TISS
(TISS - 76)TISS
(TISS - 76)Classification
Class IV : >= 40 points
Class III : 20 - 39 points
Class II : 10 -19 points
Class I : < 10 points
TISS explanation code
4 Point Interventions : a) Point score
for 2 days after more recent cardiac arrest. b) This does not mean
intermittent mandatory ventilation wich is a 3-point intervention. It
does mean that regardless of the internal plumbing of the ventilator,
the patient's full mandatory needs are being supplied by the machine.
Wether or not the patient is ineffectively breathing around the
ventilator is irrelevant as long as the ventilator is providing all
the patient's needed minute ventilation. d) Use Sengstaken-Blakemore
or Linton tube for esophageal or gastric bleeding. e) Pitressin
infusion via IMA, SMa, gastric artery catheters for control of
gastrointestinal bleeding, or other intra-arterial infusion. This
does nor includ standard 3 ml/h heparin flush to maintain catheter
patency. g) Active pacing even if a chronic pacemaker. h) Include
first 2 runs of an acute dialysis. Include chronic dialysis in
patient whose medical situation now renders dialysis instable. j)
Continuous or intermittent cooling to achieve body temperature less
than 33°C. k) Use of a blood pump or manual pumping of blood in
the patient who requires rapid blood replacement. p) May even be the
initial emergency operative procedure - precludes diagnostics tests,
i.e. angiography, CT scan.
3 Point Interventions : d) The patient is supplying some of
his own venlatory needs. g) Not a daily point score. Patient must
have been intubated in the ICU (elective or emergency) within
previous 24 h. i) Measurement of intake/output above and beyond the
normal 24 h routine. Frequent adjustment of intake according to total
output. x) Includes Rheomacrodex. bb) For example, Strykerframe,
CircOlectric.
2 Point Interventions : g) Replacement of clear fluids over
and above the ordered maintenance level.
1 Point Interventions : k) Must have a decubitus ulcer. Does
not include preventive therapy.
General guidelines for use of TISS
1) Data should be collected at the same
time each day, preferably in the morning and by the same
observer.
2) A TISS item should be checked if it was performed at any time
during the previous 24 h.
3) When the patient is discharged from the ICU, we recommend a
discharge TISS that reflects the previous shift or 8 h period.
4) Total TISS points should decrease as the patient improves.
Conversely, one can safely assume that if TISS points increase, more
interventions or more intensive care is being delivered to the
patient indicating deterioration of the patient's condition.
Therefore, if the TISS points are rising while the patient is, in
fact, improving or vice versa, check for errors because interventions
may have been added inappropriately. A simple question to the
patient's nurse concerning the patient's current status is
helpful.
5) Many interventions are interrelated and can be automatically
eliminated from consideration. For example, if the patient was
extubated for previous 24 h, any intervention related to an intubated
patient such as controlled ventilation will not apply.
6) When several related intervention are applied within the same 24
h, only award 1 set of points for the maximum intervention. For
example, if a patient was on controlled ventilation (4 points), then
paced on IMV (3 points), to CPAP (3 points), to T-piece (2 points),
and then extubated all within the same 24 h period, assign only 4
points (for controlled ventilation), the maximum intervention
offered.
7) Though not essential, we recommend that TISS data collectors have
a critical care nursing background. they can easily identify the
interventions and make the appropriate associations within and
between categories. Collection time is minimized and results are
reproducible.
Reference
Keene AR and al. Therapeutic Intervention Scoring System : Update 1983. Crit Care Med. 1983:11,1-3.
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