Hip & Knee Replacement 2016 (HK2016) Measures Document

Transcription

1 Hip & Knee Replacement 2016 (HK2016) Measures Document HK2016 Version: 1 - covering patients discharged between 01/04/2016 and present. Programme Lead: Sam Doddridge Clinical Leads: Mr Derek Pegg Mr Sanat Shah Number of Measures In Clinical Focus Area (CFA) Clinical Process Measures 6 Data Measures - Mandatory 1 advancing.quality@nhs.net Website: Produced on 17 March 2016

2 Introduction Every year approximately 200,000 people undergo elective hip and knee replacement surgery in the United Kingdom. Hip Replacement Hip replacement is currently the most common orthopaedic operation, used to treat joint failure caused by osteoarthritis. Other indications include rheumatoid arthritis, avascular necrosis, traumatic arthritis and arthritis associated with other clinical conditions. The aims of the procedure are pain relief and improvement in hip function. Knee Replacement Knee replacement, also referred to as knee arthroplasty is a surgical procedure to replace the weight bearing surfaces of the knee joint to relieve pain and disability. Rationale for this operation includes osteoarthritis, rheumatoid arthritis and psoriatic arthritis. Risks and complications of hip and knee replacement are similar to those of other joint replacements. The most serious complication is infection of the joint which occurs in less than 1% of patients. Other complications include deep vein thrombosis, nerve injuries, persistent pain and stiffness. The Advancing Quality measures aim to ensure the patient receives consistent reliable care throughout their journey. Therefore improving the patient's experience, reducing hospital length of stay and the potential of readmission. Page 2

3 Measures In Clinical Focus Area Measure Type Measure ID Clinical Process Measure Data Measure - Mandatory HK-01 HK-02 HK-03 HK-04 HK-05 HK-06 HK-07 Measure Name Prophylactic antibiotic within 1 hour prior to surgical incision Temperature taken within 1 hour prior to surgical incision Tranexamic acid administered during surgery Received appropriate VTE prophylaxis within 12 hours of surgery end time Patient walking within 24 hours of surgery end time Regular prescription of analgesia and laxative on day of surgery Pre-op patient education Page 3

4 Measure ID: Measure Name: HK-01 Prophylactic antibiotic within 1 hour prior to surgical incision Unique Record Identifier: Measure Description: Hip and knee replacement patients should be administered prophylactic antibiotics within 1 hour prior to surgical incision. Measure Type: Clinical Process Measure Rationale: The use of prophylaxis with antibiotics is to establish bactericidal tissue and serum levels at the time of skin incision. Antibiotic therapy within 1 hour of surgical incision has been proven to reduce the risk of infection. Numerator Statement: Number of patients who received prophylactic antibiotics within one hour prior to surgical incision. Denominator Statement: Number of patients eligible to received prophylactic antibiotics within one hour prior to surgical incision. Measure Reported As: The percentage of patients who received prophylactic antibiotics within one hour prior to surgical incision. Improvement Noted As: An increase in the rate. Notes: Patients who received vancomycin (Appendix V Table 1) or a fluoroquinolone (Appendix V Table 2) for prophylactic antibiotics should have the antibiotics administered within two hours prior to surgical incision. Data Elements: To be considered complete the following data elements should be recorded for the measure:- Antibiotic - administered prior 1hr Clinical Trial (HK2016) Other surgeries (HK2016) Measure Exclusions: Clinical Trial - There is evidence in the medical record that the patient participated in a clinical trial affecting care or treatment related to this AQ measure set. Other Surgeries - Documentation in the medical record stating that the patient has undergone a procedure requiring general or spinal/epidural anaesthesia that occurred, during this hospital stay, within three days prior to or after the principal procedure Page 4

5 Measure ID: Measure Name: HK-02 Temperature taken within 1 hour prior to surgical incision Unique Record Identifier: Measure Description: Hip and knee replacement patients should have their temperature taken within 1 hour prior to surgical incision. Measure Type: Clinical Process Measure Rationale: Keeping patients warm has been associated with a threefold decrease in the rate of wound infection, a reduction in operative blood loss, a decrease in untoward cardiac events, including ventricular tachycardia, and a reduction in nitrogen excretion and patient discomfort. Maintenance of a normal temperature during surgery is central to reducing the stress of the surgical procedure and reducing the risk of organ dysfunction. Numerator Statement: Number of patients who have their temperature taken within 1 hour prior to surgical incision. Denominator Statement: Number of patients eligible to have their temperature taken within 1 hour prior to surgical incision. Measure Reported As: The percentage of patients who have their temperature taken within 1 hour prior to surgical incision. Improvement Noted As: An increase in the rate Data Elements: To be considered complete the following data elements should be recorded for the measure:- Clinical Trial (HK2016) Other surgeries (HK2016) Temperature Recorded Measure Exclusions: Clinical Trial - There is evidence in the medical record that the patient participated in a clinical trial affecting care or treatment related to this AQ measure set. Other Surgeries - Documentation in the medical record stating that the patient has undergone a procedure requiring general or spinal/epidural anaesthesia that occurred, during this hospital stay, within three days prior to or after the principal procedure Page 5

6 Measure ID: Measure Name: HK-03 Tranexamic acid administered during surgery Unique Record Identifier: Measure Description: Hip and knee replacement patients should be administered tranexamic acid within 1 hour of surgical incision, either prior to or after. Measure Type: Clinical Process Measure Rationale: An intraoperative dose of tranexamic acid has been shown to reduce the perioperative decrease in haemoglobin and red blood cell transfusion rates in patients having TKA and THA. Numerator Statement: Number of patients who have tranexamic acid administered during surgery. Denominator Statement: Number of patients who are eligible to have tranexamic acid administered during surgery. Measure Reported As: The percentage of patients who have tranexamic acid administered during surgery. Improvement Noted As: An increase in the rate. Data Elements: To be considered complete the following data elements should be recorded for the measure:- Clinical Trial (HK2016) Other surgeries (HK2016) Tranexamic acid - administered Tranexamic acid - reason Measure Exclusions: Tranexamic acid - Documentation in the medical record a reason or contraindication for not administering tranexamic acid. Other Surgeries - Documentation in the medical record stating that the patient has undergone a procedure requiring general or spinal/epidural anaesthesia that occurred, during this hospital stay, within three days prior to or after the principal procedure. Clinical Trial - There is evidence in the medical record that the patient participated in a clinical trial affecting care or treatment related to this AQ measure set. Page 6

7 Measure ID: Measure Name: HK-04 Unique Record Identifier: Measure Description: Received appropriate VTE prophylaxis within 12 hours of surgery end time Hip and knee replacement patients should have a recommended venous thromboembolism prophylaxis administered within 12 hours of surgery end time. Measure Type: Clinical Process Measure Rationale: Evidence that VTE is one of the most common postoperative complications and prophylaxis is the most effective strategy to reduce morbidity and mortality, it is often underused. The frequency of venous thromboembolism (VTE), that includes deep vein thrombosis and pulmonary embolism, is related to the type and duration of surgery, patient risk factors, duration and extent of postoperative immobilization, and use or non-use of prophylaxis. Numerator Statement: Number of patients who have a recommended pharmacological venous thromboembolism prophylaxis administered within 12 hours of surgery end time. Denominator Statement: Number of patients eligible to have a recommended pharmacological venous thromboembolism prophylaxis administered within 12 hours of surgery end time. Measure Reported As: The percentage of patients who have a recommended pharmacological venous thromboembolism prophylaxis administered within 12 hours of surgery end time. Improvement Noted As: An increase in the rate. Data Elements: To be considered complete the following data elements should be recorded for the measure:- Bleeding Risk - documented Clinical Trial (HK2016) Dural Puncture (HK2016) Severe Renal Impairment Time Exclusion VTE Prophylaxis - declined VTE Prophylaxis - reason VTE Prophylaxis - type VTE Prophylaxis in 12 hrs Warfarin - surgery Measure Exclusions: Patients who decline VTE therapy Patients who have a bleeding risk Patients with traumatic puncture of dura during insertion of epidural catheter Patients with a reason or contraindication documented by Consultant for not administering VTE Time exclusion - Patient was discharged within 12 hours of surgery end time, or surgery lasted less than 30 minutes Clinical Trial - There is evidence in the medical record that the patient participated in a clinical trial affecting care or treatment related to this AQ measure set. Page 7

8 Measure ID: Measure Name: HK-05 Patient walking within 24 hours of surgery end time Unique Record Identifier: Measure Description: Hip and knee replacement patients should be walking within 24 hours of surgery end time. Measure Type: Clinical Process Measure Rationale: Early mobilisation walking following total hip & knee replacement has been found to reduce the risk of deep-vein thrombosis and other complications. Early mobilisation was defined as beginning to walk within 24 hours after hip/ knee replacement surgery end time. Numerator Statement: Number of patients who are walking within 24 hours of surgery end time. Denominator Statement: Number of patients who are eligible to be walking within 24 hours of surgery end time. Measure Reported As: The percentage of patients who are walking within 24 hours of surgery end time. Improvement Noted As: An increase in the rate. Data Elements: To be considered complete the following data elements should be recorded for the measure:- Clinical Trial (HK2016) Other surgeries (HK2016) Walking - reason Walking - refused Walking - within 24 hours Measure Exclusions: Clinical Trial - There is evidence in the medical record that the patient participated in a clinical trial affecting care or treatment related to this AQ measure set Other Surgeries - Documentation in the medical record stating that the patient has undergone a procedure requiring general or spinal/epidural anaesthesia that occurred, during this hospital stay, within three days prior to or after the principal procedure Documentation in the patient notes that they refused to walk Documentation in the patient notes that there was a reason they were unable to walk Page 8

9 Measure ID: Measure Name: HK-06 Unique Record Identifier: Measure Description: Regular prescription of analgesia and laxative on day of surgery Hip and knee replacement patients should have documentation in their medical records of a regular prescription of analgesia and laxative on the day of surgery. Measure Type: Clinical Process Measure Rationale: A regular prescription of analgesia and laxatives on the day of surgery will reduce post-operative pain, encourage early mobilisation and reduce the risk of constipation in the post-operative period. Numerator Statement: Number of patients who receive a regular prescription of analgesia and laxatives on the day of surgery. Denominator Statement: Number of patients who are eligible to receive a regular prescription of analgesia and laxatives on the day of surgery. Measure Reported As: The percentage of patients who receive a regular prescription of analgesia and laxatives on the day of surgery. Improvement Noted As: An increase in the rate. Data Elements: To be considered complete the following data elements should be recorded for the measure:- Analgesia and Laxative - prescribed Analgesia and Laxative - reason Clinical Trial (HK2016) Other surgeries (HK2016) Measure Exclusions: Clinical Trial - There is evidence in the medical record that the patient participated in a clinical trial affecting care or treatment related to this AQ measure set Medical contraindication or reason not to prescribe analgesia and laxative Other Surgeries - Documentation in the medical record stating that the patient has undergone a procedure requiring general or spinal/epidural anaesthesia that occurred, during this hospital stay, within three days prior to or after the principal procedure Page 9

10 Measure ID: Measure Name: HK-07 Pre-op patient education Unique Record Identifier: Measure Description: Hip and knee replacement patients should receive pre-operative education prior to surgery. Measure Type: Data Measure - Mandatory Rationale: Educating patients about postoperative routines may reduce the incidence of postoperative complications, the most serious of which is pulmonary embolism resulting from deep vein thrombosis and other post-operative complications. If a patient is unduly anxious, physical recovery and well-being may be affected, prolonging hospital stay and increasing the cost of care. By ensuring full understanding of the operation and postoperative routines, and promoting physical recovery and psychological well-being through preparatory information, it is hypothesised that patients will be less anxious, have a shorter hospital stay and be better able to cope with postoperative pain. Numerator Statement: The number of patients who receive pre-operative patient education. Denominator Statement: The number of patients who are eligible to receive pre-operative patient education. Measure Reported As: The percentage of patients who receive pre-operative patient education. Improvement Noted As: An increase in the rate. Data Elements: To be considered complete the following data elements should be recorded for the measure:- Clinical Trial (HK2016) Pre-Op Education Pre-Op Education - reason Measure Exclusions: Clinical Trial - There is evidence in the medical record that the patient participated in a clinical trial affecting care or treatment related to this AQ measure set There is a documented reason in the patient notes for not participating in pre-op education Page 10

11 Appendices I. Data Elements Required for Clinical Focus Area Data Element Definition Source Collected for Measures Analgesia and Laxative - prescribed Analgesia and Laxative - reason Antibiotic - administered prior 1hr Bleeding Risk - documented A regular prescription of analgesia and laxatives is documented on the day of surgery. There is a reason documented by a consultant (or person working as part of the consultant team) for not prescribing analgesia and/or laxatives on day of surgery. Documentation within the medical record that the patient received antibiotics within 1 hour prior to surgery. Documentation in the medical record by the consultant (or person working as part of the consultant team) of a risk of bleeding or active bleeding within the timeframe of arrival to 24 hours after surgery end time. Clinical Trial (HK2016) Documentation in the medical record that the patient was involved in a clinical trial during this hospital stay, directly affecting AQ Measures (specific to the AQ clinical condition the patient was treated for during this spell of care/treatment). Clinical trials are organised studies to provide large bodies of clinical data for statistically valid evaluation or treatment. These studies are usually rigorously controlled tests of new drugs, invasive medical devices, or therapies on human subjects. Dural Puncture (HK2016) Other surgeries (HK2016) Pre-Op Education Pre-Op Education - reason Severe Renal Impairment Temperature Recorded Time Exclusion Documentation in the medical record that a traumatic puncture of the dura occurred during insertion of epidural catheter. There is documentation of another procedure(s) requiring general or spinal anaesthesia were performed on the patient, during this hospital stay, within three days prior to or after the principal procedure. Documentation in the medical record that the patient had pre-operative education. Documentation in the medical record of a reason why the patient did not participate in preoperative education. Documentation in the medical record that the patient has severe renal impairment at the time of surgery. Documentation in the medical record that the patient had their temperature recorded within 1 hour prior to surgical incision. The surgery took less than 30 minutes, or the patient was discharged within 12 hours of surgery end time HK-06 HK-06 HK-01 HK-04 HK-01, HK-02, HK- 03, HK-04, HK-05, HK-06, HK-07 HK-04 HK-01, HK-02, HK- 03, HK-05, HK-06 HK-07 HK-07 HK-04 HK-02 HK-04 Tranexamic acid - Documentation in the medical record that HK-03 Page 11

12 administered Tranexamic acid - reason VTE Prophylaxis - declined VTE Prophylaxis - reason tranexamic acid was administered within 1 hour of surgical incision. This can be 1 hour prior to up to one hour after surgical incision. Documentation in the medical record of a reason for not administering tranexamic acid. Documentation in the medical record that the patient declined pharmacological prophylactic venous thromboembolism (VTE) within 12 hours of surgery end time. There is documentation in the medical record of a reason for not administering pharmacological venous thromboembolism (VTE) prophylaxis. VTE Prophylaxis - type The name of the VTE administered should be entered within the VTE drug table. VTE Prophylaxis in 12 hrs Walking - reason Walking - refused Walking - within 24 hours Warfarin - surgery Documentation in the medical record pharmacological prophylactic venous thromboembolism (VTE) was administered within 12 hours of surgery end time. The name of the VTE administered should be entered within the VTE drug table. Documentation in the medical record of a reason for the patient not being able to walk within 24 hours of the surgery end time Documentation in the medical record that the patient refused to walk. Documentation in the medical record that the patient was walking within 24 hours of surgery end time. Documentation in the medical record of a clinical need for the prescription of warfarin at the time of surgery. HK-03 HK-04 HK-04 HK-04 HK-04 HK-05 HK-05 HK-05 HK-04 Page 12

13 II. Population Identification Criteria with Codes The population is made up of all patients identified in Groups 1 to 4. From July 2016 discharges, bilateral procedures are now included in the population. GROUP 1 All patients must be >= 18 AND Patients must not have any diagnosis in the Hip Fracture Diagnosis List coded anywhere in any episode AND Patient has a dominant spell diagnosis of a procedure from the Hip Arthroplasty Procedure List GROUP 2 All patients must be >= 18 AND Patients must not have any diagnosis in the Hip Fracture Diagnosis List coded anywhere in any episode AND Patient has a dominant spell diagnosis of a procedure from the Ambiguous Arthroplasty Procedure List and has a subsequent procedure in the Bone Related to Hip Procedure List GROUP 3 All patients must be >= 18 AND Patient has a dominant spell diagnosis of a procedure from the Knee Arthroplasty Procedure List GROUP 4 All patients must be >= 18 AND Patient has a dominant spell diagnosis of a procedure from the Ambiguous Arthroplasty Procedure List and has a subsequent procedure in the Bone Related to Knee Procedure List Hip Fracture Diagnosis List S720 Fracture of neck of femur S7200 Fracture of neck of femur, closed S7201 Fracture of neck of femur, open S721 Pertrochanteric fracture S7210 Pertrochanteric fracture, closed S7211 Pertrochanteric fracture, open S722 Subtrochanteric fracture S7220 Subtrochanteric fracture, closed S7221 Subtrochanteric fracture, open Hip Arthroplasty Procedure List W481 Primary prosthetic replacement of head of femur NEC W951 Primary hybrid prosthetic replacement of hip joint using cement NEC W931 Primary hybrid prosthetic replacement of hip joint using cemented acetabular component W941 Primary hybrid prosthetic replacement of hip joint using cemented femoral component W461 Primary prosthetic replacement of head of femur using cement W471 Primary prosthetic replacement of head of femur not using cement W371 Primary total prosthetic replacement of hip joint using cement W381 Primary total prosthetic replacement of hip joint not using cement W391 Primary total prosthetic replacement of hip joint NEC Knee Arthroplasty Procedure List W401 Primary total prosthetic replacement of knee joint using cement W411 Primary total prosthetic replacement of knee joint not using cement W421 Primary total prosthetic replacement of knee joint NEC O181 Primary hybrid prosthetic replacement of knee joint using cement O188 Other specified hybrid prosthetic replacement of knee joint using cement O189 Unspecified hybrid prosthetic replacement of knee joint using cement Page 13

14 Ambiguous Arthroplasty Procedure List W521 Primary prosthetic replacement of articulation of bone using cement NEC W531 Primary prosthetic replacement of articulation of bone not using cement NEC W541 Primary prosthetic replacement of articulation of bone NEC Bone Related to Hip Procedure List Z762 Neck of femur Z763 Trochanter of femur Z768 Specified femur NEC Z769 Femur NEC Z843 Hip joint Z761 Head of femur Bone Related to Knee Procedure List Z845 Tibiofemoral joint Z846 Knee joint Z765 Lower end of femur NEC Z774 Upper end of tibia NEC Z778 Specified tibia NEC Z779 Tibia NEC Z844 Patellofemoral joint Page 14

15 III. References Antimicrobial prophylaxis for surgery: An advisory statement from the National Surgical Infection Prevention Project. Bratzler, Dale W. et al. The American Journal of Surgery, Volume 189, Issue 4, Artz, Neil et al. 'Physiotherapy Provision Following Discharge After Total Hip And Total Knee Replacement: A Survey Of Current Practice At High-Volume NHS Hospitals In England And Wales'. Musculoskelet. Care 11.1 (2012): Web. Bruyère, O. et al. 'Health-Related Quality Of Life After Total Knee Or Hip Replacement For Osteoarthritis: A 7- Year Prospective Study'. Arch Orthop Trauma Surg (2012): Web. C. A. Willis-Owen, FRCS (Trauma & Orth), Orthopaedic Fellow; A. Konyves, FRCS(Trauma & Orth), Orthopaedic Fellow; D. K. Martin, MS(Orth), FRACS, FAOrthA, Orthopaedic Surgeon. Factors affecting the incidence of infection in hip and knee replacement. J Bone Joint Surg Br August 2010 vol 92-B no Daltroy, L. H., Morlino, C. I., Eaton, H. M., Poss, R. and Liang, M. H. (1998), Preoperative education for total hip and knee replacement patients. Arthritis & Rheumatism, 11: doi: /art Den Hertog A, Gliesche K, Timm J, Mühlbauer B, Zebrowski S. Pathway-controlled fast-track rehabilitation after total knee arthroplasty: a randomized prospective clinical study evaluating the recovery pattern, drug consumption, and length of stay, Arch Orthop Trauma Surg E. O. Pearse. B. F. Caldwell. R. J. Lockwood.J. Hollard. Early mobilization after conventional knee replacement may reduce the risk of postoperative venous thromboembolism. J Bone Joint Surg Br March 2007 vol.89-b no Ekbäck, Gustav MD; Axelsson, Kjell MD, PhD; Ryttberg, Lars MD; Edlund, Bror MD, PhD; Kjellberg, Jill Chief CRNA; Weckström, Johan MD; Carlsson, Olle PhD; Schött, Ulf MD, Ph. Tranexamic Acid Reduces Blood Loss in Total Hip Replacement Surgery. Anesthesia & Analgesia. Nov 2000 vol 91- Issue Guerra, M. L., P. J. Singh, and N. F. Taylor. 'Early Mobilization Of Patients Who Have Had A Hip Or Knee Joint Replacement Reduces Length Of Stay In Hospital: A Systematic Review'. Clinical Rehabilitation (2014): n. pag. Web. Ho, K M; Ismail, H. Use of intravenous tranexamic acid to reduce allogeneic blood transfusion in total hip and knee arthroplasty: A meta-analysis Australian Society of Anaesthetists Isaac D1, Falode T, Liu P, I'Anson H, Dillow K, Gill P. Accelerated rehabilitation after total knee replacement Oct;12(5): John Meehan, MD; Amir A. Jamali, MD; Hien Nguyen, MD. Prophylactic Antibiotics in Hip and Knee Arthoplasty. J Bone Joint Surg Am, 2009 Oct 01; 91 (10): Larsen, Kristian et al. 'Accelerated Perioperative Care And Rehabilitation Intervention For Hip And Knee Replacement Is Effective: A Randomized Clinical Trial Involving 87 Patients With 3 Months Of Follow-Up'. Acta Orthopaedica 79.2 (2008): Web. M. Sukeik, MD; S. Alshryda; F. S. Haddad; J. M. Mason, Systemic review and meta-analysis of the use of tranexamic acid in total hip replacement. J Bone Joint Surg Br, January 2011, vol. 93-B n Malviya, Ajay et al. 'Enhanced Recovery Program For Hip And Knee Replacement Reduces Death Rate'. Acta Orthopaedica 82.5 (2011): Web. McDonald S, Hetrick SE, Green S. Pre-operative education for hip or knee replacement. Cochrane Database of Systematic Reviews 2004, Issue 1. Art. No.: CD DOI: / CD pub2. McDonald S, Page MJ, Beringer K, Wasiak J, Sprowson A. Preoperative education for hip or knee replacement. Cochrane Database of Systematic Reviews 2014, Issue 5. Art. No.: CD DOI: / CD pub3. Moretti.B.et al. Active warming systems to maintain perioperative normothermia in hip replacement surgery: a therapeutic aid or a vector of infection? Journal of Hospital Infection, Volume 73, Issue 1, Simpson, A Hamish RW et al. 'Targeted Rehabilitation To Improve Outcome After Total Knee Replacement (TRIO): Study Protocol For A Randomised Controlled Trial'. Trials 15.1 (2014): 44. Web. Wilmore DW, Kehlet H. Management of patients in fast track surgery. BMJ : British Medical Journal. 2001;322(7284): Yoon, Richard S. et al. 'Patient Education Before Hip Or Knee Arthroplasty Lowers Length Of Stay'. The Journal of Arthroplasty 25.4 (2010): Web. Page 15

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24 V. Appendices Table 1 Antibiotics (Vancomycin) Generic Drug Name Vancomycin Vancomycin Vancomycin Vancomycin Vancomycin Vancomycin Proprietary Name Lyphocin Vancocin Vancocin HCL Vancoled Vancomycin Vancomycin Hydrochloride Table 2 Antibiotics (Fluroquinolone) Generic Drug Name Alatrofloxacin Alatrofloxacin Moxifloxacin Ciprofloxacin Ciprofloxacin Ciprofloxacin Ciprofloxacin Ofloxacin Gatifloxacin Levofloxacin Levofloxacin Moxifloxacin Moxifloxacin Ofloxacin Gatifloxacin Gatifloxacin Trovafloxacin Trovafloxacin Trovafloxacin Trovafloxacin Proprietary Name Alatrofloxacin Alatrofloxacin Mesylate Avelox Ciloxan Ciprofloxacin Ciprofloxacin Hydrochloride Cipro Floxin Gatifloxacin Levaquin Levofloxacin Moxifloxacin Moxifloxacin Hydrochloride Ofloxacin TEC-PAQ Tequin Trovafloxacin Trovafloxacin Mesylate Trovafloxacin/Alatrofloxacin Trovan Page 24

25 Hip & Knee Replacement: Advancing Quality Data form Name: Hospital Number: DOB: / / NHS: Ethnicity: Source of Admission Admission Date & Time / / : Discharge Date & Time / / : Discharge Destination Discharge Method EXCLUSIONS 1. Clinical trial? Yes No If Yes, stop 2. Traumatic puncture of the dura Yes No If Yes, skip 3, 4, Was the patient eligible for a time exclusion? - Surgery less than 30 min incision to closure - Discharged within 12hr of surgery end time Yes No If Yes, skip 4, Is there a documented bleeding risk? Yes No If Yes, skip Other surgical procedure Yes No If Yes, skip 6-9, ANTIBIOTICS 6. Antibiotics administered within 1 hour prior to surgical incision? Yes No TEMPERATURE 7. Patients temperature recorded within 1 hour prior to surgical incision? Yes No TRANEXAMIC ACID 8. Contraindication to administering tranexamic acid? Yes No If Yes, skip 9 9. Tranexamic acid administered an hour prior to or after surgical incision? Yes No VALIDATIONS Form completed by Designation Inputted by Date Input / / VTE SURGERY 10. Patient declined VTE prophylaxis? Yes No If Yes, skip Reason documented for not administering VTE prophylaxis? Yes No If Yes, skip VTE prophylaxis VTE Date Time 13. Warfarin indicated at the time of surgery? Yes No 14. Severe renal impairment at the time of surgery? Yes No 15. VTE prophylaxis within 12 hours of surgery end time? Yes No WALKING 16. Patient refused to walk? Yes No If Yes, skip 17 & Reason documented for patient not walking within 24 hours of surgery end time? Yes No If Yes, skip Patient walking within 24 hours post-surgical end time? Yes No ANALGESIA & LAXATIVES 19. Reason documented for not prescribing analgesia and laxative on the day of surgery? Yes No If Yes, skip Regular prescription of analgesia and laxatives on the day of surgery Yes No DATA COLLECTION ONLY 21. Reason documented for not participating in pre-operative education Yes No If Yes, skip Pre-operative education provided? Yes No ADVANCING QUALITY HK2016 DATA COLLECTION FORM VERSION 1.3 Page 25