Review of the Stroke and VTE Measure Sets
|
|
- Bartholomew Todd
- 8 years ago
- Views:
Transcription
1 Review of the Stroke and VTE Measure Sets Vicky Agramonte, RN, MSN IPRO Quality Data Reporting and Improvement Project Presentation to NYS Hospitals January 29, 2013
2 The QIO Program CMS Leads a national healthcare quality improvement program, implemented locally by an independent network of QIOs in each state and territory. IPRO The federally funded Medicare Quality Improvement Organization (QIO) for New York State, under contract with the Centers for Medicare & Medicaid Services (CMS). 2
3 The QIO Program Largest federal program dedicated to improving health quality at the local level, Trustworthy partners for the continual improvement of healthcare for all Americans, Focuses on three broad aims: Better patient care, Better population health, Lower healthcare costs through improvement. 3
4 The QIO Program As the QIO for New York State, IPRO works to achieve the goals of the national QIO program by Convening communities of providers, practitioners and patients across the state to: Share knowledge, Spread best practices, Achieve rapid, wide-scale improvements in patient care. 4
5 The QIO Program The QIO Program supports patients by: Providing information to help you better manage your own healthcare, Reviewing quality of care complaints, Working with local healthcare providers to make healthcare safer and patient-centered, Listening to you and learning from your experiences, Helping to remove roadblocks between you and better healthcare. 5
6 The QIO Program The QIO Program supports patients by: Managing and sharing evidence-based best practices, knowledge and tools for improving health quality, efficiency and value. Serving as a change agent for rapid, widespread and significant improvements that contribute to broader national healthcare goals. Facilitating collaborative learning and action that results in better, more patient-centered care. Encouraging beneficiaries to take a more active role in their own healthcare. 6
7 QIO Program Priorities Beneficiary- and Family-Centered Care Improving Individual Patient Care by Reducing Healthcare-Associated Infections in Hospitals Healthcare-Acquired Conditions in Nursing Homes Adverse Drug Event and through Quality Reporting Integrating Care for Populations and Communities Improving Health for Populations and Communities 7
8 Stroke (STK) Measure Set Version 4.2b
9 Stroke (STK) Measure Set Total of 8 STK Measures Required by both CMS and The Joint Commission effective January 1, 2013 discharges. Measure ID# Measure Short Name Type of Measure STK-4 Thrombolytic Therapy Acute Intervention STK-1 Venous Thromboembolism (VTE) Prophylaxis Early Management STK-5 Antithrombotic Therapy By End of Hospital Day 2 Early Management STK-2 Discharged on Antithrombotic Therapy Discharge STK-3 Anticoagulation Therapy for Atrial Fibrillation/Flutter Discharge STK-6 Discharged on Statin Medication Discharge STK-8 Stroke Education Discharge STK-10 Assessed for Rehabilitation Discharge 9
10 Stroke (STK) Measure Set Initial Patient Population Two populations: STK-2, STK-3, STK-4, STK-5, and STK-6 measures: ICD-9-CM Principal Diagnosis code for ischemic stroke required (Appendix A, Table 8.1) STK-1, STK-8, and STK-10 measures: An ICD-9-CM Principal Diagnosis code for ischemic OR hemorrhagic stroke required (Appendix A, Tables 8.1 and 8.2) 10
11 Stroke (STK) Measure Set Initial Patient Population Excluded Populations All STK measures Age < 18 years Length of Stay > 120 days Patients enrolled in Clinical Trial (stroke patients) Patients admitted for Elective Carotid Intervention 11
12 Stroke (STK) Measure Set One Acute Measure 12
13 Stroke (STK) Measure Set STK-4 Thrombolytic Therapy Measures the proportion of acute ischemic stroke patients who arrive at the hospital within 2 hours of time last known well (the last time they were known to be at baseline or without the signs and symptoms of the current stroke) and for whom IV TPA was initiated within 3 hours of time last known well. IV TPA within 3 hours of stroke symptom onset improves outcomes at 3 months Reduced mortality, reduced dependency with ADLs. 13
14 Stroke (STK) Measure Set STK-4 Thrombolytic Therapy Clock starts with ARRIVAL date/time. Only patients who received care or services in the ED before inpatient admission are included. Exclusions: Time last known well to ED arrival > 2 hours or unknown. Documentation of a Reason for Not Initiating IV Thrombolytic: Patient/family refusal, NIHSS score of zero, or initiation of IV or IA thrombolytic at a transferring hospital Nursing documentation is acceptable. Physician/APN/PA or pharmacist documentation of other reason for not initiating IV TPA. 14
15 Stroke (STK) Measure Set Two Early Measures 15
16 Stroke (STK) Measure Set STK-1 VTE Prophylaxis Measures the proportion of ischemic AND hemorrhagic stroke patients who received VTE prophylaxis or have documentation of why no VTE prophylaxis was given the day of or the day after hospital admission. Stroke patients are at increased risk of developing VTE. Early prophylactic therapies help prevent VTE. 16
17 Stroke (STK) Measure Set STK-1 VTE Prophylaxis Uses ADMISSION date, not arrival date. VTE prophylaxis inclusions: Low-dose unfractionated heparin Low-molecular-weight heparin (e.g., Lovenox) Intermittent pneumatic compression devices Factor Xa inhibitors (e.g., Arixtra) Warfarin Venous foot pumps 17
18 Stroke (STK) Measure Set STK-1 VTE Prophylaxis Oral Factor Xa inhibitors (e.g., Xarelto) Requires physician/apn/pa documentation of why Oral Factor Xa inhibitor was administered for VTE prophylaxis (e.g., A- fib/flutter, HX hip or knee replacement surgery, treatment of VTE) Graduated compression stockings - Not sufficient, in and of themselves. Requires additional form of prophylaxis or Reason for No VTE Prophylaxis Hospital Admission. 18
19 Stroke (STK) Measure Set STK-1 VTE Prophylaxis Exclusions: LOS < 2 days, Comfort Measures Only documented on day of or day after hospital arrival. Documentation of a Reason for No VTE Prophylaxis Hospital Admission: Included in the numerator (NOT excluded). Documentation of a reason for not administering both mechanical AND pharmacological VTE prophylaxis must be present. Reasons must be written by the day after hospital admission. 19
20 Stroke (STK) Measure Set STK-1 VTE Prophylaxis (continued) Reasons must be documented by a physician/apn/pa or pharmacist (Exception: Patient/family refusal, Risk assessment form showing low risk for VTE). Differences exist in VTE prophylaxis measures and abstraction of VTE prophylaxis elements (STK vs. VTE vs. SCIP): See abstraction guidelines for more information. 20
21 Stroke (STK) Measure Set STK-5 Antithrombotic Therapy By End of Hospital Day 2 Measures the proportion of ischemic stroke patients administered antithrombotic therapy by the end of hospital day 2. Early antithrombotic therapy reduces stroke mortality and morbidity. 21
22 Stroke (STK) Measure Set STK-5 Antithrombotic Therapy By End of Hospital Day 2 Clock starts with ARRIVAL date, not admission. Day of arrival = day 1. Documentation of antithrombotic administration must be written on day 1 or 2. Acceptable antithrombotics are listed in Appendix C, Table
23 Stroke (STK) Measure Set STK-5 Antithrombotic Therapy By End of Hospital Day 2 Exclusions: LOS < 2 days Comfort Measures Only documented on day of or day after arrival IV or IA TPA Administered at This Hospital or Within 24 Hours Prior to Arrival Documentation of Reason For Not Administering Antithrombotic Therapy By End Of Hospital Day 2: Must be written on day 1 or 2. Reasons must be documented by a physician/apn/pa or pharmacist (Exception: Patient/family refusal). 23
24 Stroke (STK) Measure Set Five Discharge Measures 24
25 Stroke (STK) Measure Set STK-2 Discharged on Antithrombotic Therapy Measures the proportion of ischemic stroke patients prescribed antithrombotic therapy at hospital discharge. Antithrombotic agents reduce stroke mortality, strokerelated morbidity, and stroke recurrence rates. Acceptable antithrombotics same as STK-5 (Appendix C, Table 8.2). 25
26 Stroke (STK) Measure Set STK-2 Discharged on Antithrombotic Therapy Exclusions: Comfort Measures Only documented Patients transferred to another hospital, left AMA, expired, or discharged to home/facility for hospice Physician/APN/PA or pharmacist documentation of a Reason For Not Prescribing Antithrombotic Therapy at Discharge 26
27 Stroke (STK) Measure Set STK-3 Anticoagulation Therapy for Atrial Fibrillation/Flutter Measures the proportion of ischemic stroke patients with a-fib/flutter who are prescribed anticoagulation therapy at hospital discharge. Nonvalvular a-fib (NVAF) is a common arrhythmia and an important risk factor for stroke. Anticoagulants help prevent recurrent stroke in high stroke risk a-fib patients with TIA or prior stroke. 27
28 Stroke (STK) Measure Set STK-3 Anticoagulation Therapy for Atrial Fibrillation/Flutter (continued) Atrial Fibrillation/Flutter includes history of a-fib (e.g., remote, persistent, or paroxysmal) or atrial flutter (including history of ablation procedure) OR current a- fib/flutter on EKG. Exceptions: A-fib/flutter that terminated within 8 weeks following CABG, hx transient and entirely reversible episode of atrial fibrillation or flutter due to thyrotoxicosis. 28
29 Stroke (STK) Measure Set STK-3 Anticoagulation Therapy for Atrial Fibrillation/Flutter Acceptable anticoagulants include warfarin, direct thrombin inhibitors (e.g., dabigatran), heparin, lowmolecular-weight heparin (e.g., Lovenox), and Oral Factor Xa inhibitors (e.g., Xarelto). ASA alone is NOT acceptable. Exclusions similar to STK-2: Comfort Measures Only documented Patients transferred to another hospital, left AMA, expired, or discharged to home/facility for hospice Physician/APN/PA or pharmacist documentation of a Reason For Not Prescribing Anticoagulation Therapy 29
30 Stroke (STK) Measure Set STK-6 Discharged on Statin Medication Measures the proportion of ischemic stroke patients with LDL- c 100 mg/dl, or LDL-c not measured, or who were on a lipid-lowering medication prior to hospital arrival that are prescribed a statin at hospital discharge. Intensive lipid-lowering therapy using statins is associated with a dramatic reduction in the rate of recurrent ischemic stroke and major coronary events. 30
31 Stroke (STK) Measure Set STK-6 Discharged on Statin Medication Comparison of STK-6 to the AMI-10 statin measure: STK-6 automatically includes patients who were on a lipidlowering agent prior to arrival (statin or non-statin), regardless of LDL-c level. In contrast, AMI-10 does not factor in whether a patient was on/not on a lipid-lowering agent prior to arrival. LDL-c testing timeframes: In STK-6, patients with an LDL-c 100 mg/dl within the first 48 hours after arrival or within 30 days prior to arrival are INCLUDED. In contrast, AMI-10 EXCLUDES AMI patients who were not prescribed a statin at discharge but there is an LDL-c < 100 mg/dl within the first 24 hours after arrival or within 30 days prior to arrival. 31
32 Stroke (STK) Measure Set STK-6 Discharged on Statin Medication (continued) Comparison of STK-6 to the AMI-10 statin measure: Both STK-6 and AMI-10 include patients with no LDL-c measured within the prescribed timeframe. 32
33 Stroke (STK) Measure Set STK-6 Discharged on Statin Medication Exclusions (for both STK-6 and AMI-10): Comfort Measures Only documented Patients transferred to another hospital, left AMA, expired, or discharged to home/facility for hospice Documentation of a Reason For Not Prescribing Statin Medication at Discharge: Statin allergy Nursing documentation is acceptable Physician/APN/PA or pharmacist documentation of other reason for not prescribing statin at discharge 33
34 Stroke (STK) Measure Set STK-8 Stroke Education Measures the proportion of ischemic AND hemorrhagic stroke patients or their caregivers who were given educational materials during the hospital stay which addressed ALL of the following: Activation of emergency medical system/911 if signs or symptoms of stroke occur Follow-up with a physician/apn/pa after discharge Names of all medications prescribed at discharge Risk factors for stroke What to do if warning signs or symptoms of stroke occur 34
35 Stroke (STK) Measure Set STK-8 Stroke Education Comparison of STK-8 to the HF-1 discharge instructions measure: Both STK-8 and HF-1 include only patients discharged to home and exclude Comfort Measures Only documented. Abstraction of education elements will be very similar to HF-1 discharge instruction elements. Documentation in the medical record must make clear that the patient was given written instructions that address all five areas. Difference from HF-1: In STK-8, credit can be taken if documentation indicates that written instructions were not given because the patient is cognitively impaired and there is no caregiver available. 35
36 Stroke (STK) Measure Set STK-10 Assessed for Rehabilitation Measures the proportion of ischemic AND hemorrhagic stroke patients who received one or more of the following: Assessment for rehab services by a member of the rehab team Rehab services given by a member of the rehab team during the hospitalization Referral to rehab services following discharge Transfer to a rehab facility 36
37 Stroke (STK) Measure Set STK-10 Assessed for Rehabilitation Rehab interventions initiated early following stroke can help prevent complications, minimize impairment, and maximize function. Requires documentation by a member of the rehab team. Rehab team is defined as: Physician Physiatrist Neuro-psychologist Physical therapist Occupational therapist Speech and language pathologist 37
38 Stroke (STK) Measure Set STK-10 Assessed for Rehabilitation Cases with documentation of a reason for not completing a rehabilitation assessment are included in the numerator (NOT excluded). Documentation of symptom resolution without explicit documentation that the patient does not need rehab services does not count as a reason. Exclusions: Comfort Measures Only documented Patients transferred to another hospital, left AMA, expired, or discharged to home/facility for hospice 38
39 Questions?
40 Venous Thromboembolism (VTE) Measure Set Version 4.2b
41 TJC/CMS VTE Core Measure Set Beginning January 2013 CMS will require data collection of the VTE measure set for all IPPS hospitals: VTE 1 - VTE Prophylaxis VTE 2 ICU VTE Prophylaxis VTE 3 VTE Patients with Anticoagulant Overlap VTE 4 VTE Patients Receiving UFH with Monitoring by Protocol/Nomogram VTE 5 VTE Warfarin Therapy Discharge Instruction VTE 6 Hospital-Acquired Potentially Preventable VTE 41
42 VTE Initial Patient Population 42
43 3 Initial Sub-Populations All 3 sub-populations include inpatient discharges who are >= 18 years of age and have a Length of Stay (LOS)<=120 days and any ICD-9-CM Diagnosis Code. No VTE diagnosis sub-population (sub-population 1) Principal VTE diagnosis sub-population (sub-population 2) Other VTE Only sub-populations (sub-population 3) 43
44 Sub-Population 1 No - VTE VTE-1 Venous Thromboembolism Prophylaxis and VTE-2 Intensive Care Unit Venous Thromboembolism Prophylaxis Any ICD-9-CM Diagnosis Code Except for Principal OR Other Diagnosis Codes of VTE (Table 7.03), Obstetrics (Table 7.02) or Obstetrics-VTE (Table 7.04). 44
45 VTE-1 Intent & Rationale Intent: This measure assesses the number of patients who received VTE prophylaxis or have documentation why no VTE prophylaxis was performed with in a specific time frame. Timeframe being the day of OR the day after hospital admission OR surgery end date for surgeries that start the day of OR the day after hospital admission. Rationale: Hospitalized patients at high-risk for VTE may develop an asymptomatic deep vein thrombosis (DVT) and die from pulmonary embolism (PE) even before the diagnosis is suspected. 45
46 VTE-1 Numerator & Denominator Information Numerator: Patients who received VTE prophylaxis or have documentation why no VTE prophylaxis was given: the day of OR the day after hospital admission the day of OR the day after surgery end date for surgeries that start the day of OR the day after hospital admission Denominator: All patients Variable Key: Length of Stay, Initial ICU Day, ICU LOS, Initial Prophylaxis Day, Initial Surgical Prophylaxis Day 46
47 VTE-1 Data Elements Data Elements determining Numerator: Reason for No VTE Prophylaxis Hospital Admission Reason for Oral Factor Xa Inhibitor Surgery End Date Surgical Procedure VTE Prophylaxis VTE Prophylaxis Date Data Elements determining Denominator: Admission Date Birthdate Clinical Trial Comfort Measures Only Discharge Date ICD-9-CM Other Diagnosis Codes ICD-9-CM Principal Diagnosis Code ICU Admission or Transfer ICU Discharge Date 47
48 VTE-2 Intent & Rationale Intent: This measure assesses the number of patients who received VTE prophylaxis or have documentation why no VTE prophylaxis was given within a specific time frame in the Intensive Care Unit (ICU). Timeframe being the day of OR the day after the initial admission (or transfer) to the Intensive Care Unit (ICU) OR surgery end date for surgeries that start the day of OR the day after ICU admission (or transfer). Rationale: Criteria for admission to the Intensive Care Unit (ICU) puts patients at an increased risk for developing VTE and subsequent increased risk of morbidity from PE. 48
49 VTE-2 Numerator & Denominator Information Numerator: Patients who received VTE prophylaxis or have documentation why no VTE prophylaxis was given: the day of OR the day after ICU admission (or transfer) the day of OR the day after surgery end date for surgeries that start the day of OR the day after ICU admission (or transfer). Denominator: Patients directly admitted or transferred to ICU Variable Key: Length of Stay, ICU LOS, ICU Initial Prophylaxis Day, ICU Initial Surgical Prophylaxis Day, ICU Initial Surgery Day 49
50 VTE-2 Data Elements Data Elements determining Numerator: Anesthesia Start Date ICU VTE Prophylaxis ICU VTE Prophylaxis Date Reason for No VTE Prophylaxis ICU Admission Reason for Oral Factor Xa Inhibitor - ICU Admission Surgery End Date ICU Admission Surgical Procedure ICU Admission Data Elements determining Denominator: Admission Date Birth date Clinical Trial Comfort Measures Only Discharge Date ICD-9-CM Other Diagnosis Codes ICD-9-CM Principal Diagnosis Code ICD-9-CM Principal Procedure Code ICU Admission or Transfer Date ICU Admission or Transfer ICU Discharge Date 50
51 Sub-population 2 Principal VTE VTE-3 VTE Patients With Anticoagulation Overlap Therapy VTE-4 VTE Patients Receiving Unfractionated Heparin With Dosages/Platelet Count Monitoring by Protocol VTE-5 Venous Thromboembolism Discharge Instructions ICD-9-CM Principal Diagnosis Codes of VTE (Table 7.03) or Obstetrics-VTE (Table 7.04). 51
52 VTE-3: VTE Patients with Anticoagulation Overlap Intent & Rationale Intent: This measure assesses the number of patients diagnosed with confirmed VTE who received an overlap of parenteral (intravenous [IV] or subcutaneous [subcu]) anticoagulation and warfarin therapy. Overlap therapy should be administered for at least 5 days with an international normalized ratio (INR) >= 2 prior to discontinuation of the parenteral anticoagulation therapy, discharged on both medications or have a Reason for Discontinuation of Parenteral Therapy. Patients who received less than 5 days of overlap therapy should be discharged on both medications or have a Reason for Discontinuation of Parenteral Therapy. 52
53 VTE-3: VTE Patients with Anticoagulation Overlap Intent & Rationale (continued) Rationale: For patients who present with a confirmed acute VTE, parenteral anticoagulation is the first line of therapy because of its rapid onset of action. 53
54 VTE-3 Numerator & Denominator Information Numerator: Patients who received overlap therapy. Denominator: Patients with confirmed VTE who received warfarin. Included Populations: Discharges with an ICD-9-CM Principal or Other Diagnosis Codes of VTE as defined in Appendix A, Table 7.03 or 7.04 Variable Key: Overlap Therapy Days 54
55 VTE-3 Data Elements Data Elements determining Numerator: INR Value Overlap Therapy Overlap Therapy Start Date Parenteral Anticoagulant End Date Parenteral Anticoagulant Prescribed at Discharge Reason for Discontinuation of Parenteral Therapy Data Elements determining Denominator: Admission Date Birthdate Clinical Trial Comfort Measures Only Discharge Date Discharge Disposition ICD-9-CM Other Diagnosis Codes 55
56 VTE-3 Data Elements Data Elements determining Numerator: INR Value Overlap Therapy Overlap Therapy Start Date Parenteral Anticoagulant End Date Data Elements determining Denominator (continued): ICD-9-CM Principal Diagnosis Code VTE Confirmed VTE Diagnostic Test Warfarin Administration Parenteral Anticoagulant Prescribed at Discharge Reason for Discontinuation of Parenteral Therapy 56
57 VTE-3 VTE Therapy Pts with AC Overlap VTE patients with anticoagulation overlap therapy: Patients with acute VTE Either principal (present on admission) or other diagnosis (hospital-acquired) Diagnosis listed on Appendix A, Table 7.03 VTE Diagnosis listed on Appendix A, Table 7.04 Obstetric VTE Overlap Therapy: Warfarin AND Parenteral anticoagulants Treatments listed on Appendix H, Table
58 Parenteral Anticoagulant Agents 58
59 VTE-3 VTE Therapy Pts with AC Overlap Numerator: Patients who received warfarin and parenteral anticoagulation overlap therapy Five or more days, with an INR greater than or equal to 2 prior to discontinuation of parenteral therapy OR five or more days, with an INR less than 2 and discharged on overlap therapy OR Less than five days and discharged on overlap therapy OR With documentation of reason for discontinuation of overlap therapy OR with documentation of a reason for no overlap therapy Denominator: Patients with a confirmed VTE who receive warfarin 59
60 VTE-4: VTE Patients Receiving Unfractionated Heparin with Dosages/Platelet Count Monitoring by Protocol or Nomogram Intent & Rationale Intent: This measure assesses the number of patients diagnosed with confirmed VTE who received intravenous (IV) UFH therapy dosages AND had their platelet counts monitored using defined parameters such as a nomogram or protocol. Rationale: Subtherapeutic and supratherapeutic levels can lead to thromboembolic or bleeding complications that may increase the patient s length of stay. The use of weight-based nomograms has increased the likelihood that a therapeutic partial prothromboplastin time (aptt) will be achieved within the first 24 to 48 hours of therapy. 60
61 VTE-4 Numerator & Denominator Information Numerator: Patients who have their IV UFH therapy dosages AND platelet counts monitored according to defined parameters such as a nomogram or protocol. Denominator: Patients with confirmed VTE receiving IV UFH therapy. Included Populations: ICD-9-CM Principal or Other Diagnosis Codes of VTE as defined in Appendix A, Table 7.03 or
62 VTE-4 Data Elements Data Elements determining Numerator: Monitoring Documentation Data Elements determining Denominator: Admission Date Birthdate Clinical Trial Comfort Measures Only Discharge Date Discharge Disposition ICD-9-CM Other Diagnosis Codes 62
63 VTE-4 Data Elements (continued) Data Elements determining Numerator: Monitoring Documentation Data Elements determining Denominator: ICD-9-CM Principal Diagnosis Code UFH Therapy Administration VTE Confirmed VTE Diagnostic Test 63
64 VTE-5: Venous Thromboembolism Warfarin Therapy Discharge Instructions Intent & Rationale Intent: This measure assesses the number of patients diagnosed with confirmed VTE that are discharged to home on warfarin with written discharge instructions that address ALL 4 criteria: compliance issues, dietary advice, follow-up monitoring, and information about the potential for adverse drug reactions/interactions. Home is defined as: home, home care, court/law enforcement or home on hospice care. 64
65 VTE-5: Venous Thromboembolism Warfarin Therapy Discharge Instructions Intent & Rationale (continued) Rationale: Reduce the likelihood of patient harm associated with the use of anticoagulant therapy by utilizing patient education. This is a vital component to achieve successful outcomes, and reduce hospital readmission rate for patients in anticoagulant therapy programs. 65
66 VTE-5 Numerator & Denominator Information Numerator: Patients with documentation that they OR their caregivers were given written discharge instructions or other educational material about warfarin that addressed ALL of the following: compliance issues dietary advice follow-up monitoring potential for adverse drug reactions and interactions Denominator: Patients with confirmed VTE discharged on warfarin therapy. 66
67 VTE-5 Data Elements Data Elements determining Numerator: Discharge Instructions Address Compliance Issues Discharge Instructions Address Dietary Advice Discharge Instructions Address Follow-up Monitoring Discharge Instructions Address Potential for Adverse Drug Reactions and Interactions Data Elements determining Denominator: Admission Date Birthdate Clinical Trial Discharge Date Discharge Disposition ICD-9-CM Other Diagnosis Codes ICD-9-CM Principal Diagnosis Code 67
68 VTE-5 VTE Discharge Instructions Discharge instructions address all of the following: Compliance including all of the following statements: Importance of taking warfarin as instructed Importance of monitoring warfarin with scheduled PT/INR Dietary advice-including all of the following statements: Advised a consistent amount of foods with vitamin K rather than avoidance Avoid major changes in dietary habits, or notify a health professional 68
69 VTE-5 VTE Discharge Instructions Follow-up monitoring including all of the following statements : Name and phone number of health professional/clinic or office monitoring the anticoagulation therapy Next PT/INR laboratory blood draw Potential for adverse drug reactions and interaction including all of the following: Diet and medications can affect PT/INR Do not take or discontinue any medication or OTC medication except on the advice of a physician or pharmacist Warfarin increases the risk of bleeding 69
70 Sub-population 3 Other Diagnosis Code of VTE VTE-3 VTE Patients with Anticoagulation Overlap Therapy VTE-4 VTE Patients Receiving Unfractionated Heparin With Dosages/Platelet Count Monitoring by Protocol VTE-5 Venous Thromboembolism Discharge Instructions VTE-6 Hospital Acquired Potentially-Preventable VTE ICD-9-CM Other Diagnosis Code of VTE or Obstetrics-VTE 70
71 VTE-6: Hospital Acquired Potentially- Preventable Venous Thromboembolism Intent & Rationale Intent: This measure assesses the number of patients diagnosed with confirmed VTE during hospitalization (not present at admission) who did NOT receive VTE prophylaxis in a specific time frame. Timeframe being, between hospital admission and the day before the VTE diagnostic testing order date. 71
72 VTE-6: Hospital Acquired Potentially- Preventable Venous Thromboembolism Intent & Rationale (continued) Rationale: The incidence of preventable venous thromboembolism (VTE) among hospitalized patients is overwhelming and contributes to extended hospital stays and the rising cost of health care. In spite of formal guidelines and recommendations for preventative care, problems remain. 2nd most common post-op complication 2nd most common cause of excess LOS 3rd common cause of excess mortality/charges 72
73 VTE-6 Numerator & Denominator Information Numerator: Patients who received no VTE prophylaxis prior to the VTE diagnostic test order date. Denominator: Patients who developed confirmed VTE during hospitalization. Included Populations: Discharges with an ICD-9-CM Other Diagnosis Codes of VTE as defined in Appendix A, Table 7.03 or
74 VTE-6 Data Elements Data Elements determining Numerator: VTE Prophylaxis Status Data Elements determining Denominator: Admission Date Birthdate Clinical Trial Comfort Measures Only Data Elements determining Denominator Continued: ICD-9-CM Other Diagnosis Codes ICD-9-CM Principal Diagnosis Code VTE Confirmed VTE Diagnostic Test VTE Present at Admission Discharge Date 74
75 VTE 6 Aiming for the Denominator VTE 6 is an inverse measure, different than what we are used to. It captures adverse outcomes: Goal is 0% for this measure. Numerator: Patients who develop VTEs because of NO or INSUFFICIENT prophylaxis. Cases with patients who develop VTE despite prophylaxis go in the denominator, which does NOT count against the hospital. 75
76 Simple VTE Order Set 76
77 77
78 UFH Protocol Example VTE nursing-driven, weight-based protocol using anti-xa levels Initial dose: 80 IU/kg (ABW) bolus followed by infusion of 18 units/kg/hr (ABW) Anti-Xa level Response Next level Bolus 25 units/kg; increase infusion by 3 units/kg/hr 6 hours Increase infusion by 2 units/kg/hour 6 hours Increase infusion by 1 units/kg/hour 6 hours NO CHANGE Next am Decrease infusion by 1 units/kg/hour 6 hours STOP INFUSION for 1 hr, then decrease by 2 units/kg/hr 6 hours after restart STOP INFUSION for 1 hr, then decrease by 3 units/kg/hr 6 hours after restart STOP INFUSION for 2 hr, then decrease by 4 units/kg/hr 6 hours after restart 78
79 References Qualitynet. Specifications Manual for National Hospital Inpatient Quality Measures. Version 4.2 Venous Thromboembolism National Hospital Inpatient Quality Measures. Retrieved September 25, 2012 from ublic%2fpage%2fqnettier2&cid=
80 For more information Karen O Leary Project Manager (518) ext 124 koleary@nyqio.sdps.org Vicky Agramonte Project Manager (518) ext 115 vagramonte@ipro.org IPRO CORPORATE HEADQUARTERS 1979 Marcus Avenue Lake Success, NY IPRO REGIONAL OFFICE 20 Corporate Woods Boulevard Albany, NY This material was prepared by IPRO, the Medicare Quality Improvement Organization for New York State, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents do not necessarily reflect CMS policy. 10SOW-NY-AIM
Overview of the TJC/CMS VTE Core Measures
Overview of the TJC/CMS VTE Core Measures CMS Specification Manual 4.2 January 1, 2013 June 30, 2013 Victoria Agramonte, RN, MSN Project Manager, IPRO VTE Regional Learning Sessions NYS Partnership for
More informationStroke/VTE Quality Measure Build for Meaningful Use Stage 1
Stroke/VTE Quality Measure Build for Meaningful Use Stage 1 Presented by Susan Haviland, BSN RN Senior Consult, Santa Rosa Consulting Meaningful Use Quality Measures Centers for Medicare and Medicaid Services
More informationCLINICAL QUALITY MEASURES FINALIZED FOR ELIGIBLE HOSPITALS AND CRITICAL ACCESS HOSPITALS BEGINNING WITH FY 2014
CLINICAL QUALITY MEASURES FINALIZED FOR ELIGIBLE HOSPITALS AND CRITICAL ACCESS HOSPITALS BEGINNING WITH FY 2014 e 55 0495 2 Emergency Department (ED)- 1 Emergency Department Throughput Median time from
More informationconvey the clinical quality measure's title, number, owner/developer and contact
CMS-0033-P 153 convey the clinical quality measure's title, number, owner/developer and contact information, and a link to existing electronic specifications where applicable. TABLE 20: Proposed Clinical
More informationInpatient Anticoagulation Safety. To provide safe and effective anticoagulation therapy through a collaborative approach.
Inpatient Anticoagulation Safety Purpose: Policy: To provide safe and effective anticoagulation therapy through a collaborative approach. Upon the written order of a physician, Heparin, Low Molecular Weight
More informationInpatient Quality Reporting Program
Venous Thromboembolism 2015 Abstraction Guidance Questions and Answers Moderator: Candace Jackson, RN Inpatient Quality Reporting Support Contract Lead, HSAG Speakers: Denise Krusenoski, MSN, RN, CMSRN,
More informationDVT/PE Management with Rivaroxaban (Xarelto)
DVT/PE Management with Rivaroxaban (Xarelto) Rivaroxaban is FDA approved for the acute treatment of DVT and PE and reduction in risk of recurrence of DVT and PE. FDA approved indications: Non valvular
More informationInpatient and Outpatient Manual Changes for 2015
Inpatient and Outpatient Manual Changes for 2015 Jill Daniel Project Manager Quality Measures Abstraction 15-036-AB GoToWebinar The Questions Chat Box Set your audio option Introduction to Data Dictionary
More informationAHA/ASA Ischemic Stroke Performance Measures
AHA/ASA Ischemic Stroke Performance Measures 1. Venous thromboembolism prophylaxis Percentage of patients with ischemic stroke who receive venous thromboembolism prophylaxis Numerator Hospital day 0 or
More informationHospital Inpatient Quality Reporting (IQR) Program
Clinical Process Measures Program Changes for Fiscal Year 2014 Beginning with January 1, 2012 discharges; hospitals will begin data collection and submission for 4 new measures. Hospitals will not be required
More informationDabigatran etexilate for the treatment and secondary prevention of deep vein thrombosis and/or pulmonary embolism ERRATUM
Dabigatran etexilate for the treatment and secondary prevention of deep vein thrombosis and/or pulmonary embolism ERRATUM This report was commissioned by the NIHR HTA Programme as project number 12/78
More informationNational Patient Safety Goals Effective January 1, 2015
National Patient Safety Goals Goal 1 Nursing are enter ccreditation Program Improve the accuracy of patient and resident identification. NPSG.01.01.01 Use at least two patient or resident identifiers when
More informationNational Patient Safety Goals Effective January 1, 2015
National Patient Safety Goals Effective January 1, 2015 Goal 1 Improve the accuracy of resident identification. NPSG.01.01.01 Long Term are ccreditation Program Medicare/Medicaid ertification-based Option
More informationNew Oral Anticoagulants. How safe are they outside the trials?
New Oral Anticoagulants How safe are they outside the trials? Objectives The need for anticoagulant therapy Indications for anticoagulation Traditional anticoagulant therapies Properties of new oral anticoagulants
More informationNational Hospital Inpatient Quality Reporting Measures Specifications Manual
National Hospital Inpatient Quality Reporting Measures Specifications Manual Release Notes Version: 5.0 Release Notes Completed: March 9, 2015 Guidelines for Using Release Notes The Release Notes Version
More informationNY Medicaid. EHR Incentive Program
Eligible Hospitals Participation Year 2-3 (MU1) Webinar www.emedny.org/meipass 1 Background Original Legislation The Health Information Technology for Economic and Clinical Health (HITECH) Act, part of
More informationThe Centers for Medicare & Medicaid Services (CMS) Acute Care Hospital Fiscal Year (FY) 2018 Quality Improvement Program Measures
ID Me asure Name NQF # - (HRRP) ID Me asure Name NQF # - (HRRP) ID Me asure Name NQF # - (HRRP) CMS Measures Fiscal Year 2018 The Centers for Medicare & Medicaid Services (CMS) Acute Care Fiscal Year (FY)
More informationNnEeWw DdEeVvEeLlOoPpMmEeNnTtSs IiıNn OoRrAaLl AaNnTtIiıCcOoAaGgUuLlAaTtIiıOoNn AaNnDd RrEeVvEeRrSsAaLl
NnEeWw DdEeVvEeLlOoPpMmEeNnTtSs IiıNn OoRrAaLl AaNnTtIiıCcOoAaGgUuLlAaTtIiıOoNn AaNnDd RrEeVvEeRrSsAaLl Mikele Wissing, RN June 2014 Introduction until recently, was the unrivaled medication for treatment
More informationemeasures Transitions
WHITE PAPER 1010100010101010101010101001000011001 10101000101101101000100000101010010000101011001001010110 0101000101101010001010101010101010100100001010 0101000101101010001011011010001000001010100100
More informationThrombosis and Hemostasis
Thrombosis and Hemostasis Wendy Lim, MD, MSc, FRCPC Associate Professor, Department of Medicine McMaster University, Hamilton, ON Overview To review the important developments in venous thromboembolism
More informationTime for a Cool Change Measure and Compare
Time for a Cool Change Measure and BRENDA BARTKOWSKI, CMA, CCA, BS HPA M ANAGER, C LINICAL D ATA A BSTRACTION About Amphion Dedicated core measure staff Experienced leadership in healthcare technology
More informationAnticoagulation Dosing at UCDMC Indication Agent Standard Dose Comments and Dose Adjustments VTE Prophylaxis All Services UFH 5,000 units SC q 8 h
Indication Agent Standard Dose Comments and Dose Adjustments VTE Prophylaxis All Services UFH 5,000 units SC q 8 h See EMR adult VTE prophylaxis CI order set Enoxaparin See service specific dosing Assess
More informationThree-Star Composite Rating Method
Three-Star Composite Rating Method CheckPoint uses three-star composite ratings to enable consumers to more quickly and easily interpret information about hospital quality measures. Composite ratings combine
More informationOutpatient Treatment of Deep Vein Thrombosis with Low Molecular Weight Heparin (LMWH) Clinical Practice Guideline August 2013
Outpatient Treatment of Deep Vein Thrombosis with Low Molecular Weight Heparin (LMWH) Clinical Practice Guideline August 2013 General Principles: There is compelling data in the medical literature to support
More informationAnticoagulant therapy
Anticoagulation: The risks Anticoagulant therapy 1990 2002: 600 incidents reported 120 resulted in death of patient 92 deaths related to warfarin usage 28 reports related to heparin usage Incidents in
More informationService Specification Template Department of Health, updated June 2015
Service Specification Template Department of Health, updated June 2015 Service Specification No. : 2 Service: Commissioner Lead: Provider Lead: Period: Anti-coagulation monitoring Date of Review: 31 st
More informationThree new/novel oral anticoagulants (NOAC) have been licensed in Ireland since 2008:
Key Points to consider when prescribing NOACs Introduction Three new/novel oral anticoagulants (NOAC) have been licensed in Ireland since 2008: Dabigatran Etexilate (Pradaxa ) 75mg, 110mg, 150mg. Rivaroxaban
More informationACUTE STROKE REGISTRY (NJASR) VERSION 2.0) (Continued)
New Jersey Department of Health ACUTE STROKE REGISTRY (NJASR) VERSION 2.0 A. DEMOGRAPHIC DATA *Hospital Type (1): 1=Primary 2=Comprehensive 3=Other *Hospital Code (2): *Hospital Transferred From Code (3):
More information2.5mg SC daily. INR target 2-3 30 mg SC q 12 hr or 40mg daily. 10 mg PO q day (CrCl 30 ml/min). Avoid if < 30 ml/min. 2.
Anticoagulation dosing at UCDMC (SC=subcutaneously; CI=continuous infusion) Indication Agent Dose Comments Prophylaxis Any or No bleeding risk factors see adult heparin (VTE prophylaxis) IV infusion order
More informationABOUT XARELTO CLINICAL STUDIES
ABOUT XARELTO CLINICAL STUDIES FAST FACTS Xarelto (rivaroxaban) is a novel, oral direct Factor Xa inhibitor. On September 30, 2008, the European Commission granted marketing approval for Xarelto for the
More informationInternational Hospital Inpatient Quality Measures
I-Acute Myocardial Infarction (I-AMI) I-AMI-1 Aspirin at Arrival Aspirin received within 24 hours of arrival to the hospital for patients having an acute myocardial infarction (AMI). I-AMI-2 Aspirin Prescribed
More informationHITECH Act Update: An Overview of the Medicare and Medicaid EHR Incentive Programs Regulations
HITECH Act Update: An Overview of the Medicare and Medicaid EHR Incentive Programs Regulations The Health Information Technology for Economic and Clinical Health Act (HITECH Act) was enacted as part of
More informationTitle of Guideline. Thrombosis Pharmacist)
Title of Guideline Contact Name and Job Title (author) Guideline for patients receiving Rivaroxaban (Xarelto ) requiring Emergency Surgery or treatment for Haemorrhage Julian Holmes (Haemostasis and Thrombosis
More informationNational Hospital Inpatient Quality Reporting Measures Specifications Manual
National Hospital Inpatient Quality Reporting Measures Specifications Manual Release Notes Version: 4.2 Release Notes Completed: June 25, 2012 Guidelines for Using Release Notes Release Notes 4.2 provide
More informationTo aid practitioners in prescribing unfractionated heparin and low-molecular-weight heparins to patients.
UNFRACTIONATED HEPARIN AND LOW-MOLECULAR-WEIGHT HEPARIN TARGET AUDIENCE: All Canadian health care professionals. OBJECTIVE: To aid practitioners in prescribing unfractionated heparin and low-molecular-weight
More informationGet With The Guidelines - Stroke PMT Special Initiatives Tab for Ohio Coverdell Stroke Program CODING INSTRUCTIONS Effective 10-24-15
Get With The Guidelines - Stroke PMT Special Initiatives Tab for Ohio Coverdell Stroke Program CODING INSTRUCTIONS Effective 10-24-15 Date and time first seen by ED MD: The time entered should be the earliest
More informationUse of Antithrombotic Agents In The Presence Of Neuraxial Anesthesia
Use of Antithrombotic Agents In The Presence Of Neuraxial Anesthesia Insertion, removal or presence of a catheter in selected sites can place a patient who is antithrombotic agent at risk for a local bleeding
More informationPrescriber Guide. 20mg. 15mg. Simply Protecting More Patients. Simply Protecting More Patients
Prescriber Guide 20mg Simply Protecting More Patients 15mg Simply Protecting More Patients 1 Dear Doctor, This prescriber guide was produced by Bayer Israel in cooperation with the Ministry of Health as
More informationWhat Does Pregnancy Have to Do With Blood Clots in a Woman s Legs?
Patient s Guide to Prevention of Blood Clots During Pregnancy: Use of Blood-Thinning A Patient s Guide to Prevention of Blood Clots During Pregnancy: Use of Blood-Thinning Drugs to Prevent Abnormal Blood
More informationCommittee Approval Date: September 12, 2014 Next Review Date: September 2015
Medication Policy Manual Policy No: dru361 Topic: Pradaxa, dabigatran Date of Origin: September 12, 2014 Committee Approval Date: September 12, 2014 Next Review Date: September 2015 Effective Date: November
More informationFDA Approved Oral Anticoagulants
FDA Approved Oral Anticoagulants Generic (Trade Name) Warfarin (Coumadin, Jantoven ) 1 FDA approved indication Prophylaxis and treatment of venous thromboembolism (VTE) Prophylaxis and treatment of thromboembolic
More informationMCHENRY WESTERN LAKE COUNTY EMS SYSTEM OPTIONAL CE ADVANCED LEVEL (EMTP, PHRN, ECRN) August 2013. Anticoagulants
MCHENRY WESTERN LAKE COUNTY EMS SYSTEM OPTIONAL CE ADVANCED LEVEL (EMTP, PHRN, ECRN) August 2013 Anticoagulants Anticoagulants are agents that prevent the formation of blood clots. Before we can talk about
More informationCDEC FINAL RECOMMENDATION
CDEC FINAL RECOMMENDATION RIVAROXABAN (Xarelto Bayer Inc.) New Indication: Pulmonary Embolism Note: The Canadian Drug Expert Committee (CDEC) previously reviewed rivaroxaban for the treatment of deep vein
More informationSession 3 Topics. Argatroban. Argatroban. Drug Use and Adverse Effects. Laboratory Monitoring of Anticoagulant Therapy
~~Marshfield Labs Presents~~ Laboratory Monitoring of Anticoagulant Therapy Session 3 of 4 Michael J. Sanfelippo, M.S. Technical Director, Coagulation Services Session 3 Topics Direct Thrombin Inhibitors:
More informationEHR Meaningful Use 2014 (Stage 1 & 2) DR Reporting Strategies
EHR Meaningful Use 2014 (Stage 1 & 2) DR Reporting Strategies International MUSE Conference 2013 Educational Session: #1179 Date: Friday May 31 at 3:30 pm Presenter: Glen D Abate Session Agenda CMS EHR
More informationHERTFORDSHIRE MEDICINES MANAGEMENT COMMITTEE (HMMC) RIVAROXABAN RECOMMENDED see specific recommendations for licensed indications below
Name: generic (trade) Rivaroxaban (Xarelto ) HERTFORDSHIRE MEDICINES MANAGEMENT COMMITTEE (HMMC) RIVAROXABAN RECOMMENDED see specific recommendations for licensed indications below What it is Indications
More informationFailure or significant adverse effects to all of the alternatives: Eliquis and Xarelto
This policy has been developed through review of medical literature, consideration of medical necessity, generally accepted medical practice standards, and approved by the IEHP Pharmacy and Therapeutics
More informationPulmonary Embolism Treatment Update
UC SF Pulmonary Embolism Treatment Update Jeffrey Tabas, MD Professor UCSF School of Medicine Emergency Department San Francisco General Hospital sf g h Disclosure No Financial Relationships to Disclose
More informationAntithrombotic therapy
Orthogeriatrics Clinical Summary Document Antithrombotic therapy Topics Preexisting anticoagulation and timing of surgery Reversal of anticoagulation Perioperative thromboprophylaxis When should we be
More informationPrevention of stroke and systemic embolism in adult patients with non-valvular atrial fibrillation (AF) with one or more risk factors
News Release For use outside the US and UK only Bayer Pharma AG 13342 Berlin Germany Tel. +49 30 468-1111 www.bayerpharma.com Bayer s Xarelto Approved in the EU for the Prevention of Stroke in Patients
More informationAnticoagulants in Atrial Fibrillation
Anticoagulants in Atrial Fibrillation Starting and Stopping Them Safely Carmine D Amico, D.O. Overview Learning objectives Introduction Basic concepts Treatment strategy & options Summary 1 Learning objectives
More informationCLINICAL PRACTICE GUIDELINE: MOBILITY WITH A DEEP VEIN THROMBOSIS (DVT) Page 1 of 10
Page 1 of 10 1.0 FOCUS: Mobilization with a Deep Vein Thrombosis (DVT). The purpose of this clinical practice guideline (CPG) is to ensure that new knowledge is integrated across Fraser Health and to standardize
More informationDevang M. Desai, MD, FACC, FSCAI Chief of Interventional Cardiology Director of Cardiac Catheterization Lab St. Mary s Hospital and Regional Medical
Devang M. Desai, MD, FACC, FSCAI Chief of Interventional Cardiology Director of Cardiac Catheterization Lab St. Mary s Hospital and Regional Medical Center A.Fib affects 2.2 million Americans. The lifetime
More informationDabigatran (Pradaxa) Guidelines
Dabigatran (Pradaxa) Guidelines Dabigatran is a new anticoagulant for reducing the risk of stroke in patients with atrial fibrillation. Dabigatran is a direct thrombin inhibitor, similar to warfarin, without
More information2016 PQRS OPTIONS FOR INDIVIDUAL MEASURES: CLAIMS, REGISTRY
Measure #326 (NQF 1525): Atrial Fibrillation and Atrial Flutter: Chronic Anticoagulation Therapy National Quality Strategy Domain: Effective Clinical Care 2016 PQRS OPTIONS FOR INDIVIDUAL MEASURES: CLAIMS,
More informationNovel Anticoagulation Agents DISCLOSURES. Objectives ATRIAL FIBRILLATION TRIALS. NOAC Comparison 6/12/2015
Novel Anticoagulation Agents DISCLOSURES James W. Haynes, MD Department of Family Medicine Univ of TN Health Science Center (Chattanooga) Objectives Understand mechanism of action behind the NOAC agents
More informationLow Molecular Weight Heparin. All Wales Medicines Strategy Group (AWMSG) Recommendations and advice
Low Molecular Weight Heparin All Wales Medicines Strategy Group (AWMSG) Recommendations and advice Starting Point Low Molecular Weight Heparin (LMWH): Inhibits factor Xa and factor IIa (thrombin) Small
More informationTo provide an evidenced-based approach to treatment of patients presenting with deep vein thrombosis.
DEEP VEIN THROMBOSIS: TREATMENT TARGET AUDIENCE: All Canadian health care professionals. OBJECTIVE: To provide an evidenced-based approach to treatment of patients presenting with deep vein thrombosis.
More informationKevin Saunders MD CCFP Rivergrove Medical Clinic Wellness Institute @ SOGH April 17 2013
Kevin Saunders MD CCFP Rivergrove Medical Clinic Wellness Institute @ SOGH April 17 2013 Family physician with Rivergrove Medical Clinic Practice in the north end since 1985 Medical Director of the Wellness
More informationHow To Get A Dose Of Bayer Healthcare'S Oral Anticoagulant, Xarelto
News Release FOR UK HEALTHCARE MEDIA ONLY Bayer HealthCare Bayer plc Bayer House Strawberry Hill Newbury Berkshire, RG14 1JA www.bayer.co.uk Bayer s Xarelto (rivaroxaban) Recommended by CHMP for EU Approval
More informationUniversity of Illinois at Chicago College of Pharmacy. Hospital Compliance with Proposed JCAHO Performance Measures for VTE
1 Hospital Compliance with Proposed JCAHO Performance Measures for VTE Vikrant Vats, PhD Post Doc Research Associate Center of Pharmacoeconomic Research Background/Rationale Venous thromboembolism (VTE)
More informationVenous Thromboembolism: Long Term Anticoagulation. Dan Johnson, Pharm.D.
Venous Thromboembolism: Long Term Anticoagulation Dan Johnson, Pharm.D. Disclosures No financial relationships with products discussed Off-label use of drug therapy always discussed Objectives Review clinical
More informationClinical Practice Guideline for Anticoagulation Management
Clinical Practice Guideline for Anticoagulation Management This guideline is to inform practitioners of the Standard of Care for providing safe and effective anticoagulation management for ambulatory patients.
More informationAtrial Fibrillation Management Across the Spectrum of Illness
Disclosures Atrial Fibrillation Management Across the Spectrum of Illness NONE Barbara Birriel, MSN, ACNP-BC, FCCM The Pennsylvania State University Objectives AF Discuss the pathophysiology, diagnosis,
More informationNew Oral Anticoagulant Drugs What monitoring if any is required?
New Oral Anticoagulant Drugs What monitoring if any is required? Michelle Williamson Supervising Scientist High Throughput Haematology Pathology Queensland PAH Laboratory Overview Background What new oral
More informationPartnership for Healthcare Payment Reform Total Knee Replacement Pilot Quality Report Quarter 1 Quarter 4, 2013
Partnership for Healthcare Payment Reform Total Knee Replacement Pilot Quality Report Quarter 1 Quarter 4, 2013 Introduction This report outlines the total knee replacement pilot quality results for care
More information2. Background This indication of rivaroxaban had not previously been considered by the PBAC.
PUBLIC SUMMARY DOCUMENT Product: Rivaroxaban, tablets, 15mg and 20mg, Xarelto Sponsor: Bayer Australia Ltd Date of PBAC Consideration: March 2013 1. Purpose of Application The application requested the
More informationNEWER ANTICOAGULANTS: FOCUS ON STROKE PREVENTION IN ATRIAL FIBRILLATION AND DEEP VEIN THROMBOSIS/PULMONARY EMBOLISM
NEWER ANTICOAGULANTS: FOCUS ON STROKE PREVENTION IN ATRIAL FIBRILLATION AND DEEP VEIN THROMBOSIS/PULMONARY EMBOLISM Carol Lee, Pharm.D., Jessica C. Song, M.A., Pharm.D. INTRODUCTION For many years, warfarin
More informationHow To Take Xarelto
A patient's guide Your clinic's contact details are: Name: Contact number: Contents 2 Why have I been prescribed Xarelto? 2 What is Xarelto? 3 How do I take Xarelto? 3 What should I do if I miss a dose
More informationStroke: Major Public Health Burden. Stroke: Major Public Health Burden. Stroke: Major Public Health Burden 5/21/2012
Faculty Prevention Sharon Ewer, RN, BSN, CNRN Stroke Program Coordinator Baptist Health Montgomery, Alabama Satellite Conference and Live Webcast Monday, May 21, 2012 2:00 4:00 p.m. Central Time Produced
More informationSpecifications Manual for National Inpatient Hospital Quality Reporting Measures
Specifications Manual for National Inpatient Hospital Quality Reporting Measures Release Notes Version: 4.4 Release Notes Completed: June 11, 2014 Guidelines for Using Release Notes Release Notes 4.4 provide
More informationClinical Quality Measures. for 2014
Clinical Quality Measures for 2014 Mission of OFMQHIT To advance the implementation and use of vital health information technology to improve healthcare quality, efficiency and safety by assisting physician
More informationAn Audit of the Documentation and Correct Referral of Patients on Initiation of New Oral Anticoagulants (Dabigatran, Rivaroxaban, Apixaban)
Sabiha Fatima Hussaini Sabiha.hussaini@salisbury.nhs.uk An Audit of the Documentation and Correct Referral of Patients on Initiation of New Oral Anticoagulants (Dabigatran, Rivaroxaban, Apixaban) April
More informationLAMC Reversal Agent Guideline for Anticoagulants 2013. Time to resolution of hemostasis (hrs) Therapeutic Options
LAMC Reversal Agent Guideline for Anticoagulants 2013 Medication resolution of hemostasis (hrs) Intervention Administration Instructions Heparin 3-4 Protamine 1mg IV for every 100 units of heparin Slow
More informationInvestor News. Not intended for U.S. and UK media
Investor News Not intended for U.S. and UK media Bayer AG Investor Relations 51368 Leverkusen Germany www.investor.bayer.com Bayer s Xarelto (Rivaroxaban) Approved for the Treatment of Pulmonary Embolism
More information2/17/2015 ANTICOAGULATION UPDATE OBJECTIVES BRIEF REVIEW: CLASSES OF ORAL ANTICOAGULANTS
ANTICOAGULATION UPDATE C AR R I E P AL M E R, D N P, RN, AN P - BC OBJECTIVES At the end of the presentation, the NP will be able to: Identify new indications for target-specific oral anticoagulants (TSOACs),
More informationClinical Study Synopsis
Clinical Study Synopsis This Clinical Study Synopsis is provided for patients and healthcare professionals to increase the transparency of Bayer's clinical research. This document is not intended to replace
More informationValue-Based Purchasing
Emerging Topics in Healthcare Reform Value-Based Purchasing Janssen Pharmaceuticals, Inc. Value-Based Purchasing The Patient Protection and Affordable Care Act (ACA) established the Hospital Value-Based
More informationPublished 2011 by the American Academy of Orthopaedic Surgeons 6300 North River Road Rosemont, IL 60018. AAOS Clinical Practice Guidelines Unit
Volume 4. AAOS Clinical Guideline on Preventing Venous Thromboembolic Disease in Patients Undergoing Elective Hip and Knee Arthroplasty Comparison with Other Guidelines Disclaimer This clinical guideline
More informationAnticoagulation Therapy Update
Anticoagulation Therapy Update JUDY R. WALLING, FNP-BC ARRHYTHMIA MANAGEMENT MUSC CARDIOLOGY Outline Who do we anticoagulate? Review classes of Anticoagulants Review examples of Anticoagulants Review CHADS2
More informationNew Treatments for Stroke Prevention in Atrial Fibrillation. John C. Andrefsky, MD, FAHA NEOMED Internal Medicine Review course May 5 th, 2013
New Treatments for Stroke Prevention in Atrial Fibrillation John C. Andrefsky, MD, FAHA NEOMED Internal Medicine Review course May 5 th, 2013 Classification Paroxysmal atrial fibrillation (AF) Last < 7
More informationCardiovascular Disease
Cardiovascular Disease 1 Cardiovascular Disease 1. More target specific oral anticoagulants (TSOAC) 2. Vorapaxar (Zonivity) 3. Continued noise about a polypill 4. WATCHMAN 3 1 2 3 4 Left Atrial Appendage
More informationMeaningful Use (MU) Education
Meaningful Use (MU) Education The 2014 MU training program has been developed to ensure high quality patient outcomes in conjunction with meeting CMS regulatory requirements. The new charting and ordering
More informationComparison between New Oral Anticoagulants and Warfarin
Comparison between New Oral Anticoagulants and Warfarin Warfarin was the mainstay of oral anticoagulant therapy until the recent discovery of more precise targets for therapy. In recent years, several
More informationBuilding a Safe Anticoagulation Program By knowing that Safety is not about numbers, Safety is about an attitude..
Building a Safe Anticoagulation Program By knowing that Safety is not about numbers, Safety is about an attitude.. Speakers: Sue Dawson, MA, RN, CCRP Clinical Specialist-Cardiology Cam F. Campbell, M.D.
More informationVenous Thromboembolic Treatment Guidelines
Venous Thromboembolic Treatment Guidelines About the NYU Venous Thromboembolic Center (VTEC) The center s mission is to deliver advanced screening, detection, care, and management services for patients
More informationPreventing Blood Clots After Hip or Knee Replacement Surgery or Surgery for a Broken Hip. A Review of the Research for Adults
Preventing Blood Clots After Hip or Knee Replacement Surgery or Surgery for a Broken Hip A Review of the Research for Adults Is This Information Right for Me? Yes, if: You are considering or planning to
More informationNumerator Details. - An acute or nonacute inpatient admission with a diagnosis of AOD (AOD Dependence
Description Measure 0004: Initiation and Engagement of Alcohol and Other Drug Dependence Treatment (IET) (National Committee for Quality Assurance) The percentage of adolescent and adult patients with
More informationHow To Manage An Anticoagulant
PERI-OPERATIVE MANAGEMENT OF PATIENTS WHO ARE RECEIVING A NEW ORAL ANTICOAGULANT (DABIGATRAN, RIVAROXABAN, APIXABAN) TARGET AUDIENCE: All Canadian health care professionals, including primary care physicians,
More informationTrust Guideline for Thromboprophylaxis in Trauma and Orthopaedic Inpatients
A clinical guideline recommended for use In: By: For: Key words: Department of Orthopaedics, NNUHT Medical staff Trauma & Orthopaedic Inpatients Deep vein thrombosis, Thromboprophylaxis, Orthopaedic Surgery
More information3/3/2015. Patrick Cobb, MD, FACP March 2015
Patrick Cobb, MD, FACP March 2015 I, Patrick Cobb, MD, DO NOT have a financial interest/arrangement or affiliation with one or more organizations that could be perceived as a real or apparent conflict
More informationDisclosure. New Agents for Treatment of DVT. Prevalence of DVT VTE. Normal Hemostasis 7/17/2015. Mark Oliver, MD, RVT, RPVI,FSVU
New Agents for Treatment of DVT Disclosure PI Adopt and Amplify trials Mark Oliver, MD, RVT, RPVI,FSVU BMS and Pfizer Speaker VTE Venous Thromboembolism Recognized DVT s New : 170,000 Recurrent : 90,000
More informationThe author has no disclosures
Mary Bradbury, PharmD, BCPS Clinical Pharmacy Specialist, Cardiac Surgery September 18, 2012 Mary.bradbury@inova.org This presentation will discuss unlabeled and investigational use of products The author
More informationMedicare & Medicaid EHR Incentive Program Final Rule. Implementing the American Recovery & Reinvestment Act of 2009
Medicare & Medicaid EHR Incentive Program Final Rule Implementing the American Recovery & Reinvestment Act of 2009 Overview American Recovery & Reinvestment Act (Recovery Act) February 2009 Medicare &
More informationUpdates to the Alberta Drug Benefit List. Effective January 1, 2016
Updates to the Alberta Drug Benefit List Effective January 1, 2016 Inquiries should be directed to: Pharmacy Services Alberta Blue Cross 10009 108 Street NW Edmonton AB T5J 3C5 Telephone Number: (780)
More informationCritical Bleeding Reversal Protocol
Critical Bleeding Reversal Protocol Coagulopathy, either drug related or multifactorial, is a major contributing factor to bleeding related mortality in a variety of clinical settings. Standard therapy
More informationUHS CLINICAL CARE COLLABORATION: Outpatient & Inpatient
Guidelines for Anticoagulation Initiation and Management Y2014 UHS CLINICAL CARE COLLABORATION: Outpatient & Inpatient Topic Page Number MEDICATION FLOW AND PATIENT FLOW... 2 AND 3 PARENTERAL ANTICOAGULANTS...
More informationEast Kent Prescribing Group
East Kent Prescribing Group Rivaroxaban (Xarelto ) Safety Information Approved by the East Kent Prescribing Group. Approved by: East Kent Prescribing Group (Representing Ashford CCG, Canterbury and Coastal
More information9/28/15. Dabigatran. Rivaroxaban. Apixaban. Edoxaban. From the AC Forum Centers of Excellence website: Dabigatran, Rivaroxaban, & Apixaban
Identify the FDA approved direct oral anticoagulants (DOACs) Linda Kelly, PharmD, PhC, CACP Presbyterian Healthcare Services Distinguish the differences in the dosing of DOACs for various indications Describe
More information