$TXT Created by at MNTVBB.DOMAIN.EXT (KIDS) on Thursday, 03/09/23 at 07:51 ============================================================================= Run Date: MAY 17, 2023 Designation: SR*3*209 Package : SR - SURGERY Priority: Mandatory Version : 3 SEQ #194 Status: Released Compliance Date: JUN 16, 2023 ============================================================================= Subject: UPDATE WOUND CLASSIFICATION DESCRIPTION Category: - Data Dictionary Description: ============ This patch addresses the following issue: The National Surgery Office requests that the help text description ("??") displayed for the WOUND CLASSIFICATION field (#1.09) in the SURGERY file (#130) be updated to the 2018 Centers for Disease Control and Prevention (CDC) Wound Classification definitions. Patch Components: ----------------- Files & Fields Associated: File Name (Number) Field Name (Number) New/Modified/Deleted ------------------ -------------------- -------------------- SURGERY (#130) WOUND CLASSIFICATION Modified (#1.09) Forms Associated: Form Name File Number New/Modified/Deleted --------- ----------- -------------------- N/A Mail Groups Associated: Mail Group Name New/Modified/Deleted --------------- -------------------- N/A Options Associated: Option Name Type New/Modified/Deleted ----------- ---- -------------------- N/A Protocols Associated: Protocol Name New/Modified/Deleted ------------- -------------------- N/A Security Keys Associated: Security Key Name ----------------- N/A Templates Associated: Template Name Type File Name (Number) New/Modified/Deleted ------------- ---- ------------------ -------------------- N/A Remote Procedures Associated: Remote Procedure Name New/Modified/Deleted --------------------- -------------------- N/A Parameter Definitions Associated: Parameter Name New/Modified/Deleted -------------- -------------------- N/A Additional Information: ----------------------- New Service Requests (NSRs): N/A Patient Safety Issues (PSIs): N/A Defect Tracking System Ticket(s) & Overview: 1. INC26047546 - Update Wound Classification Description Problem: -------- The National Surgery Office requests that the help text description ("??") displayed for wound classification information in VistA Surgery be updated from the 2007 CDC Wound Classification definitions to the 2018 CDC Wound Classification definitions. Resolution: ----------- This patch replaces the current text in the DESCRIPTION file attribute for the WOUND CLASSIFICATION field (#1.09) in the SURGERY file (#130) with the text supplied by the Product Manager for Surgery. Test Sites: ----------- Lt. Col. Luke Weathers, Jr. VAMC (Memphis, TN) Central Arkansas Veterans HCS (Little Rock, AR) Software and Documentation Retrieval Instructions: -------------------------------------------------- The software for this patch is being released in a PackMan message. There are no documentation changes associated with this patch release. Patch Installation: ------------------- Pre-Installation Instructions: This patch may be installed with users on the system although it is recommended that it be installed during non-peak hours to minimize potential disruption to users. This patch should take less than 5 minutes to install. It is not necessary to disable any options. Installation Instructions: 1. Choose the PackMan message containing this build. Then select the INSTALL/CHECK MESSAGE PackMan option to load the build. 2. From the Kernel Installation & Distribution System Menu, select the Installation Menu. From this menu, A. Select the Verify Checksums in Transport Global option to confirm the integrity of the routines that are in the transport global. When prompted for the INSTALL NAME enter SR*3.0*209. NOTE: Using will not bring up a Multi-Package build even if it was loaded immediately before this step. It will only bring up the last patch in the build. B. Select the Backup a Transport Global option to create a backup message. You must use this option and specify what to backup; the entire Build or just Routines. The backup message can be used to restore the routines and components of the build to the pre-patch condition. i. At the Installation option menu, select Backup a Transport Global. ii. At the Select INSTALL NAME prompt, enter your build SR*3.0*209. iii. When prompted for the following, enter "B" for Build. Select one of the following: B Build R Routines Enter response: Build iv. When prompted "Do you wish to secure your build? NO//", press and take the default response of "NO". v. When prompted with, "Send mail to: Last name, First Name", press to take default recipient. Add any additional recipients. vi. When prompted with "Select basket to send to: IN//", press and take the default IN mailbox or select a different mailbox. C. You may also elect to use the following options: i. Print Transport Global - This option will allow you to view the components of the KIDS build. ii. Compare Transport Global to Current System - This option will allow you to view all changes that will be made when this patch is installed. It compares all of the components of this patch, such as routines, DDs, templates, etc. D. Select the Install Package(s) option and choose the patch to install. i. If prompted 'Want KIDS to Rebuild Menu Trees Upon Completion of Install? NO//', answer NO. ii. When prompted 'Want KIDS to INHIBIT LOGONs during the install? NO//', answer NO. iii. When prompted 'Want to DISABLE Scheduled Options, Menu Options, and Protocols? NO//', answer NO. Post-Installation Instructions: None Installation Verification: -------------------------- Successful installation can be verified by using VA FileMan's List File Attributes option [DILIST] to confirm that the DESCRIPTION attribute for the WOUND CLASSIFICATION field (#1.09) in the SURGERY file (#130) matches the text below: DESCRIPTION: Definition Revised (2018): Indicate whether the wound has been classified by the primary surgeon as: >> Class 1 - Clean (C): An uninfected surgical wound in which no inflammation or infection is encountered and the respiratory, alimentary, genital, or urinary tracts are not entered. Clean wounds are primarily closed and, if necessary, drained with closed drainage. Surgical Wound incisions that are made after nonpenetrating (e.g. blunt) trauma should be included in this category if they meet the criteria. >> Class 2 - Clean/Contaminated (CC): A surgical wound in which the respiratory, alimentary, genital, or urinary tracts are entered under controlled conditions and without unusual contamination. Specifically included in this category are surgical procedures involving the biliary tract, appendix, vagina, and oropharynx, provided no evidence of infection is encountered and no major break in technique occurs. >> Class 3 - Contaminated (D): [1] an open, fresh, accidental wound. [2] a surgical procedure in which a major break in sterile technique occurs (e.g. emergency open cardiac massage) or [3] when gross spillage from the gastrointestinal tract and [4] incisions in which acute, nonpurulent inflammation is encountered. >> Class 4 - Dirty/Infected (I): Dirty/Infected (I): [1] an old traumatic wound with retained or devitalized tissue, [2] a wound that involves existing clinical infection or [3] perforated viscera. This definition suggests that the organisms causing postoperative infection were present in the wound before the surgical procedure. Back-Out/Roll Back Plan: ------------------------ Back-out will be done only with the concurrence and participation of the development team and appropriate VA site/region personnel. The decision to back-out software will be a joint decision between the development team, VA site/region personnel and other appropriate VA personnel. Prior to installing an updated Kernel Installation & Distribution System (KIDS) package, the site/region should have saved a backup of the build in a mail message using the Backup a Transport Global option [XPD BACKUP] from the Installation menu [XPD INSTALLATION MENU]. The back-out plan is to restore the data dictionary from the backup created. The message containing the backed-up build can be loaded with the "Xtract PackMan" function at the Message Action prompt. The PackMan function "INSTALL/CHECK MESSAGE" is then used to install the backed-up build onto the VistA system. From the Kernel Installation & Distribution System Menu [XPD MAIN], select the Installation menu [XPD INSTALLATION MENU]. Then select the Install Package(s) option [XPD INSTALL BUILD] and choose the patch (SR*3.0*209b) to install. No data was modified by this patch installation and, therefore no rollback strategy is required. Validation of Back-Out Plan: ---------------------------- The back-out plan can be verified by using VA FileMan's List File Attributes option [DILIST] to confirm that the DESCRIPTION attribute for the WOUND CLASSIFICATION field (#1.09) in the SURGERY file (#130) matches the pre-patch text below: DESCRIPTION: Definition Revised (2007): Indicate whether the wound has been classified by the primary surgeon as: >> Class 1 - Clean (C): Respiratory, alimentary, genital, or uninfected urinary tracts are not entered. Uninfected surgical wounds. No inflammation is encountered. Closed primarily and, if necessary, drained with closed drainage. Surgical incisional wounds that occur with nonpenetrating (eg blunt) trauma should be included in this category if they meet the criteria. [No hollow organ (e.g. bladder, stomach, vagina, lung, etc.) is entered; no breaks in aseptic technique.] Examples: - Exploratory laparotomy - Mastectomy or breast reduction - Neck dissection - Nonpenetrating blunt trauma - Thyroidectomy - Total hip replacement - Vascular operations (e.g. AAA, AV fistula, CEA, aortoiliac bypass) - Hernia repair - CABG, AVR - Craniotomy, majority neurosurgery - Pleura biopsy - Sternotomy - Abdominoplasty - Bone anchored hearing aids (BAHA) - Penile prosthesis placement - Dupuytren's release, finger - Liposuction - Carpal tunnel release - Hydrocele repair >> Class 2 - Clean/Contaminated (CC): Respiratory, alimentary, genital, or urinary tracts are entered under controlled conditions and without unusual contamination. Specifically, procedures involving the biliary tract, appendix, vagina, and oropharynx are included in this category, provided no evidence of infection or major breaks in technique are encountered. (Hollow organ entered but controlled; no inflammation; primary wound closure; minor break in aseptic technique; mechanical drain used.) Examples: - Bronchoscopy - Routine appendectomy - Cholecystectomy (e.g., any approach) - Laryngectomy - Small bowel resection - Oropharynx entered - GYN procedures - Vagina entered - Whipple pancreaticoduodenectomy - Pulmonary resection - Transurethral resection of prostate - Head & Neck cancer operations (e.g., oropharynx) - Sigmoid colectomy - Minor break in technique - Gastrointestinal or respiratory tract entered without significant spillage - Genitourinary tract entered in absence of infected urine >> Class 3 - Contaminated (D): Open fresh, accidental (e.g. traumatic) wounds. Procedures that have major breaks in sterile technique (eg, open cardiac massage) or gross spillage from the gastrointestinal tract and incisions in which acute, nonpurulent inflammation is encountered are included in this category. Examples: - Appendectomy for gangrenous appendicitis - Bile spillage during cholecystectomy - Diverticulitis - Laparotomy for penetrating injury with intestinal spillage - Entrance of genitourinary or biliary tracts in presence of infected urine or bile - Necrotic tissue without evidence of purulent drainage (e.g. dry gangrene) >> Class 4 - Dirty/Infected (I): Old traumatic wounds that have retained devitalized tissue and those that involve existing clinical infection or perforated viscera. This definition suggests that the organisms causing postoperative infection were present in the surgical field before the procedure. (Untreated, uncontrolled spillage from an internal organ; pus in operative wound; open suppurative wound; severe inflammation.) Examples: - Excision and drainage of abscess - Myringotomy for otitismedia - Perforated bowel - Peritonitis (abdominal exploration for acute bacterial peritonitis) - Acute bacterial inflammation, without pus - Transection of 'clean' tissue for the purpose of surgical access to a collection of pus - Traumatic wound with foreign bodies, fecal contamination, or delayed treatment, or all of these; or from dirty source Routine Information: ==================== No routines included. ============================================================================= User Information: Entered By : Date Entered : FEB 21, 2023 Completed By: Date Completed: MAY 17, 2023 Released By : Date Released : MAY 17, 2023 ============================================================================= Packman Mail Message: ===================== $END TXT