Transcript EPRP Data Collection Instrument update

3QFY2010
Confidential and Proprietary
CGPI
No changes to:
 Topic Validation
 TBI
 Core
 SCI/SCI AD
 Diabetes
 Low Back Pain
 CHF
 SMI
Confidential and Proprietary
Shared Data Module
Beginning with question 28, there are
some additions to the Shared Module
 These new questions will be enabled on
cases flagged for Diabetes
 The questions pertain to diabetes
control, specifically hemoglobin A1C and
diabetes medications

 The questions are similar in nature to the
current questions about LDL control and lipid
lowering medications.
Confidential and Proprietary
HbA1c

Question 28 (hba1cva) Was the most
recent HbA1c test obtained at the VA?
 This question is not applicable if no HbA1c
was done in the past year
Confidential and Proprietary
Question 29 (posta1cdne)
After the study end date and up to the
date the chart was opened for review
was an HbA1c obtained?
 If yes, in the subsequent questions,
enter the date, value and whether or not
the HbA1c test was obtained at the VA

Confidential and Proprietary
Diabetes Medications
Cases flagged for DM, age >=18 and <
65 with a HbA1c >= 8% will get a series
of questions about diabetes medications
 There are questions about insulin and
oral anti-diabetes medications as
applicable

Confidential and Proprietary
Question 51 (oninsulin)
This question asks if the patient was
currently prescribed insulin on the date
of the most recent HbA1c
 Please read the answer options carefully

 Answer 1 if the patient was currently
prescribed (taking) insulin on the date the
most recent HbA1c was obtained
 Answer 2 if the patient was not currently
prescribed insulin on the date the most
recent hbA1c was obtained even if insulin
was newly prescribed on that date
Confidential and Proprietary
Question 51 (continued)
Use answer #3 only if there is
documentation on the date the most
recent HbA1c was obtained that insulin
was currently prescribed and that the
patient was not taking insulin on that
date
 Please note the many examples of
names for insulin in the
definition/decision rules

Confidential and Proprietary
Question 52 (rxinsulin)

Review the record to see if insulin was
prescribed within 3 months following the
date of the HbA1c
 If 3 months have not elapsed and insulin
was not prescribed at the time of the review,
answer 2 (no).
Confidential and Proprietary
Oral Anti-Diabetes Medications
Questions 53 and 54 address whether
the patient is taking oral anti-diabetes
medication
 There is a long list of these agents in the
definition/decision rules although it is not
exhaustive
 Please familiarize yourself with these
drugs so you do not miss them
during review

Confidential and Proprietary
Question 53 (poantidm)
On the date of the most recent HbA1c
was the patient prescribed (taking) any
oral anti-diabetes medications?
 The computer will display the date of
the most recent HbA1c in the question

Confidential and Proprietary
Question 53 (continued)
 Answer 1 if the patient was currently
prescribed (taking) any oral anti-diabetes
medications on the date the most recent
HbA1c was obtained
 Answer 2 if the patient was not currently
prescribed any oral anti-diabetes
medications on the date the most recent
hbA1c was obtained even if one was newly
prescribed on that date
Confidential and Proprietary
Question 53 (continued)

Use answer #3 only if there is
documentation on the date the most
recent HbA1c was obtained that an oral
anti-diabetes medication was currently
prescribed and that the patient was not
taking it on that date
Confidential and Proprietary
Question 54 is a table

You will enter the name of each oral
anti-diabetic medication the patient was
prescribed (taking) on the date of the
most recent HbAIC.
 You will choose the name of the drug from a
drop down box
You will enter the daily dose of the
medication
 You will indicate whether the medication
was obtained from the VA

Confidential and Proprietary
Changes/Additions to Oral AntiDiabetes Medications
Questions 55-57 address
changes/additions to oral anti-diabetes
medications within 3 months of the date of
the most recent HbA1c.
 Question 55: change in the daily dose

 Includes increasing or decreasing the dose or
discontinuing of an oral anti-diabetic medication
 If 3 months have not elapsed and there was not
a change to an oral anti-diabetes medication at
the time of the review, answer 2 (no).
Confidential and Proprietary
Question 56 (addmrx)

Review the record to see if a new oral
anti-diabetic medication was added
within 3 months following the HbA1c

If 3 months have not elapsed and a new oral
anti-diabetic medication was not added at the
time of the review, answer 2 (no).
Confidential and Proprietary
Table for changes/additions

Question 57 is table for information
about changes/additions to oral antidiabetes medications that occurred
within 3 months of the most recent
HbA1c.
Confidential and Proprietary
Question 57 (continued)
For each change or addition you will enter
 The name of the
 The
drug

 (select from drop
down box)

 If the actual date of
The daily dose
the change is not
known, enter the date
the change was noted
in a clinic note
 can enter zzzz.zzz if
the dose is not
documented or
 0000.000 if the
medication was
discontinued
type of change
The date the change
was made

Whether or not the
medication was
obtained from the
VA
Confidential and Proprietary
Nutrition/Dietician Referral
Question 58 asks if the record documents
a nutrition/dietician referral within the 3
months following the most recent HbA1c
 Look for documentation that a nutritional
consult or referral to a dietician was offered
to the patient

 Referral should be related to diabetes
management
 May be a referral to a weight loss clinic or for
weight management
 Documentation that the patient is being seen by
a dietician or will seek nutrition care outside the
VA is also acceptable
Confidential and Proprietary
Referral for Diabetes
Management
Question 59 asks if the record documents
a referral for diabetes management within
the 3 months following the most recent
HbA1c
 Examples of diabetes management
referrals:






Diabetes Clinic
Endocrinology
Nurse Managed Diabetes Clinic
Diabetes Education Program
Pharmacy Clinic for Diabetes
Confidential and Proprietary
MH Module Changes
Alcohol
 Change to AUDIT-C, question 2
 Answer option 0 now reads: 0, 1 or 2 drinks
Confidential and Proprietary
MH Module Changes
Depression
 Please note the changes to the
applicable ICD-9 CM codes in questions
52 and 56 (depression) and 58 and 62
(bipolar disorder)
 Look for these codes as a reason for a
clinical encounter in the applicable
timeframe
Confidential and Proprietary
Codes

Codes for depression:
 296.2x, 296.3x, 298.0, 300.4, 301.12, 309.0,
309.1, 309.28, and 311

Codes for bipolar disorder:
 296.5x, 296.6x, 296.7, and 296.8x
Confidential and Proprietary
A Familiar Question is Back
Question 164 asks if the record
identifies the principal mental health
provider.
 The definition/decision rules provide
guidance about the responsibilities of
the principal mental health provider

Confidential and Proprietary
PI Module


A skip pattern change has been made so that only
females age 40 or older will get the mammogram
questions
There is a wording change in question 80
(mamrad)
 The question now asks if the results of the
mammogram were documented in the radiology
package (words “performed by VHA” are now
omitted)
 Look for the actual mammogram results. If the
document says the actual report is scanned in,
answer no.
Confidential and Proprietary
Ischemic Heart Disease Module


The only change is in the definition/decision
rules of question 10 (lvefind)
There are two additions to the Exclude list
 3) diastolic dysfunction, failure, function or
impairment
 4) ventricular dysfunction, failure or function NOT
described as left ventricular

You will see this same change in IHF and ACS
in the corresponding questions.
Confidential and Proprietary
Medication Reconciliation

A refusal option has been added to
question 26 (comopmed) regarding
providing a list of reconciled meds to the
next provider of service
 Option 98: patient refused to authorize
transmission of list

This same change is in the medication
reconciliation module for inpatients
Confidential and Proprietary
CGPI Scoring Changes
There are no changes to CGPI scoring
for 3Q10
 There are some changes to the catnums
that are included in several indicators

 Catnum 60 cases have been added to
several indicators
 Catnum 16 and 48 have been removed from
DM measures

The catnum column of the exit report
guide will reflect these changes.
Confidential and Proprietary
HBPC
Confidential and Proprietary
HBPC Admission Date
There is an important addition to the
definition/decision rules of question 7
(admisdt)
 If the patient was discharged from
HBPC and re-admitted within 48 hours
for administrative reasons, do not count
as a new admission

Confidential and Proprietary
Timeframes for Medication
Management
For the questions medrev and nomedrev
the timeframe displayed in the question
has changed as follows
 For patients admitted within the past
year and <=120 days the time frame is
from the date of admission to 30 days
after admission

Confidential and Proprietary
Timeframes for Medication
Management (continued)


For patients admitted within the past year and
>120 days, the time frame for medrev and
nomedrev is from the date of the most recent
documentation the patient was on 9 or more
VA medications to 110 days after that date
For patients admitted for more than one year
the time frame for medrev and nomedrev is
from the date of the most recent
documentation the patient was on 9 or more
VA medications to 110 days after that date
Confidential and Proprietary
Caregiver Strain


A new question has been added to the series
about screening for caregiver strain
Question 30 (nocargiv) asks
 Does the record document that the person living with
the patient at home is NOT the patient’s caregiver?
 In order to answer “1,” there must be
documentation that the person living with the
patient at home is NOT a caregiver (i.e., person
does not provide care or is unable to provide
care to the patient)
 The definition/decision rules also provide some
examples of documentation that would cause a “yes”
answer
Confidential and Proprietary
Caregiver Strain
This new question is not included in
scoring at this time
 Scoring for the caregiver strain
indicators (hc21 and hc22) is unchanged
from previous quarters

Confidential and Proprietary
HBPC Exit Report

Scoring for hc18 is revised to reflect the
change for Pharmacy review from 90
days to 110 days
Confidential and Proprietary
Inpatient Instrument Changes
Joint Commission changes become
effective with discharges on or after
4/1/10.
 You will not see April discharges until the
May 10th pull list
 Since the first pull list of 3Q10 will be
March discharges, the Joint Commission
questions will be the same as 2Q10

Confidential and Proprietary
IHF
Confidential and Proprietary
Weight Monitoring Instructions
The requirements for weight monitoring
instructions have changed
 The changes apply to both the
antecedent care question and the
discharge instruction question
 You no longer need to see the 3 bulleted
points that were in the previous weight
monitoring instructions

Confidential and Proprietary
Weight Monitoring Instructions
(continued)

Weight monitoring (examples)
 Call in weights
 Check weight
 Contact physician/advanced practice






nurse/physician assistant (physician/APN/PA) if
sudden weight gain
Daily weights
Watch weight
Weigh patient
Weigh self
Weight check
Instruction directed toward weight loss only is
not considered weight monitoring instruction
Confidential and Proprietary
Comfort Measures

An excluded data source has been
added to the definition/decision rules:
 Restraint Order Sheet

This change will appear in all
instruments that have the comfort
measures question
Confidential and Proprietary
Change to ACEI and ARB Rules

This change appears in all instruments
that have the ACEI and ARB medication
questions
 ACEIs may be described as RAS (renin-
angiotensin system) or RAAS (reninangiotensin-aldosterone system)
blockers/inhibitors.
 ARBs may be described as RAS (renin-
angiotensin system) or RAAS (reninangiotensin-aldosterone system)
blockers/inhibitors.
Confidential and Proprietary
Another Medication Question
Change

The following rule appears in the d/d
rules for the “reason for not prescribing”
questions for ACEI, ARB, beta blocker,
(and aspirin and lipid lowering drugs in
ACS).
 If there is conflicting documentation in the record
regarding a reason for not prescribing (ACE, ARB etc)
at discharge, accept as a “yes” for the applicable
reason.
Confidential and Proprietary
Smokcigs

There is clarification in the
definition/decision rules about cigarette
smoking and other forms of tobacco use
 If the record documents “tobacco use” or
“+smoker” but the type of product is not
specified, assume this refers to cigarette
smoking unless documentation in
another Only Acceptable Source
suggests that the tobacco product is
pipe, cigar, or chewing tobacco.

This change will also appear in PN and
ACS
Confidential and Proprietary
Caregiver
Note that the examples of caregiver has
been expanded to include prison
official or other law enforcement
provider
 This applies to smoking cessation
counseling and discharge instructions in
IHF

Confidential and Proprietary
New Questions

If an IHF record is flagged as having a
diagnosis of diabetes mellitus there is a
new series of questions about insulin
discharge instructions

Please read all rules for each question carefully as not all of
the points will be emphasized in this presentation

These questions are not Joint
Commission questions, so you will see
them in the software for the first pull list
of 3Q10
Confidential and Proprietary
Was Insulin Prescribed at Discharge?
To answer question 94, it is important to
review all discharge medication
documentation in the record
 Please note the bulleted points for
guidance if there is conflicting
documentation among the sources
 The rules contain a list of insulin names
you may see, but the list is not
exhaustive.

Confidential and Proprietary
IF……
the patient did not have insulin
prescribed as a discharge medication
you will proceed to the hfseenyr
question as applicable
 If the patient was prescribed insulin at
discharge you will proceed to 4
questions about discharge instructions

Confidential and Proprietary
General Rules

Some general rules apply to the two questions
(95, 96) about written discharge instructions
 Written instructions given anytime during the hospital stay
are acceptable
 If the patient refused written discharge instructions or
other educational material answer “yes”
 Videos, CDs and DVDs are acceptable as educational
material if there is clear documentation that the material
includes information about the specific data element ( e.g.
sick day rules) and the patient was given a copy to take
home.
Confidential and Proprietary
Question 95 dcdm1


This question asks
about discharge
instructions
addressing what to
do if hypoglycemic
symptoms occur
The instructions may
include, but are not
limited to:






If patient is unconscious, a
spouse or friend should call 911
How and when to inject glucagon
If conscious, treat immediately by
eating a food or glucose
replacement with 15-20 g of fastacting carbohydrates (CHO)
Check blood glucose in 15
minutes. If <70 mg/dL or
symptoms have not subsided,
take an additional 15g CHO.
Eat a meal with CHO within 30
minutes
If blood glucose is still <70 mg/dL
and does not increase after
eating, seek further medical help
Confidential and Proprietary
Question 96 dcdm2


This question asks
about discharge
instructions
addressing sick day
rules
Instructions may
include but are not
limited to:





Take diabetes medication.
Self-monitor blood glucose more
frequently.
Test urine ketones if DM type 1.
Eat the usual amount of CHO
divided into smaller meals and
snacks if necessary—if blood
glucose is >250 mg/dL, the usual
CHO may be unnecessary.
Drink fluids frequently, 8 oz per
hour while awake.
Confidential and Proprietary
Question97 dcdm3
Does the medical record document the
patient/caregiver’s ability to administer
insulin was assessed?
 Please read each answer option
carefully

 Each answer option has explicit
definition/decision rules
Confidential and Proprietary
Question98 dcdm4
Does the medical record document the
patient/caregiver’s ability to perform selfmonitoring of blood glucose (SMBG)
was assessed?
 Please read each answer option
carefully

 Each answer option has explicit
definition/decision rules
Confidential and Proprietary
Exit Report and Scoring
There are no changes to IHF scoring for
3Q10
 The new insulin discharge instructions
are not on the exit report

Confidential and Proprietary
Pneumonia
Confidential and Proprietary
Topic Validation

Changes to Question 21 (cxrctabn)
 There are some additions to the inclusion list
of abnormal chest x-ray findings; please
note the highlighted wording
 The recommended order for suggested data
sources (formerly the priority order) has one
addition: #6 remainder of hospital record
Confidential and Proprietary
Addition to Rules

A new rule was added to question 25
with regard to records that do not
contain an ED form
 Do not use an H&P labeled Admit H&P or an
H&P that contains an admit note or order
within the body of text

The same instruction applies in question
26 with regard to direct admits
Confidential and Proprietary
PN Acute Care Module

For the purpose of the Pneumonia data
collection:
 If there is documentation of a
‘hospitalization’ or ‘admission’, assume it
was an acute care hospitalization unless
there is documentation that states
otherwise.

This rule applies to questions 1 (heltrisk)
and 5 (prehosp)
Confidential and Proprietary
Other Infections

Please note important changes to the
definition/decision rules of question 2
(othrinf)
 Do not assume a bacterial infection if there is only
documentation with the suffix ‘itis’. For example,
physician documents cystitis without documentation
of UTI, bladder infection, or antibiotic treatment
ordered for the cystitis.
 Several conditions have been removed from the
inclusion list
 There is one addition and a few deletions from
the exclusion list
Confidential and Proprietary
Positive Pathogen
This question has been moved from the
validation module to the acute care
module
 Definition/Decision rule modifications:

 If there is documentation of a positive
culture performed within a week prior to
arrival, select “yes”
 Note the clarification to the exclusions
Confidential and Proprietary
Blood Cultures
Question 13 (blctdon) now includes the
“the day of arrival” in the question.”
 Answer option 3 has changed to read
“the day prior to arrival up until the time
of presentation to the hospital”.
 Please note other clarifications in the
definition/decision rules.

Confidential and Proprietary
Blood Culture Date/Time
(Questions 14 and 15)

These questions reflect the same
wording change as the blood culture
question re: day prior to arrival, day of
arrival

Definition/decision rule changes to date
question:
 If there is supportive documentation that a blood culture
was collected and it is the earliest mention of a blood
culture, this date and time can be used, e.g., ‘BC sent to
lab’, ‘blood culture received time’.
 Do not use physician orders as they do not demonstrate
collection of the blood culture.
Confidential and Proprietary
PN Scoring Changes

There are some changes to cap 16, cap
13 and cap14 with regard to excluded
populations
 These changes will be highlighted in the 3Q
Exit Report Guide

* Remember that JC scoring changes
become effective with discharges 4/1/10
and later.
 The 2Q exit report guide will be effective for
the first pull list
Confidential and Proprietary
ACS
Confidential and Proprietary
Initial Presentation Module

Question12 (ecgintrp) has changes in
the definition/decision rules re:
documentation that would not be
included as an ST elevation
 ST-elevation described as a range where it cannot be
determined if ST-elevation is less than 1mm/.10mV (e.g. 0.5 –
1mm ST-elevation)
 ST-elevation described as old, chronic, or previously seen

These same changes are found in the After
Admission and Transfer In modules
Confidential and Proprietary
Reasons for Not Administering Aspirin

Please note the definition/decision rules
regarding whether to consider warfarin
as a pre-arrival medication
 Warfarin/Coumadin as pre-arrival medication =
consider warfarin/coumadin to be a pre-arrival
medication if there is documentation the patient was
on it prior to arrival, regardless of setting. Includes
cases where there is indication the warfarin/coumadin
was on temporary hold or the patient has been noncompliant/self-discontinued their medication.

The same change is in the After Presentation
module
Confidential and Proprietary
Other ACS Modules

No changes other than those noted
except some wording changes in the
definition/decision rules of pcidelay and
fibdelay in the Revascularization module
Confidential and Proprietary
ACS Scoring

No changes for 3Q10 including for
discharges >= 4/1/10
Confidential and Proprietary
Surgical Care
Confidential and Proprietary
Changes!
This instrument has several important
changes for 3Q10
 Please be sure to read all highlighted
sections in the data base questions
carefully as not all changes will be
detailed in this presentation

Confidential and Proprietary
Anesthesia Start Date and Time
Note the rules about the priority for
determining anesthesia start date and
time
 The anesthesia record is the priority
data source but if the date and/or time is
not documented on that record, the
other suggested data sources may be
used to determine date and time

 Examples of other suggested sources: intraoperative
record, circulator record, post-anesthesia evaluation
record, operating room notes.
Confidential and Proprietary
Surgical Incision Time
Please review the rules for question 22.
 Surgical incision time is the time the
initial incision was made for the principal
procedure
 The priority lists for determining time
have changed so please review them
carefully

Confidential and Proprietary
Anesthesia End Date and Time


The Anesthesia End Date occurs when the
operative anesthesia provider signs-off the
care of the patient to the person assuming the
postoperative anesthesia care in the postanesthesia care area, intensive care unit, or
other non-PACU recovery area.
As with begin date and time the anesthesia record
is the priority data source, but in the absence of
that other suggested data sources may be used to
determine these data elements
Confidential and Proprietary
Clinical Trials

Some specific examples of clinical trials
relevant to SCIP measures have been
added to the definition/decision rules:
 The use of antibiotics
 Testing a new beta blocker
 Use of VTE prophylaxis
Confidential and Proprietary
Hair Removal

A new answer option has been added to
question 35 (hairgone)
 Hair removal performed with a razor from
the scrotal area OR from the scalp after a
current traumatic head injury
Confidential and Proprietary
Infection Prior to the Principal
Procedure

Please note the new definition/decision
rules for joint revision cases
 Select “Yes” if the current principal
procedure was a joint revision AND there is
documentation that a culture of the operative
wound was taken prior to the administration
time of the prophylactic antibiotic.
 Please review the definition of a joint
revision and documentation of a culture
Confidential and Proprietary
Infection Prior to the Principal
Procedure

New conditions have been added to the
“includes” list
 Endometritis
 Free air in abdomen
 Perforation of the bowel
Confidential and Proprietary
Infection Prior to the Principal
Procedure

New conditions have been added to the
“excludes” list
 Colonized or positive screens for MRSA, VRE or
for other bacteria
 Fungal infections
 History of infection, recent or recurrent infections
not documented as active or current

Bowel perforation without fecal
contamination or infection has been
removed from this list
Confidential and Proprietary
Antibiotics Prior to Arrival or More Than 24
Hours Prior to Incision
The colnprep question is gone
 If the patient had colon surgery (Table
5.03) and recvanti is 1 or 2, you will get
a new question (#39 oralabx) that asks:

 Were the ONLY antibiotics administered prior to hospital
arrival or more than 24 hours prior to incision either (oral
Neomycin Sulfate + Erythromycin Base) OR (oral
Neomycin Sulfate + Metronidazole)?

Please review the definition/decision
rules carefully to determine yes or no
answers
Confidential and Proprietary
Reasons to Extend Antibiotics
Questions 44-49 are new questions that
ask about specific conditions as a
reason to extend antibiotics
postoperatively
 The timeframe for all 3 questions is
“within 2 days (3 days following CABG
or other cardiac surgery) following the
principal procedure with the day of
surgery being day 0”

Confidential and Proprietary
Reasons to Extend Antibiotics
Question 44 asks if there is
physician/APN/PA documentation that
erythromycin was administered
postoperatively for the purpose of
increasing gastric motility
 The definition/decision rules provide
other terms for “increasing gastric
motility”

Confidential and Proprietary
Reasons to Extend Antibiotics


Question 45 asks if there is physician/APN/PA
documentation that an antibiotic was administered
postoperatively for the treatment of hepatic
encephalopathy
Question 46 asks if there is physician/APN/PA
documentation that an antibiotic was administered
postoperatively as prophylaxis of Pneumocystis
pneumonia (PCP) to a patient with a diagnosis of
AIDS?
Confidential and Proprietary
Reasons to Extend Antibiotics
Question 47 (extndabx4) asks about
clinician documentation of infection
 This is similar to the question in previous
quarters but please read the
definition/decision rules carefully

 Please only consider documentation within
the acceptable timeframe
 Please refer to the inclusion table and note
excluded data sources when answering this
question.
Confidential and Proprietary
Reasons to Extend Antibiotics
Questions 48 and 49 pertain to joint
revision surgeries and will be skipped if
the principal procedure code is not on
Table 5.04 or 5.05
 The timeframe for both questions is
“within 2 days following the principal
procedure with the day of surgery being
day 0”

Confidential and Proprietary
Questions 48 and 49

There must be documentation that the
current principal procedure was a joint
revision
 The same joint must have been operated on
in a previous surgery that was an
arthroplasty, total or partial OR
 There must be documentation that hardware
was removed during the current principal
procedure
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Current Malignancy

Question 48 asks if there is clinician
documentation that the patient has a
current malignancy of the lower
extremity involving the same extremity
as the principal procedure that was a
joint revision surgery
 The lower extremity includes the hip, knee
and foot joints
 See d/d rules for examples of lower
extremity malignancies
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Question 49

This question asks if there is
documentation that a culture was taken
at the operative site after incision, prior
to administration of the prophylactic
antibiotic prior to a principal procedure
that was a joint revision surgery
 Documentation of the culture does not have
to be clinician documentation
 Documentation may be found intraoperatively or post-operatively
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Question 56 (urincath)

A definition for intra-operative period
was added to the definition/decision
rules
 For this data element, the intra-operative
period begins when the patient enters the
operating room and ends when the
patient leaves the operating room.
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Urinary Catheter Removal

The timeframe in question 57 (cathout)
is changed to Post Operative Day 0
(POD 0) through Post Operative Day 2
(POD2)
 Anesthesia end date is postoperative day 0
 POD2 ends at midnight of the second
postoperative day
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VTE Prophylaxis
Oral Factor Xa Inhibitor has been added
as an option for VTE prophylaxis
 Brand name: Rivaroxaban
 The exit report guide will show how this
drug “counts” in scoring

Confidential and Proprietary
BB Prior to Arrival

There are some important changes to
the definition/decision rules of question
63: daily beta blocker prior to arrival
 If there is documentation that the beta-blocker was taken
daily at “home” or is a “current” medication, select “1.”
 If a beta-blocker is listed as a home medication without
designation of how often or when it is taken, select “1.”
 If the beta-blocker is listed as a daily “home” or “current”
medication, but the physician/APN/PA does not continue it
after arrival, select “1.”
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BB Prior to Arrival

More important changes to the
definition/decision rules of question 63:
 If the beta-blocker is listed as a daily “home” or “current”
medication and is continued after arrival, but discontinued
prior to surgery, select “1.”
 If there is documentation that the beta-blocker is a
home/current medication and additional documentation
indicates the beta-blocker was not taken daily, select “2.”
For example, metoprolol is listed as a home medication,
but the nurse notes, “patient states he is not taking
metoprolol every day.”
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Reasons for Not Administering a BB

The following is an addition to the
definition/decision rules of question 66
 Documentation to hold all meds or to
hold all PO meds alone, is not acceptable
as a reason for not administering a betablocker during the perioperative period.
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Blood Management
There are changes to the time frame for
the blood management questions about
type and screen and type and cross
 Question 67 now asks if the record
documents the result of a type and
screen during the 30 days prior to
surgery
 The parameter in the date question has
changed accordingly

Confidential and Proprietary
Blood Management
Question 69 now asks if the record
documents the result of a type and cross
during the 4 days prior to surgery
 The parameter in the date question has
changed accordingly

Confidential and Proprietary
Informed Consent

No changes to this module
Confidential and Proprietary
Surgical Care Scoring
Joint revision was removed as an
exclusion from sip1d and e, sip2d and e,
and sip3d and e
 An exclusion for all sip3 indicators for
antibiotic doses > 1440 minutes and
<=2880 minutes with a reason to extend
the antibiotic dose
 Hairgone8=true will pass sip11j
 vtelaxis8-=true will pass sip13 and 14 for
surgeries on Table 5.22, 5.23, 5.24

Confidential and Proprietary
VTE Changes

There are some changes in VTE, but
they have already been noted in other
instruments
 Oral Xa factor as prophylaxis
 Change to type and screen and type and
cross timeframes
 Minor rule additions in the comfort questions
and discharge instructions
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No Changes to:
Delirium Risk
 Skin Assessment
 Fall Assessment
 HBIPS

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3Q10 Learning Assessment
A link will be provided to access the 3Q
Learning Assessment
 Please have your data set questions
available when completing the
assessment
 The assessment must be completed no
later than COB on 4/14/10

 3Q10 pull lists will not be assigned until
the assessment has been completed
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