Physician's Core Measure Pocket Guide AMI

Transcription

1 Physician's Core Measure Pocket Guide Core Measure Hotline: Ext Indicator: AMI AMI VER. 9/2018 MUST document WHY no ASA unless there is documentation of contraindication or patient currently on medication such as Coumadin, Xarelto, Pradaxa. ASA within 24hrs. of hospital arrival MUST address this indicator no matter of time frame of cardiac event. If AMI occurred during hospitalization but not at admission, documentation must reflect why ASA was not initiated upon admission. LDL within 24hrs. of arrival MUST be ordered within 24 hrs. of HOSPITAL ARRIVAL TIME. Evaluation of LVS function Some reference to past echo, recent cardiac cath (if EF evaluated at that time) or narrative description of LV function MUST be documented in current record on every admission. MUST have clear documentation

2 ACEI/ARB at Discharge if EF < 40% for not prescribing ACEI/ARB at discharge. Allergy must be to BOTH ACEI/ARB. Documentation of the following 5 conditions are exclusions for both medications at discharge: Discharge Prescriptions: If any of these medications are not prescribed, explicit rationale MUST be documented. Statin only needs to be prescribed for LDL > 100 if the patient was on lipid lowering medication previously. AMI Order Set: CHEST PAIN Discharge Order Set: AMI STROKE Indicator: STROKE Antithrombotic Therapy MUST be ordered by end of Day 2 unless contraindicated. LDL obtained within 48 hours of arrival MUST be ordered within 48 hours of HOSPITAL ARRIVAL TIME. Assessment for Rehabilitation MUST have any order for any form of rehab services while hospitalized. Medication Reconciliation ALL discharge medications (from discharge summary and med rec) MUST match with written instructions given with patients. In your discharge dictation, please add "Please see Medical Reconciliation for all final home meds". ** Patients with documented carotid stenosis fall into the stroke population and should be treated as a stroke patient due to their increased risk. ** Stroke Order Set: STROKE Discharge Order Set: STROKE HF Indicator: Heart Failure Some reference to past echo, recent cardiac cath (if EF evaluated during procedure) or narrative

3 Evaluation of LVS function during procedure) or narrative description of LV function MUST be documented in current record on every admission. ACEI/ARB at Discharge if EF < 40% MUST have clear documentation for not prescribing ACEI/ARB at discharge. Allergy must be to BOTH ACEI/ARB. Documentation of the following 5 conditions are exclusions for both medications at discharge: Medication Reconciliation ALL discharge medications (from discharge summary and med rec) MUST match with written instructions given with patients. In your discharge dictation, please add "Please see Medical Reconciliation for all final home meds". HF Order Set: HEART FAILURE Discharge Order Set: HEART FAILURE SCIP Indicator: SCIP Appropriate Prophylactic Antibiotic Selection If Prophylactic Post-op Antibiotics ordered: MUST be completed within 24hrs. of anesthesia end time; 48hrs. for cardiac surgery Foley catheter discontinued by POD2 See SCIP Antibiotic table below Post-op antibiotics are not required, but if they are ordered, they MUST be ordered for delivery to be within the mentioned time frames. If they are ordered and scheduled past the parameters, there MUST be clear documentation of possible/actual infection. MD/APN/PA order required to maintain catheter beyond POD 2. Reasons to continue foley MUST be clearly documented PRI to end of POD 2. Examples of acceptable inclusion statement: discharge" rest" VTE ordered and initiated within 24hrs. of anesthesia end time VTE prophylaxis MUST be ordered and/or applied or administered within 24hrs. of anesthesia end time. Cardiac surgeries are excluded. SCIP Indicator: SCIP Patients on beta blocker therapy prior to arrival should receive BB

4 Beta Blocker Therapy Perioperatively within 24hrs. of surgery as well as POD 1 POD 2. If BB not ordered, MUST clearly document rationale for not ordering during the perioperative timeframe. SCIP Prophylactic Antibiotic Regimen Selected Surgeries CABG, Other Cardiac or Vascular Hip/Knee Arthroplasty Prophylactic Antibiotic Regimen Selected Surgeries Colon Surgery Hysterectomy Cefotetan, Cefoxitin, Ampicillin/Sulbactam Ertapenem Metronidazole + Cefazolin, Cefuroxime or Ceftriaxone Clindamycin + Aminoglycoside Clindamycin + Quinolone Clindamycin + Aztreonam Metronidazole + Aminoglycoside Metronidazole + Quinolone Cefotetan, Cefazolin, Cefoxitin, Cefuroxime or Ampicillin/Sulbactam Clindamycin + Aminoglycoside Clindamycin + Quinolone Clindamycin + Aztreonam Metronidazole + Aminoglycoside Metronidazole + Quinolone *For cardiac, orthopedic and vascular surgeries, if the patient is allergic to B-lactam antibiotics, Vancomycin or Clindamycin are acceptable substitutes. **Vancomycin is acceptable with a physician/apn/pa/ pharmacist documented justification for its' use (allergy to Penicillin; known +MRSA; hospitalized >24hrs.; Cardiac valve surgery). Surgical Order Set: Specific Surgical Order Set Indicator: Pneumonia Pneumonia Blood cultures within 24hrs. Of arrival for patients transferred or admitted to ICU Initial Antibiotic Selection Blood cultures MUST be ordered on patients transferred to or admitted to ICU See Pneumonia antibiotic

5 Initial Antibiotic Selection consensus recommendations below Pneumonia Antibiotic Consensus Recommendations Non-ICU Ceftriaxone + Azithromycin Levofloxacin Non-ICU Pseudomonal Risk Piperacillin/Tazobactam + Levofloxacin NON-ICU B-lactam Allergy/Pseudomanal Risk ONLY Aztreonam + Levofloxacin ICU Azithromycin + Ceftriaxone Azithromycin + Piperacillin/Tazobactam Levofloxacin + Piperacillin/Tazobactam Pneumonia Order Set: PNEUMONIA VTE Indicator: VTE VTE Prophylaxis All inpatients 18 and older need to have VTE prophylaxis or documentation supporting contraindication to BOTH mechanical and pharmacological VTE prophylaxis by hospital Day 2. ICU VTE Prophylaxis All patients admitted or transferred to ICU need to have VTE prophylaxis initiated or documentation supporting contraindication to BOTH mechanical and pharmacological VTE prophylaxis ICU Day 2. Overlap Therapy for Confimed VTE *Does NOT apply to patients started on Pradaxa or Xarelto* All patients with a confirmed VTE started on Warfarin therapy require a 5 day overlap of parenteral anticoagulation (i.e., Heparin, Lovenox, etc.) or documentation supporting rationale for early discontinuation. patient must be discharged on overlap of Warfarin and Lovenox until INR is > 2. VTE Order Set: VTE MODULE Sepsis Indicator: Severe Sepsis infection Documentation of Palliative Care/Comfort Care Consult or conversation within 3hrs. of presentation of Severe Sepsis excludes case. All within 1st hour of presentation

6 All within 1st hour of presentation hypotension is present Fluids must be ordered at 30mL/kg crystalloid NS or LR Repeat lactic acid MUST be repeated within 5 hrs if initial lactic acid is equal to or greater than 2. Antibiotic Recommendations Combination Therapy Monotherapy (must provide reason for) Piperacillin/Tazobactam & Vancomycin PCN Allergy Aztreonam & Vancomycin Levofloxacin Ceftriaxone Ertapenem Sepsis Order Set: SEPSIS Septic Shock Indicator: Septic Shock Severe Sepsis criteria AND: than 90) or MAP less than 65 after fluid resuscitation Documentation of Palliative Care/Comfort Care Consult or conversation within 6hrs. Of presentation of Septic Shock excludes case. All within 1st hour of presentation Fluids must be ordered at 30mL/kg crystalloid NS or LR Repeat lactic acid MUST be repeated within 5 hours if lactic acid is equal to or greater than 2 Vasopressor if hypotension persists after fluid resuscitation within 6hrs. of Septic Shock Norepinephrine Vasopressin Focused Exam (within 5hrs.) Sepsis Tissue Perfusion Assessment 2001 Template