be sent to you

Log in using your USERNAME and PASSWORD

Site response to Central adjudication

Centrally adjudicated patients will appear on the adjudication table as stage 4b If the Central adjudicator agreed with all the adjudications, stage 4b will be skipped and the patient file closes (stage 5)

4b

= Initial central adjudication queries

4b

= Subsequent central adjudication queries

Central Adjudication done: Stage 4b

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Stage 2

Complete

initial site adjudication

Stage 3

Complete 3 & 6 month follow-up

Stage 4a

Central

adjudicator reviews each adjudication and either agrees or disagrees with each suspicion of infection

Stage 4b

Both adjudicators agree on all suspicions of infection

Stage 5

Patient chart closed

Investigators Confirmation

Site adjudicator reviews each adjudication and either agrees or disagrees with centrals adjudicators changes

If the site disagrees with any of the central changes or has made any changes

If the central adjudicator agrees with

all

of the site adjudicators

Central disagrees with at least one adjudication

Stage 4b

NOTE: Sites responses removed

All adjudications that the central adjudicator has disagreed to will automatically remove the sites response upon completionAll adjudications that the central adjudicator agreed to will not be changed

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This

was

removed because the Central Adjudicator disagreed with Infection ID #1

The sites response

was not changed

Comments

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Click to see your old response and an explanation why the central adjudicator disagreed in a new windowThe number in brackets indicates the number of comments that have been recordedUse the comments window to track the discussion and the changes to suspicion of infection Click to add additional comments

Site Response to Central adjudication

The CENTRAL ADJUDICATOR RESPONSE column will show either as an agree or a disagree (with a new response and the reasoning why in the comments)You must re-adjudicate all adjudications that the central disagreed toYou will have 2 options to enter in the NEWLY ACQUIRED INFECTION column: Agree OR Disagree

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OPTION 1: Select this if you agree with the determination made by the Central. If so, the following options stay disabledThis is a newly acquired infectionThis is not a newly acquired infectionThis is a previously adjudicated infection

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OPTION 2:

Select this if you disagree with any aspect of the determination made by the central (such as the presence of infection, the category of infection and/or the degree of certainty). Re-adjudicate using the following options:This is a newly acquired infectionThis is not a newly acquired infectionThis is a previously adjudicated infection

Site Response to Central adjudication

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If you

disagree, you must save a comment explaining your reasoning. All adjudications that you disagree to will automatically remove the centrals response upon completion

Site Response to Central adjudication

Incorrect Response

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This will be removed because the

you

disagreed with Infection ID #1

You can not agree to a response that will be removed

This will be

also be removed

because

it refers to

Infection ID #

1 which will be removed

Since the central

response is automatically removed when you disagree (eg infection ID #1), any adjudication that refers to it (eg infection ID #2) will be removed as wellAn error will trigger if you try to agree with a response that will be removed

Correct Response

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You

must select disagree and select previous to your (site) response

If infection ID # 2 is a previous infection to ID #1, you must disagree and select that the suspicion is a previous adjudicated to your response

Site: to complete final adjudication

Once adjudication is done, press The status will go back to Stage 4a for the central adjudicator to reviewThe central adjudicator will have the opportunity to agree/disagree to adjudications you disagreed withThis process will continue between site and central adjudicator until there is consensus for all the adjudicationsOnce both adjudicators agree on all the responses, adjudication will be complete and the patient will automatically be set to stage 5

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Site/Central Adjudication done: Stage 5

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Stage 2

Complete

initial site adjudication

Stage 3

Complete 3 & 6 month follow-up

Stage 4a

Central

adjudicator reviews each adjudication and either agrees or disagrees with each suspicion of infection

Stage 4b

Both adjudicators agree on all suspicions of infection

Stage 5

Patient chart closed

Investigators Confirmation

Site adjudicator reviews each adjudication and either agrees or disagrees with centrals adjudicators changes

If the site disagrees with any of the central changes or has made any changes

If the central adjudicator agrees with

all

of the site adjudicators

Central disagrees with at least one adjudication

Site Investigator

Remember the Site Investigator/MD delegate must determine the presence or absence of infection, the categories of infection and the degree of certaintyUpon completion at stage 5, print the adjudication table (right click and print) and have the Site Investigator sign it for source verification purposes

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Whenever the or the buttons are clicked, they will run data checks. There are 4 types of checksPartial responsesMissing responsesMissing Explanation

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Data Checks

1) Partial responses Check

Partial responses can not be saved. For example, the category of infection and the degree of certainty must be completed for newly acquired infections to be savedThis applies to both and

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2) Missing responses check

Missing responses can be saved only with For example, infection ID # 1-4 has been completed but # 5 has not. You can save infections 1-4 with the button but you will not be allowed to choose until infection #5 has been filled out

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3) Missing Explanation Check

If you disagree with the central adjudicators response, you must write a reason in the comment boxThis applies to both and

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