Transcript 1QFY2013 Inpatient Instrument Update.ppsx

1
1st Quarter FY 2013
EPRP Update-Inpatient
Instruments
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OBJECTIVES
• The purpose of this presentation is to provide an
update on EPRP inpatient instruments and scoring
by
▫ Summarizing changes to questions and definition and
decision rules for 1QFY2013
▫ Summarizing scoring changes for 1QFY2013
• It is important that you review the actual question
documents along with this presentation
• After reviewing the presentation and question sets,
please send any questions to your Regional Manager
or WVMI
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Inpatient Instruments
• As you know The Joint Commission now
updates their instruments in January and July,
so we will not see those changes until 2Q
• However there are some other significant
changes to some instruments
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ACS
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Major Changes to ACS
• Several revisions have been made to better align
the ACS instrument with ACC (American College
of Cardiology) ACTION guidelines
• Please review all modules carefully and be aware
of changes to skip patterns
• The ACS After Admission module has been
removed
• The Transfer from Community module has been
removed
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ACS Validation Module
• Q1 cardrest
▫ Intent of question remains the same; the reference to
cardiac arrest that occurred during inpatient care was
removed
• The questions about treatment in a community hospital prior
to arrival at VA facility (comm1tx and comminpt) remain in
the module when answered “yes” the case will be excluded
from ACS review, but common modules will be enabled
• The question inptacs (did ACS occur after admission) also
remains and if answered “yes” the case will be excluded from
ACS review, but common modules will be enabled
• *See exclusion statement at the end of the Validation module
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ACS-History and Assessment Module
• Please review the History and Assessment
module carefully as several changes have been
made
• The past cardiac history questions have been
deleted
• There are wording changes to several other
questions
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Pasthx4 Changes
• pasthx4_4: Is now Tobacco Use Disorder (exclude
history of tobacco use) ICD-9 CM code 305.1 is
applicable if coded
• pasthx4_7: cerebrovascular disease (TIA, carotid artery
stenosis/intervention); there are additional ICD-codes
that are applicable
• pasthx4_11: COPD changed to Chronic Lung Disease and
code 491.22 added (chronic obstructive bronchitis with
acute bronchitis)
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Pasthx4 Changes
• pasthx4_23: Hypertension is now one entry; no longer
separated into complicated and uncomplicated
• pasthx4_25: Prior CVA/stroke (new)
• Pasthx4_26: Prior PCI (new)
• pasthx4_27: Dyslipidemia (new); atherosclerosis and
lipid disorders was deleted
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Laboratory Testing
• There are several changes in the laboratory testing
section so please review highlighted changes carefully
• Some questions have been deleted
• The word “obtained” has been replaced with “collected”
in several questions
▫ Collected: when the blood sample was actually drawn
from the patient. Most lab reports have date and time
sample is collected.
• The word “highest” has been replaced with “peak” in
several questions
▫ Peak: of all the samples (e.g. troponin, creatinine, etc)
collected, enter the highest value reported for this
patient.
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Cutoff
• Q23 asks for the “cutoff point” relevant to the
first troponin level collected for this patient
▫ Cutoff point= the lowest level at which troponin is
considered positive
▫ If this troponin was a point of care test
(POC) and the result is reported as only
“positive” or “negative” without a lab
reference range, enter zzz.zzz for the
“cutoff point”.
▫ Do not enter zzz.zzz for troponin tests
performed by laboratory.
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Cutoff for Peak troponin
• Q33 asks for the “cutoff point” relevant to the
peak troponin level for this patient
• This is a new question added because the
bioassay used to determine the first troponin
maybe be different from subsequent levels
• If this troponin was a point of care test (POC)
and the result is reported as only “positive”
or “negative” without a lab reference range,
enter zzz.zzz for the “cutoff point”.
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New questions-Hemoglobin
• Q37-40 ask about hemoglobin levels
• Q37: enter the value of the initial hemoglobin
level collected following hospital arrival
▫ Enter zz.zz if no hemoglobin was done
during the entire episode of care
▫ Enter the date the initial hemoglobin was
collected in q38
 The date will be autofilled 99/99/9999 if no
hemoglobin was done
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Hemoglobin
• Q39 asks you to enter the value of the lowest
hemoglobin level collected following hospital
arrival
▫ If no hemoglobin or only one hemoglobin was
collected during the entire episode of care enter
zz.zz
▫ Enter the date of the lowest hemoglobin level in
q40
 The date will be autofilled 99/99/9999 if no
hemoglobin level is entered in q38
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Changes to hematocrit questions
• Q41 asks you to enter the lowest hematocrit
level collected following hospital arrival
▫ If no hematocrit was collected during the entire
episode of care enter zzz.zzz
• You will enter the unit for the hematocrit in q42
and the date of the lowest hematocrit in q43.
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Other Lab Test Question Changes
• There are some wording changes to the
creatinine and CK-MB questions
▫ Obtained
collected
▫ Highest
peak
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ACS at Initial Presentation Module
• Several questions have been deleted
• The major question changes will be outlined in
the following slides
• Please review all highlighted changes in the
questions and definition/decision rules carefully
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Q8 intrpecg
• This question has major changes from the former
question ecgintrp so please review it carefully
• What were the specific findings from
interpretation of the ECG performed closest
to hospital arrival?
• There are now only 5 answer options
▫
▫
▫
▫
▫
1. ST-segment elevation
2. LBBB
3. Isolated Posterior MI
4. Documented NSTEMI
99. Interpretation not consistent with above
terminology
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ECG Interpretation
• Look for interpretation of the ECG performed
closest to hospital arrival
• What to look for
▫ 12-lead tracing with name/initials of the
physician/APN/PA who reviewed the ECG signed
or typed on the report, OR
▫ Physician/APN/PA documentation of ECG
findings in another source (e.g., ED notes,
progress notes).
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ECG Interpretation
• Determine whether the ECG findings showed
new or presumed new ST segment elevation, or
new LBBB, or an isolated posterior MI prior to
any procedure and not longer than 24 hours
after arrival in the acute care setting
• Do not attempt to interpret the ECG, but enter
the answer based on the interpretation that is
documented
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ST-segment elevation
• New or presumed new ST-segment
elevation >/= .10mV in more than one
lead.
• As before, the inclusion guidelines for STsegment elevation are beneath the question
• The exclusion guidelines are in the definition
decision rules
• Please review inclusions and exclusions carefully
before choosing this answer
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LBBB
• LBBB (that was not known to be old on the
initial ECG) includes:
▫ Intraventricular conduction delay of LBBB type
▫ Variable LBBB
• Please review the exclusions for LBBB in the
definition/decision rules
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Isolated Posterior MI
• Infarction of the posterobasal wall of the left
ventricle.
▫ Use of posterior leads V7-V9 will show ST
segment elevation in patients with
posterior infarction.
▫ If posterior leads were not applied, ST
depression in V1-V3, without ST elevation
in other leads may be considered as
indicative of posterior ischemia or
infarction.
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Other answer options
• Choose option 4 if there is clear clinician
documentation of a NSTEMI
• If the interpretation is not consistent with STsegment elevation, LBBB, isolated posterior MI
or NSTEMI, use option 99
▫ The text box for option 99 has been deleted
• The hierarchy for ECG interpretation remains
the same as in previous quarters
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Heart Failure on Presentation
• Q 11 (changed from previous question about heart failure)
• At the time of presentation to the hospital, is there
physician/APN/PA documentation or report of heart
failure?
• Documentation to look for:
▫ Clinician documentation of clinical signs/symptoms of
heart failure, diagnosis of heart failure/CHF, diagnosis
of pulmonary edema.
▫ Chest x-ray evidence of pulmonary edema may be taken
from the chest x-ray report, but the abstractor must be
certain the x-ray was done at the time of presentation to
the hospital.
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Q12 shokpres
• At the time of presentation to the hospital, is there
physician/APN/PA documentation the patient was in a
state of cardiogenic shock?
▫ Sustained (> 30 Minutes) episode of systolic blood
pressure < 90 mm/Hg and/or the requirement for
parenteral inotropic or vasopressor agents or
mechanical support (e.g., intra-aortic balloon pump
[IABP], extracorporeal circulation, ventricular assist
devices).
▫ The diagnosis of cardiogenic shock must be documented
by a physician/APN/PA.
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Q13 frstrate
• Enter the patient’s heart rate recorded at the
time of presentation to a VHA acute care
hospital.
▫ Do not use heart rate taken from the ambulance
record.
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Rest Pain
• Q15 (restang) has a change to the time frame in
the definition of rest angina
• At the time of presentation, does the record
document the patient experienced prolonged
ongoing rest pain (pain in chest, arm, or neck
>/= 10 minutes)?
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Additional Answer Options Q20
• Two new drugs have been added as answer
options to the question about platelet
aggregation inhibitors given within the first 24
hours after hospital arrival
▫ 6. prasugrel (Effient)
▫ 7. ticagrelor (Brilinta)
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Beta Blockers
• Q24 (did the patient receive a beta blocker
within 24 hours after arrival at a VHA acute care
hospital?) now contains some examples of beta
blockers
▫ The list is not all inclusive
▫ You are urged to consult your drug book or TJC
Appendix C Table 1.3 for a complete list of beta
blockers
• The question that asked you to specify which
beta blocker was given to the patient within 24
hours after hospital arrival was deleted
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Revascularization Module
• There are a few changes and a couple of
questions have been deleted from the
revascularization module
• As always it is important to review the
highlighted changes carefully
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Contraindications to Fibrinolytic
Therapy
• This question is now the second question in the
module and you will only get the question when
primary fibrinolytic therapy was not received
during this episode of care ( i.e. question 1= no)
• Conthth2 has many changes from the former
question
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conthth2
• Some of the answer options in the previous
question were deleted and new options have
been added
• Please read each answer carefully as well as the
accompanying definition/decision rules
• This is now an indicate all that apply
question so it is important to review all the
possible answers to determine all that are
applicable
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conthth2
• Some options that are new or changed
▫
▫
▫
▫
▫
▫
▫
▫
▫
▫
▫
Recent bleeding within 6 weeks
Recent surgery/trauma within 6 weeks
Intracranial neoplasm, AV malformation or aneurysm
Suspected aortic dissection
Significant closed head injury or facial trauma
Traumatic CPR
Ischemic stroke within 3 months except acute ischemia stroke
within 3 hours
Any prior intracranial hemorrhage
Prior allergic reaction to fibrinolytic therapy
DNR at time of treatment decision
Expected door to balloon time (DTB) less than 90 minutes
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conthth2
• Again, please read all the answer options
carefully
• Review the definition/decision rules
• Keep in mind that some previous answer options
have changes
• Indicate all that apply
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GP IIb,IIIa questions
• The order of the glycoprotein blocker questions
has been changed so that you will only get the
contraindication question if the patient did not
receive a GP IIb, IIIa inhibitor
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ACS-Continuing Care and Assessment
Module
• As with other ACS modules, some questions in
Continuing Care have been deleted and several
changes have been made
• Please note highlighted changes as you review
the following slides
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Adverse Events
• Q1 (advrsent) now has fewer options but some options
are new
• At any time during this episode of care, did any of the
following events occur? (Enter dates for all that apply)
• Please review definition/decision rule changes for
▫
▫
▫
▫
Reinfarction
Cardiogenic shock
Cardiac arrest
Blood transfusion
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Adverse EventsNew answer options
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• 11. Suspected bleeding event
▫ suspected or confirmed bleeding event observed
and documented in the medical record that was
associated with any of the following:
 1) hemoglobin drop of >/= 3 gm/dL;
 2) transfusion of whole blood or PRBC;
 3) procedural intervention/surgery at the
bleeding site to stop or correct the bleeding
(such as surgical closure of the arteriotomy
site, endoscopy with cautery of a GI bleed).
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Adverse EventsNew answer options
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• 12. heart failure
▫ Clinician documentation of clinical
signs/symptoms of heart failure, diagnosis of
heart failure/CHF, diagnosis of pulmonary edema.
 Chest x-ray evidence of pulmonary edema may be
taken from the chest x-ray report, but the abstractor
must be certain the x-ray was done during this
episode of care but not on initial presentation to the
hospital.
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Adverse EventsNew answer options
• 13. CVA/stroke
▫ Loss of neurological function caused by an
ischemic or hemorrhagic event with residual
symptoms at least 24 hours after onset or leading
to death.
▫ Diagnosis must be documented by a
clinician.
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Stress Testing
• Q3 seeks information on non-invasive stress
tests that were performed during the episode of
care
• There are several changes to the options for the
type of test done and the associated rules
• The question is now an indicate all that apply
question
• You will enter the date each test was performed
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Stress Testing
Test
1.
Test Description
Standard Exercise
1.
2.
2. Stress Echocardiogram
3.
3. Stress Testing with
SPECT
ECG is done while the patient exercises on
a bike or treadmill
Ultrasound assessment of the pumping
function of the heart and status of the
heart valves immediately following activity
such as treadmill or bicycle
Isotope tracer thallium injected one to two
minutes before end of exercise or
immediately thereafter. Heart is imaged
both immediately following exercise and at
rest. May also be done with dipyridamole
if patient unable to exercise
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Stress Testing
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Test
Test Description
4. Stress Testing with
Cardiac Magnetic
Resonance (CMR)
4. Dipyridamole or adenosine
injected to mimic effect of
exercise on the heart; contrast
dye is injected; radiowaves and
strong magnetic field produce
images of the heart and coronary
arteries.
5. Uses advanced CT technology,
along with intravenous (IV)
contrast material, to threedimensional pictures of the
moving heart and great vessels.
5.
Stress Testing with
Computerized
Tomographic
Angiography (CTA) aka
multi-slice CT(MSCT),
cardiac CT, cardiac CAT
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Stress Testing
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Test
Test Description
6. Coronary Calcium
Scoring
6. Uses computed tomography (CT)
to check for buildup of calcium in
plaque on the walls of the
coronary arteries
99. Use option 99 if no
stress testing was
performed during the
episode of care, or
unable to determine
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Cathdun
• Q4 a significant change in the
definition/decision rules
▫ If the patient had a diagnostic cardiac
catheterization and also had a PCI during
the same episode, answer “1”.
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Reasons for no cath
• Q5, nocath has changed from previous quarters
• The answer options are no just yes or no
• You will look for a reason for not performing a
diagnostic catheterization documented by a
cardiologist or cardiology fellow, or cardiology
resident under appropriate supervision by the
attending physician
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Reasons for no cath
• Reasons may include but are not limited to:
▫ stress test is a more reasonable first approach for
this patient
▫ known coronary artery lesion(s) not amenable to
revascularization by PCI
▫ patient age, debilitation, or co-morbidities
preclude cardiac cath
▫ known coronary artery blockage(s) that cannot be
treated by PCI and a CABG is being considered or
is scheduled
▫ patient and/or family refused cardiac cath
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Q10 Date of Most Recent Test
• The date parameter for question 10, date of the
most recent test for LVSF, is now limited to <=5
years prior to or equal to the arrival date
and < than the discharge date.
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Smokcigs is back!
• Smokcigs and tobcess have been added back to
ACS
• Please review the questions and rules for these
two questions which are unchanged from the
previous versions
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ACS Discharge Module
• If dcdispo = 1, 5, 0r 99 you will get the questions
in the ACS Discharge module
▫ 1. Home
▫ 5. Other Health Care Facility
▫ 99. Not documented or unable to determine
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ACS-Discharge Module
• The questions that asked you to specify which drug was
prescribed at discharge (e.g which ACEI, which beta
blocker etc) have been deleted
• Instead each question about a discharge medication has
examples of that particular drug as part of the question
• The lists are not all inclusive and you should consult a
drug book or TJC Appendix C for a more complete list of
the specific medications
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Platelet Aggregation Inhibitors
• As in the Initial Presentation module, there are
two new choices in the platelet aggregation
inhibitor question
• Q7 (platagdc) new choices:
▫ 6. prasugrel (Effient)
▫ 7. ticagrelor (Brilinta)
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ACS Scoring Changes
• Ihi42 has been discontinued
• The paths for patients with AMI occurring after
acute care arrival have been removed from ihi45
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Inpatient Heart Failure
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Questions Removed
• The changes to IHF mostly involve discontinued
questions
▫ antecedent weight monitoring questions have
been removed
▫ the questions about BNP have been removed
▫ The questions that ask if a medication (ACE, ARB,
BB, aldosterone antagonist) was obtained from
the VA have been removed
▫ the questions that ask you to specify which drug
was prescribed (e.g. ACEI, ARB, BB) have all been
removed from IHF
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Minor Changes
• There are some minor wording changes to the
definition/decision rules of a few questions
• The changes are mostly for clarification and
please review all highlighted wording carefully
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IHF Scoring Changes
• Chi17 (weight instruction prior to admission)
has been discontinued
• No other changes
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Pneumonia
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Pneumonia Validation Module
• There are some important changes to a few
questions in the PN validation module
• It is important that you review these changes
carefully and are not guided by “old habits” as
you review 1Q cases
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Question 18 pnedpt
• Did the patient receive care/services in the Emergency
Department of this VAMC?
• This question is not new, but has been moved to a
different position
• The definition/decision rules have changed and are
different from the question in the Global Measures
module
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Important Differences in PN and GM ED
Question
Pneumonia (pnedpt)
• If the patient presents to the
ED and receives care/services
in the ED of this VAMC,
answer yes regardless of
whether the patient was
transferred in or not
Global Measures (edpt)
•
•
If a patient is transferred in from any
emergency department (ED) or observation
unit OUTSIDE of the VAMC under review,
select “2”. This applies even if the
emergency department or observation unit
is part of this hospital’s system (e.g., your
hospital’s free-standing or satellite
emergency department), has a shared
medical record or provider number, or is in
close proximity. Select “2”, even if the
transferred patient is seen in this facility’s
ED.
If the patient is transferred to your hospital
from an outside hospital where he was an
inpatient or outpatient, select “2”. This
applies even if the two hospitals are close in
proximity, part of the same hospital system,
have the same provider number, and/or
there is one medical record. Select “2”, even
if the transferred patient is seen in this
facility’s ED.
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ED Diagnosis
• There have been some changes to Q19 in order
to match the Joint Commission question
• Was there documentation of the diagnosis of
pneumonia as an Emergency Department
diagnosis/impression?
• Note that the word “final”
[diagnosis/impression] has been removed from
the question
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Q19 ED Diagnosis
• The answer options also have some changes and
have been re-numbered
▫ 1. There is documentation that pneumonia was a
diagnosis/impression in the ED
▫ 2. There is NO documentation that pneumonia was a
diagnosis/impression in the ED
▫ 95. Not applicable
▫ 99. Unable to determine from ED medical record
documentation (only use if the ED
diagnosis/impression is left blank in ALL Emergency
Department sources)
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Q19 ED Diagnosis
• There are some minor changes to the
definition/decision rules to reflect the changes
to the question and answer options and for
increased clarity
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Q20 pndxadm2: Admission diagnosis of
PN for the direct admit patient
• The answer options to question 20 have some changes
• Note that the options have been re-numbered and there
is a wording change from initial diagnosis to admission
diagnosis
▫ 1. There is documentation that pneumonia was an
admission diagnosis/impression upon direct admit.
▫ 2. There is NO documentation that pneumonia was an
admission diagnosis/impression upon direct admit.
▫ 99. Unable to determine (only use if there is no
documentation of ANY diagnosis in any of the ONLY
ACCEPTABLE SOURCES)
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No changes….
• There are no changes to the PN Acute Care
module
• There are no changes to PN scoring
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Surgical Care
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Definition/Decision Rule Changes
• Please review the changes to the rules of question 52
bbpreor
• The change provides guidance for looking for
documentation that a patient received a beta blocker the
day prior to surgery
▫ To select “3”, there must be a date or other documentation that
the last dose of the beta-blocker was taken on the day prior to the
day of surgery. This can include a date for the last dose or specific
documentation on the day of surgery that the patient took the
beta-blocker on the day before surgery, such as “patient states
they took beta-blocker last night before going to bed” or “states
took beta-blocker yesterday”.
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No changes
• There are no changes to the Informed Consent
module
• There are no changes to Surgical Care scoring
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Global Measures
• There are minor changes only to questions and
scoring in the GM module
• The rules of question 19 (flustat) have date
changes that reflect the current immunization
season
• The scoring of imm4 (Influenza immunization)
has been updated to include only discharge dates
>9/30/2012 and <4/1/2013
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HBIPS
• There no changes to the HBIPS instrument
• Scoring has been changed to only include
discharges >= 7/1/2012
• Coming up:
▫ In 2QFY2013 several facilities will be
adding HBIPS to their EPRP measures
▫ Your RM will be letting you know if your
facility will have HBIPS beginning next
quarter
▫ Training will be forthcoming for those of
you new to the review
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Common Modules
• There are no changes to the Fall Assessment
module, or to the scoring on the Nursing Exit
Report
• The following slides will take a look at the
changes to Inpatient Medication Reconciliation
and Delirium Risk
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Inpatient Medication Reconciliation
• There is one new question in the Inpatient Med Recon
module
• Q10 addresses discharge instructions for cases in which
the patient is discharged/transferred to Hospice-Health
Care Facility, Acute Care Facility or Other Health Care
Facility
• Changes to the skip patterns will take cases with dcdispo
3, 4, or 5 to question 10 and skip the remaining
questions in the module
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Q10 trxlist
• At the time of discharge/transfer, is there documentation
that a written list of the reconciled discharge
medications was transmitted to the next level of care
provider?
▫ 1. Yes
▫ 2. No
▫ 3. Documented medications were not prescribed at
discharge
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Q10 trxlist
• If the next level of care provider has access to the
complete electronic medical record (i.e. CPRS), select
“1.” CPRS should contain documentation that the next
level of care provider has access to the CPRS.
• Methods for transmitting the written list of reconciled
medications include, but are not limited to: FedEx,
CPRS access.
• Suggested data sources: Transfer/Discharge summary,
medication reconciliation note
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Inpatient Med Recon Scoring
• No changes to Inpatient Med Recon scoring on
the Pilot exit report
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Delirium Risk
• There are several changes to the Delirium Risk
module
▫
▫
▫
▫
New questions
Changes to existing questions
Changes to answer options
Deleted questions
• Please review all questions and
definition/decision rules carefully in addition to
the following slides
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Q1 History of cognitive impairment
• Answer options 5, 9 and 12 have been removed
(delirium, disorientation, encephalopathy)
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Q2 New Question demedrx
• Upon admission, were any of the following
medications listed as home (current)
medications for the patient?
• Indicate all that apply:
▫
▫
▫
▫
▫
1. donepezil (Aricept)
2. galantamine (Razadyne)
3. memantine (Namenda)
4. rivastigmine (Excelon)
99. None of the above
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Medications for Dementia
• The purpose of question 2 is to identify patients
who are on medications for dementia prior to
admission
• Suggested data sources: Admission H&P,
Medication Reconciliation note, ED notes
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Q3 New Question benzorx
• Upon admission, were any of the following
medications listed as home (current) medications
for the patient?
• Indicate all that apply:
▫
▫
▫
▫
▫
▫
▫
1. alprazolam (Xanax)
2. chlordiazepoxide (Librium)
3. clonazepam (Klonopin)
4. diazepam (Valium)
5. lorazepam (Ativan)
6. temazepam (Restoril)
99. None of the above
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Q6 New Question admicu
• Was the patient admitted to an intensive
care unit, coronary care unit, or
intermediate care unit?
• The intent of this question is to identify patients
that were admitted to an ICU, CCU, or
intermediate care unit.
▫ Admission to an intensive care unit is a sign that
the patient is sicker and that their severity of
illness will be higher and that they are at risk for
delirium.
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Intermediate Care Unit
• Please review the definitions for IMCU carefully!
• Step down units include:
▫ A post critical care unit for patients that are hemodynamically
stable who can benefit from close supervision and monitoring
such as frequent pulmonary toilet, vital signs, and/or
neurological and neurovascular checks.
▫ Inpatient units with telemetry monitoring that are not intensive
care units
▫ Post coronary care unit (PCCU)
▫ Specialty Care Units (e.g, bone marrow transplant, inpatient solid
organ transplant, acute inpatient dialysis, hematology/oncology,
long term acute care)
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Q6 rules
• ONLY ACCEPTABLE DATA Source: Physician
orders. Other data sources may be used to support
admission or transfer to ICU or intermediate care unit.
• The level of intensive care MUST be documented.
▫ Do not use abstractor judgment based on the type of
care administered to the patient.
• Direct admits and admissions via the ED are included
There is a similar question in the Pneumonia
instrument but there are some very different
rules for this question. Please be sure to follow
the rules carefully
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Q7 New Question adminf
• Was the patient admitted with an acute (new) infection?
• Indicate all that apply:
▫
▫
▫
▫
▫
▫
▫
▫
▫
▫
1. Pneumonia
2. Urinary tract infection (UTI)
3. Septicemia or sepsis
4. Cellulitis
5. Diverticulitis
6. Peritonitis
7. Appendicitis
8. Osteomyelitis
9. Meningitis
99. None of the above
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Acute Infection
• Look for documentation by a physician, APN, or PA that the patient
was being admitted with an infection or a possible/suspected
infection
• If there is documentation of one or more of the infections listed as
answer options in q7, choose the option(s)
▫ Documentation of symptoms (such as fever, elevated white
blood cells) should not be considered infections unless
documented as an infection or possible/suspected
infection.
▫ If an infection is documented as “chronic,” there must
be additional documentation that the infection is
current or still present upon admission. If an infection
is only documented as “chronic” without other
documentation that the infection is still present upon
admission, select “99.”
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Q8 New Question admfrac
• If there is documentation that the patient was
admitted with a new (acute) major bone fraction,
answer “yes” to question 8
• Major bone fractures:
▫
▫
▫
▫
▫
▫
▫
Hip
Femur
Leg
Vertebrae
Spine
Humerus
Arm and/or wrist
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Changes to Vital Signs Questions
• Vital signs:
▫ Enter the first respiratory rate documented after
admission
▫ Enter the first pulse rate documented after
admission
▫ Enter the first blood pressure documented after
admission
 The computer will calculate mean arterial
pressure
• Note that you are looking for the first vital
signs after admission, not after arrival
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Changes to Lab Questions
• You will look for the following blood tests obtained
during the hospital stay
▫
▫
▫
▫
▫
▫
▫
▫
Sodium
Glucose
BUN
Serum Creatinine
Serum Albumin
Total Serum Bilirubin
White Blood Cell Count (WBC)
Hematocrit
• You will enter the value of the first test obtained during
the hospital stay for each of the above tests
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Delirium Risk Scoring
• There are major changes to the scoring of FE8
on the Pilot Exit report
• New questions (e.g. demedrx, benzorx, admicu)
are factored into the denominator and may
cause cases to be included or excluded
depending on the response
• The numerator remains the same
• The changes will be detailed in the Pilot exit
report guide
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Thank YOU!
• Thanks for reviewing this presentation
• A separate slide show will outline changes in
CGPI and Frail Elderly
• Please email any questions to your Regional
Manager or WVMI