Transcript Ojectives for SCIP Part II

Developed by Kathy Wonderly RN, BSPA, CPHQ
Performance Improvement Coordinator
Developed : October 2009
Most recently updated: September 2013
 To
identify the patients who should receive
a Beta blocker during the perioperative
period.
 To recognize the approved venous
thromboembolism (VTE) prophylaxis for
surgical patients.
 To recognize the importance of the VTE
prophylaxis being started with 24 hours
before to 24 hours after surgery
 Changes for January- September 2014 will be
in italics.
This
is the only cardiac measure in
the current SCIP program.
Research has shown that mortality
increases when patients who are on
beta-blocker therapy prior to
admission do not receive a betablocker during the perioperative
period
 For
this measure the perioperative period
is defined as the day prior to surgery
through postoperative day two with day
of surgery being day zero. It is expected
that the patient will receive a dose the
day before or the day of surgery, a dose
on P.O. days 1 and 2.
 If the patient’s length of stay is less that 2
days the administration of the beta
blocker the day prior to or day of surgery
only are assessed.
Nursing role
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While ordering a medication is a physician
responsibility, nurses should remind the
physician that the patient was taking a beta
blocker prior to admission.
Nursing or often anesthesia will administer the
medication as ordered. Be sure to document
the date and time of the administration.
 As
with the other indicators if the
practitioner does not order a beta blocker
for patients who are on one prior to
admission. He/she must document the reason
for not ordering this medication. This
documentation must occur each day the
medication is not ordered. Acceptable
reasons include having a ventricular assist
device or heart transplantation.
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Acebutolol
Atenolol
Atenolol/chlorthalidone
Betapace
Betapace AF
Betaxolol
Bisoprolol
Bisoprolol/fumarate
Bisoprolol/hydrochlorothiazide
Brevibloc
Bystolic
Carvedilol
Coreg
Corgard
Corzide 40/5
Corzide 80/5 c
Esmolol
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Inderal
Inderal LA
Inderide
Inderide LA
InnoPran XL
Labetalol
Levatol
Lopressor
Lopressor HCT
Lopressor/hydrochlorothiazide
Metoprolol
Metoprolol/hydrochlorothiazide
Metoprolol Tartrate/hydrochlorothiazide
Nadolol
Nadolol/bendroflumethiazide
Nebivolol
Nebivolol HCL
Nebivolol Hydrochloride
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Penbutolol
Pindolol
Propranolol
Propranolol HCL
Propranolol Hydrochloride
Propranolol/hydrochlorothiazide
Sectral
Sorine
Sotalol
Sotalol HCL
Tenoretic
Tenormin
Tenormin I.V.
Timolol
Toprol
Toprol-XL
Trandate
Trandale HCL
Visken
Zebeta
Ziac
Specifications Manual for National Hospital Inpatient Quality
Measures Discharges 01-01-14(1Q14) through 09-30-14- (3Q14) Appendix C
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The VTE measure requires that the
ordered VTE prophylaxis is initiated
within 24 hours prior to the
anesthesia start time to 24 hours
after the anesthesia end time. This
is a nursing driven measure.
 There
are several groups of patients who are
excluded from this indicator.
 These include:
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Burn patients
Patients whose total surgical time is less
than 60 minutes
Patients who stay less than two nights.
Patients who are on oral anticoagulation
therapy prior to admission.
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There are two types of prophylaxis.
Pharmacological which include:
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Heparin
Low molecular weight heparin such
as Lovonox
Factor Xa inhibitor fondaparinux –Arixtra
or Xarelto
Warfarin (Coumadin)
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2. Mechanical prophylaxis which include :
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Graduated Compression Stockings (GCS)
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Intermittent Pneumatic Compression Devices (IPC)
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Venous Foot Pump (VFP)
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Years of research have identified that the type
of procedure done drives the choice of VTE
prophylaxis.
The following slides show the recommendations
for each category of surgery.
While ordering prophylaxis is the responsibility
of the practitioner, the nurses caring for postop patients should look for some type of order
or documentation as to why nothing was
ordered.
Procedure
Recommended prophylaxis
Elective Total Knee or Total
Hip Replacement
Any of the following
Low molecular weight
heparin
Factor Xa inhibitor including
oral route (Xarelto)
Warfarin
ICP
VFP
Low molecular weight
heparin
Aspirin
Hip Fracture surgery
Low molecular weight heparin
Low dose unfractionated
heparin
Factor Xa Inhibitor
Warfarin
ICP
Aspirin
General Surgery
Low molecular weight inhibitor
Low dose unfractionated heparin
Factor Xa Inhibitor
IPC
Urologic Surgery
Low molecular weight inhibitor
Low dose unfractionated heparin
Factor Xa Inhibitor
IPC
Pharmacological combined with
IPC or GCS
Gynecologic Surgery
Low molecular weight inhibitor
Low dose unfractionated
heparin
Factor Xa Inhibitor
IPC
Pharmacological combined with
IPC or GCS
Intracranial Neurosurgery
Low molecular weight inhibitor
Low dose unfractionated heparin
IPC with or without GCS
Any combination of the
pharmacological and mechanical
listed above.
 As
you see in the previous charts the first
choice of prophylaxis for VTE prevention is
medication with or without any mechanical
device use.
 When the patient has a documented
contraindication such as recent GI bleed ,
the mechanical device prophylaxis can be
used alone.
 Regardless
of the treatment ordered it must be
initiated in the time frame of 24 hours prior to
anesthesia start time to 24 hours after the
anesthesia end time.
 Nursing
and Pharmacy need to work together to
assure the medications are available,
administered and the start time documented
within this window.
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The SCIP core measure set is the most
complicated of all. Not only are there the most
measures but there are specific time limits
designated for six of these indicators.
The role of nursing is huge. Not only do you
need to know the recommendations but you
must be sure that each measure is addressed
within the designated timeframe.
As with the other CMS core measures each
indicator requires an action and concise
documentation.
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Reducing the complications of
surgery continues to be one of the
National Patient Safety Goals and a
goal of the health care reform
movement.
1. Patients who are taking a beta blocker prior
to arrival for surgery and receiving general
anesthesia should have a dose given during
the perioperative period which ends at
discharge from PACU.
A. True
B. False
2. The SCIP VTE measures will be met as long
as you get that patient out of bed on post-op
day 1.
A. True
B. False
3. Heparin or Lovonox can be given up to ____
hour(s) before anesthesia start time and still
be considered appropriate treatment
according to the SCIP guidelines.
A. 4
B. 16
C. 24
D. 48
4. The first choice for VTE prophylaxis is
pharmacological with or without a
mechanical device.
A. True
B. False