Trauma Measure #3 Venous Thromboembolism (VTE) Prophylaxis in Abdominal Trauma. National Quality Strategy (NQS) Domain: Patient Safety

Transcription

1 Trauma Measure #3 Venous Thromboembolism (VTE) Prophylaxis in Abdominal Trauma National Quality Strategy (NQS) Domain: Patient Safety Measure Type (Process/Outcome): Process 2016 PQRS OPTIONS FOR INDIVIDUAL MEASURES: REGISTRY DESCRIPTION: Percentage of patients aged 18 years and older evaluated as part of a trauma activation or trauma consultation who are taken to the operating room for an abdominal operation who had an order for Low Molecular Weight Heparin (LMWH), Low-Dose Unfractionated Heparin (LDUH), or mechanical prophylaxis to be given within 24 hours of the surgical end time. INSTRUCTIONS: This measure is to be reported the first time a patient is taken to the operating room for an abdominal operation following trauma. There is no diagnosis associated with this measure. It is anticipated that clinicians who perform the listed surgical procedures as specified in the denominator coding will submit this measure. Measure Reporting via Registry: CPT codes and patient demographics are used to identify patients who are included in the measure s denominator. The listed numerator options are used to report the numerator of the measure. DENOMINATOR: All patients aged 18 years or older evaluated by an eligible professional as part of a trauma activation or trauma consultation who are taken to the operating room for an abdominal operation. Denominator Instructions: CPT Category I procedure codes billed by surgeons performing surgery on the same patient, submitted with modifier 62 (indicating two surgeons, ie, dual procedures) will be included in the denominator population. Both surgeons participating in PQRS will be fully accountable for the clinical action described in the measure. Denominator Criteria (Eligible Cases): Patients aged 18 years or older on date of operation Patients evaluated as part of a trauma activation or trauma consultation Patients taken to the operating room for abdominal exploration 1

2 One of the following CPT codes for the patient encounter during the reporting period: Listed below are surgical procedures with indications for post-operative VTE prophylaxis. SURGICAL PROCEDURE Spleen and Lymph Nodes Esophagus Stomach Small Intestine Colon Rectum Biliary Pancreas CPT CODE 38100, 38101, 38115, 38120, 38571, 38572, 38747, , 43107, 43108, 43112, 43113, 43116, 43117, 43118, 43122, 43123, 43124, 43279, 43280, 43281, 43282, 43320, 43325, 43327, 43328, 43330, 43332, 43333, 43336, 43337, 43340, 43350, 43360, 43361, 43400, 43401, 43405, 43415, 43425, , 43501, 43502, 43510, 43520, 43605, 43610, 43611, 43620, 43621, 43622, 43631, 43632, 43633, 43634, 43640, 43641, 43644, 43645, 43651, 43652, 43653, 43800, 43810, 43820, 43825, 43830, 43832, 43840, 43843, 43845, 43846, 43847, 43848, 43850, 43855, 43860, 43865, 43870, , 44010, 44020, 44021, 44050, 44055, 44110, 44111, 44120, 44125, 44126, 44127, , 44141, 44143, 44144, 44145, 44146, 44147, 44150, 44151, 44155, 44156, 44157, 44158, 44160, 44180, 44186, 44187, 44188, 44202, 44204, 44205, 44206, 44207, 44208, 44210, 44211, 44212, 44227, 44238, 44300, 44310, 44312, 44314, 44316, 44320, 44322, 44340, 44345, 44346, 44602, 44603, 44604, 44605, 44615, 44620, 44625, 44626, 44640, 44650, 44660, 44661, 44680, 44700, , 45111, 45112, 45113, 45114, 45119, 45120, 45121, 45123, 45135, 45136, 45150, 45395, 45397, 45400, 45402, 45499, 45540, 45550, 45560, 45562, 45563, 45800, 45805, 45820, , 47420, 47425, 47460, 47480, 47560, 47561, 47562, 47563, 47564, 47570, 47579, 47600, 47605, 47610, 47612, 47620, 47701, 47715, 47720, 47721, 47740, 47741, 47760, 47765, 47780, 47785, 47800, 47801, 47802, 47900, , 48001, 48100, 48105, 48120, 48140, 48145, 48146, 48148, 48150, 2

3 Abdomen, Peritoneum, & Omentum Mediastinum and Diaphragm Meckel s Diverticulum, Mesentery, & Appendix Liver Vascular Surgery Urologic Surgery Gynecologic Surgery 48152, 48153, 48154, 48155, 48500, 48510, 48520, 48540, 48545, 48547, 48548, , 49002, 49010, 49020, 49040, 49060, 49250, 49255, 49320, 49321, 49322, 49329, 49402, 49900, , 39540, 39541, 39545, 39560, 39561, , 44820, 44850, 44899, 44900, 44950, 44955, 44960, 44970, , 47120, 47122, 47125, 47130, 47350, 47360, 47361, 47362, 47379, , 34820, 34830, 34831, 34832, 34833, 35081, 35082, 35091, 35092, 35102, 35103, 35111, 35112, 35121, 35122, 35131, 35132, 35189, 35221, 35251, 35281, 35531, 35535, 35536, 35537, 35538, 35539, 35540, 35560, 35563, 35565, 35631, 35632, 35633, 35634, 35636, 35637, 35638, 35646, 35647, 35663, 35665, 35840, 37617, 37619, , 50220, 50225, 50240, 50500, 50650, 50750, 50760, 50770, 50780, 50785, 51045, 51550, 51565, 51820, 51860, 51865, 51880, 57284, 57305, 57307, 58150, 58152, 58180, 58200, 58210, 58520, 58600, 58700, 58720, NUMERATOR: All patients aged 18 years or older evaluated by an eligible professional as part of a trauma activation or trauma consultation who were taken to the operating room for an abdominal operation who had an order for LMWH, LDUH, or mechanical prophylaxis to be given within 24 hours after the surgical end time. Numerator Instructions: There must be documentation of order (written order, verbal order, or standing order/protocol) for VTE prophylaxis OR documentation that VTE prophylaxis was given. Definition: Mechanical Prophylaxis Does not include TED stockings Numerator Quality-Data Coding Options for Reporting Satisfactorily: Appropriate VTE prophylaxis ordered Performance Met: Documentation that an order was given for venous thromboembolism 3

4 (VTE) prophylaxis to be given within 24 hours after the surgery end time. OR VTE prophylaxis not ordered for medical reasons Medical Performance Exclusion: Documentation of medical reasons for patient not receiving any form of VTE prophylaxis (LMWH, LDUH, or mechanical prophylaxis) within 24 hours of the surgery end time (ie ongoing bleeding or conditions where bleeding could exacerbate injuries and contraindication to mechanical prophylaxis). OR VTE prophylaxis not ordered, reasons not otherwise specified Performance Not Met: Order was not given for venous thromboembolism (VTE) prophylaxis to be given within 24 hours after the surgery end time, reason not otherwise specified. RATIONALE: This measure addresses VTE prophylaxis in patients following trauma. Many trauma patients are at an increased risk for developing VTE, including patients with spinal cord injuries, spine fractures, long bone fractures, pelvic fractures, and head injuries (Rogers, 2002). At this time, the ultimate decision regarding the initiation of VTE prophylaxis is at the discretion of the eligible provider. However, in those who do not have contraindications to prophylaxis, an order should be placed in the medical record for VTE prophylaxis within 24 hours of the surgical end time. CLINICAL RECOMMENDATION STATEMENTS: Venous Thromboembolism: Risk Factors After Injury (Eastern Association for the Surgery of Trauma Clinical Practice Guidelines) Rogers, Frederick B. MD; Cipolle, Mark D. MD, PhD; Velmahos, George MD, PhD; Rozycki, Grace MD; Luchette, Fred A. MD J Trauma Jul;53(1): Executive Summary: Antithrombotic Therapy and Prevention of Thrombosis Gordon H. Guyatt, MD, FCCP; Elie A. Akl, MD, PhD, MPH; Mark Crowther, MD; David D. Gutterman, MD, FCCP; Holger J. Schuünemann, MD, PhD, FCCP; for the American College of Chest Physicians Antithrombotic Therapy and Prevention of Thrombosis Panel * Chest. 2012;141(2_suppl):7S-47S. For major trauma patients, we suggest use of LDUH (Grade 2C), LMWH (Grade 2C), or mechanical prophylaxis, preferably with IPC (Grade 2C), over no prophylaxis. (ACCP, 2012) 4

5 For major trauma patients at high risk for VTE (including those with acute spinal cord injury, traumatic brain injury, and spinal surgery for trauma), we suggest adding mechanical prophylaxis to pharmacologic prophylaxis (Grade 2C) when not contraindicated by lower extremity injury. (ACCP, 2012) For major trauma patients in whom LMWH and LDUH are contraindicated, we suggest mechanical prophylaxis, preferably with IPC, over no prophylaxis (Grade 2C) when not contraindicated by lower-extremity injury. We suggest adding pharmacologic prophylaxis with either LMWH or LDUH when the risk of bleeding diminishes or the contraindication to heparin resolves. (Grade 2C) (ACCP, 2012) For major trauma patients, we suggest that an IVC filter should not be used for primary VTE prevention. (Grade 2C) (ACCP, 2012) For major trauma patients, we suggest that periodic surveillance with venous compression ultrasound should not be performed. (Grade 2C) (ACCP, 2012) 5