Brief Description of Measure: CMS819/HH-ORAE: Hospital Harm - Opioid-Related Adverse Events This measure assesses the number of inpatient hospitalizations for patients age 18 and older who have been administered an opioid medication and are subsequently administered an opioid antagonist within 12 hours, an indication of an opioid-related adverse event Description of Issue: Currently, the numerator looks for all opioid antagonists given after an opioid, even when the initial opioid was administered in the operating room. The majority of general anesthesia cases involve opioid administration for pain control and rapid induction, and are appropriately followed by an antagonist to reverse induction. For this reason, the measure steward’s clinical experts recommend the measure exclude any opioids given in the operating room (OR) from being evaluated for the numerator.

Proposed Solution: The measure steward proposes not including opioids administered in the OR when evaluating for the Numerator criteria. Current Numerator header: Inpatient hospitalizations where an opioid antagonist was administered outside of the operating room and within 12 hours following administration of an opioid medication. Proposed Numerator header: Inpatient hospitalizations where an opioid antagonist was administered outside of the operating room and within 12 hours following an opioid medication administered outside of the operating room. Current Numerator logic: define Encounter with Non Enteral Opioid Antagonist Administration Outside of Operating Room and within 12 Hrs After Opioid // Opioids administered before opioid antagonist AND excludes opioid antagonist administered in operating room AND limits opioid antagonist to non-enteral routes// from   ["Medication, Administered": "Opioid Antagonist"] OpioidAntagonistGiven,   "Opioid Administration" OpioidGiven,   "Denominator" EncounterWithQualifyingAge   where not exists ( EncounterWithQualifyingAge.facilityLocations EncounterLocation       where EncounterLocation.code ~ "Operating Room/Suite"         and Global."NormalizeInterval" ( OpioidAntagonistGiven.relevantDatetime, OpioidAntagonistGiven.relevantPeriod ) starts during EncounterLocation.locationPeriod   )     and ( Global."NormalizeInterval" ( OpioidAntagonistGiven.relevantDatetime, OpioidAntagonistGiven.relevantPeriod ) starts during Global."HospitalizationWithObservation" ( EncounterWithQualifyingAge )         and Global."NormalizeInterval" ( OpioidGiven.relevantDatetime, OpioidGiven.relevantPeriod ) starts during Global."HospitalizationWithObservation" ( EncounterWithQualifyingAge )         and Global."NormalizeInterval" ( OpioidGiven.relevantDatetime, OpioidGiven.relevantPeriod ) ends 12 hours or less before start of Global."NormalizeInterval" ( OpioidAntagonistGiven.relevantDatetime, OpioidAntagonistGiven.relevantPeriod )         and OpioidAntagonistGiven.route in "Routes of Administration for Opioid Antagonists"     )   return EncounterWithQualifyingAge Proposed Numerator logic: define Encounter with NonEnteral Opioid Antagonist Administered Outside of OR and within 12 Hrs After Opioid Administered Outside of OR // Excludes opioid antagonist administered in operating room AND excludes opioids administered in operating room AND opioid administered before opioid antagonist AND limits opioid antagonist to non-enteral routes// from   "Non Enteral Opioid Antagonist Administration" NonEnteralOpioidAntagonistGiven,   "Opioid Administration" OpioidGiven,   "Denominator" QualifyingEncounter   let NonEnteralOpioidAntagonistGivenStart: Global."NormalizeInterval" ( NonEnteralOpioidAntagonistGiven.relevantDatetime, NonEnteralOpioidAntagonistGiven.relevantPeriod ),   OpioidGivenStart: Global."NormalizeInterval" ( OpioidGiven.relevantDatetime, OpioidGiven.relevantPeriod ),   HospitalPeriod: Global."HospitalizationWithObservation" ( QualifyingEncounter )   where not exists ( QualifyingEncounter.facilityLocations EncounterLocation       where EncounterLocation.code ~ "Operating Room/Suite"         and NonEnteralOpioidAntagonistGivenStart starts during EncounterLocation.locationPeriod   )     and not exists ( QualifyingEncounter.facilityLocations EncounterLocation         where EncounterLocation.code ~ "Operating Room/Suite"           and OpioidGivenStart starts during EncounterLocation.locationPeriod     )     and NonEnteralOpioidAntagonistGivenStart starts during HospitalPeriod     and OpioidGivenStart starts during HospitalPeriod     and OpioidGivenStart ends 12 hours or less before start of NonEnteralOpioidAntagonistGivenStart   return QualifyingEncounter Rationale for Change: Exclude opioid administration in the OR when evaluating the Numerator criteria to align with measure intent and clinical best practice.