2014 Changes for Core Measures that Impact Physicians

Guideline for Documenting Overlap Therapy for treatment of VTE:

  • Overlap therapy: Patients must receive five days of parenteral and warfarin therapy
  • If patient does NOT receive five days of overlap therapy, then additional documentation is required:
    • Must be physician, APN, PA or pharmacist documentation
    • Must be documented on day overlap therapy is discontinued
    • Must link why parenteral therapy was discontinued

Guideline for Documenting SCIP-Inf-1, 2 and 3:

  • Patients on home antibiotics must include a reason for continuing post-op

VTE-3: Patients receiving anticoagulation overlap therapy for the treatment of VTE:

  • This measure assesses the number of patients diagnosed with confirmed DVT/PE who received an overlap of parenteral anticoagulation and warfarin therapy. For patients who received less than five days of overlap therapy, they should be discharged on both medications or have a Reason for Discontinuation of Parenteral Therapy.  
  • If overlap therapy is discontinued, there must be physician, APN, PA or pharmacist linking documentation of why the parenteral therapy was discontinued.
  • What’s new: This documentation must be found on the same day that parenteral therapy was discontinued. (Example: Lovenox discontinued on 2/1/14. The reason for discontinuing the lovenox must be documented on 2/1/14. (i.e: INR 2.6, will discontinue Lovenox).
  • Key Point: The reason for discontinuing parenteral therapy must be written on the same day that the parenteral therapy is discontinued. Addendums will no longer be accepted for this measure.

SCIP-Inf-1, 2 and 3:

  • These measures assess antibiotic administration within 1 hour prior to incision time, antibiotic selection and antibiotic discontinuation within 24 hours of anesthesia end time (48 hours for CABG/other cardiac surgery).
  • What’s new: Patients on home/chronic antibiotics prior to arrival are no longer excluded from these measures. Therefore, if a home antibiotic is continued beyond 24 hours after anesthesia end time (48 hours for CABG/other cardiac surgery), there must be a reason documented for continuing the antibiotic. (example: infection, possible/suspected infection. New: treatment of acne or rosacea are now included.)
  • Key Point: All surgery patients with antibiotics continuing beyond 24 hours after anesthesia end time (48 hours for CABG/other cardiac surgery) must have documentation by the physician/APN/PA to support the need. This even applies to patients with home/chronic antibiotics.

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