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Patient Surgical Data Collection Sheet

The document is a detailed data collection sheet for a patient's hospital admission, including medical history, surgery details, and daily assessments post-surgery. It tracks various clinical indicators, wound cultures, and surgeon opinions regarding potential surgical site infections (SSI) over multiple days. The assessment includes observations on discharge, purulent and non-purulent discharge, and other relevant clinical parameters.

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hossam.gaber87
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16 views8 pages

Patient Surgical Data Collection Sheet

The document is a detailed data collection sheet for a patient's hospital admission, including medical history, surgery details, and daily assessments post-surgery. It tracks various clinical indicators, wound cultures, and surgeon opinions regarding potential surgical site infections (SSI) over multiple days. The assessment includes observations on discharge, purulent and non-purulent discharge, and other relevant clinical parameters.

Uploaded by

hossam.gaber87
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd

Date of Hospital Admission:

Date of Discharge from PICU

Date of Discharge from Hospital:

Data Collection sheet Patient’s Study Number:

Patient’s Study Group:


Patient’s Age: months. Gender: Male

Patient’s weight: kgs. Female Admission from:

Medical History:

Surgery Done: ARISTOTLE Score:

Emergency Surgery Elective Surgery

Number of surgeries before this time:

Date of Surgery: Total Bypass Time (min): Total X-Clamp Time (min):

Total Circulatory Arrest (min): Cooling Down to(c):

Date of Chest Closure:

1- Baseline date:

* Heart rate: * Respiratory Rate: * Temperature: * Blood Pressure:

* Procalcitonin (before surgery): * CRP (before surgery): * WBC’s (before surgery):

* Respiratory Viral Panel PCR (before surgery):

* Nasal decontamination treatment: Start Date:


2- Any Evident Bacterial Infection before Surgery: Yes No

If YES :

- Site of infection:
- Cultures Results:
- Treatment Used:

3- Wound Culture Results (after surgery):

Date Organism Sensitivity Action Taken


3- Other Culture Results (after surgery):

Date Site Organism Sensitivity Action Taken

Daily Assessment Sheet( after Chest Closure)


Day 1 Day2 Day3 Day4 Day5
Purulent Discharge Yes No Yes No Yes No Yes No Yes No

Non-Purulent Discharge Yes No Yes No Yes No Yes No Yes No

If yes: If yes: If yes: If yes: If yes:


Wound Culture: Wound Culture: Wound Culture: Wound Culture: Wound Culture:
-ve +ve -ve +ve -ve +ve -ve +ve -ve +ve

Surgeon’s Opinion SSI Not SSI SSI Not SSI SSI Not SSI SSI Not SSI SSI No
Spontaneous No No No No No
Dehiscence or Wound
Re-Open by Surgeon Yes: Yes: Yes: Yes: Yes:
-Date: -Date: -Date: -Date: -Date:
- Pain or Tenderness: - Pain or Tenderness: - Pain or Tenderness: - Pain or Tenderness: - Pain or Tendernes
Yes No Yes No Yes No Yes No Yes No
- Localized Swelling: - Localized Swelling: - Localized Swelling: - Localized Swelling: - Localized Swelling
Yes No Yes No Yes No Yes No Yes No
- Redness: - Redness: - Redness: - Redness: - Redness:
Yes No Yes No Yes No Yes No Yes No
- Heat: - Heat: - Heat: - Heat: - Heat:
Yes No Yes No Yes No Yes No Yes No
- Fever (>38°c): - Fever (>38°c): - Fever (>38°c): - Fever (>38°c): - Fever (>38°c):
Yes No Yes No Yes No Yes No Yes No
- Abscess: - Abscess: - Abscess: - Abscess: - Abscess:
Yes No Yes No Yes No Yes No Yes No
- Wound Culture: - Wound Culture: - Wound Culture: - Wound Culture: - Wound Culture:
-ve +ve -ve +ve -ve +ve -ve +ve -ve +ve

Daily Assessment Sheet( after initial 5 days)


Date Date Date Date Date
Purulent Discharge Yes No Yes No Yes No Yes No Yes No

Non-Purulent Yes No Yes No Yes No Yes No Yes No


Discharge
If yes: If yes: If yes: If yes: If yes:
Wound Culture: Wound Culture: Wound Culture: Wound Culture: Wound Culture:
-ve +ve -ve +ve -ve +ve -ve +ve -ve +ve
Surgeon’s Opinion SSI Not SSI SSI Not SSI SSI Not SSI SSI Not SSI SSI Not
Spontaneous No No No No No
Dehiscence or Wound
Re-Open by Surgeon Yes: Yes: Yes: Yes: Yes:
-Date: -Date: -Date: -Date: -Date:
- Pain or Tenderness: - Pain or Tenderness: - Pain or Tenderness: - Pain or Tenderness: - Pain or Tenderness
Yes No Yes No Yes No Yes No Yes No
- Localized Swelling: - Localized Swelling: - Localized Swelling: - Localized Swelling: - Localized Swelling:
Yes No Yes No Yes No Yes No Yes No
- Redness: - Redness: - Redness: - Redness: - Redness:
Yes No Yes No Yes No Yes No Yes No
- Heat: - Heat: - Heat: - Heat: - Heat:
Yes No Yes No Yes No Yes No Yes No
- Fever (>38°c): - Fever (>38°c): - Fever (>38°c): - Fever (>38°c): - Fever (>38°c):
Yes No Yes No Yes No Yes No Yes No
- Abscess: - Abscess: - Abscess: - Abscess: - Abscess:
Yes No Yes No Yes No Yes No Yes No
- Wound Culture: - Wound Culture: - Wound Culture: - Wound Culture: - Wound Culture:
-ve +ve -ve +ve -ve +ve -ve +ve -ve +ve
Outpatient Assessment Sheet( after discharge from hospital)
Date Date Date Date Date
Purulent Discharge Yes No Yes No Yes No Yes No Yes No

Non-Purulent Yes No Yes No Yes No Yes No Yes No


Discharge
If yes: If yes: If yes: If yes: If yes:
Wound Culture: Wound Culture: Wound Culture: Wound Culture: Wound Culture:
-ve +ve -ve +ve -ve +ve -ve +ve -ve +ve

Surgeon’s Opinion SSI Not SSI SSI Not SSI SSI Not SSI SSI Not SSI SSI Not
Spontaneous No No No No No
Dehiscence or Wound
Re-Open by Surgeon Yes: Yes: Yes: Yes: Yes:
-Date: -Date: -Date: -Date: -Date:
- Pain or Tenderness: - Pain or Tenderness: - Pain or Tenderness: - Pain or Tenderness: - Pain or Tenderness
Yes No Yes No Yes No Yes No Yes No
- Localized Swelling: - Localized Swelling: - Localized Swelling: - Localized Swelling: - Localized Swelling:
Yes No Yes No Yes No Yes No Yes No
- Redness: - Redness: - Redness: - Redness: - Redness:
Yes No Yes No Yes No Yes No Yes No
- Heat: - Heat: - Heat: - Heat: - Heat:
Yes No Yes No Yes No Yes No Yes No
- Fever (>38°c): - Fever (>38°c): - Fever (>38°c): - Fever (>38°c): - Fever (>38°c):
Yes No Yes No Yes No Yes No Yes No
- Abscess: - Abscess: - Abscess: - Abscess: - Abscess:
Yes No Yes No Yes No Yes No Yes No
- Wound Culture: - Wound Culture: - Wound Culture: - Wound Culture: - Wound Culture:
-ve +ve -ve +ve -ve +ve -ve +ve -ve +ve

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