HH ORAE- PCA infusion dosage

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    • Type: Hosp Inpt eCQMs - Hospital Inpatient eCQMs
    • Resolution: Answered
    • Priority: Moderate
    • Component/s: None
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      Thank you for your inquiry regarding CMS819v3, Hospital Harm - Opioid-Related Adverse Events. Numerator events include: “Inpatient hospitalizations where a non-enteral opioid antagonist administration starts during the hospitalization outside of the operating room and 12 hours or less following an opioid medication administered outside of the operating room.”

      The RxNorm codes indicating evidence of opioids administration is agnostic of basal rate value. Patients with a basal rate of 0 mg/hr would not meet the criteria for the measure since no opioid was administered. We encourage you to work with your EHR vendor to ensure patients with orders for hydromorphone PCA basal rate of 0 mg/hr are not included in the patient population.
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      Thank you for your inquiry regarding CMS819v3, Hospital Harm - Opioid-Related Adverse Events. Numerator events include: “Inpatient hospitalizations where a non-enteral opioid antagonist administration starts during the hospitalization outside of the operating room and 12 hours or less following an opioid medication administered outside of the operating room.” The RxNorm codes indicating evidence of opioids administration is agnostic of basal rate value. Patients with a basal rate of 0 mg/hr would not meet the criteria for the measure since no opioid was administered. We encourage you to work with your EHR vendor to ensure patients with orders for hydromorphone PCA basal rate of 0 mg/hr are not included in the patient population.
    • CMS0819v3

      The MD ordered, “hydromorphone PCA infusion premix 30 mg/ 30ml NS. The order instruction included PCA setting - basal rate 0 mg/hr, bolus dose 0.3mg, lockout 7 min, max dose/hr;1.2mg.  Since this basal rate is, “0” if the patient did not receive a dose of the narcotic, it does not seem appropriate to include the patient in the measure.

      In this case, our vendor verified that the logic was working correctly using the mapping for the Rx Norm Code despite the fact that the patient was not receiving any narcotic at that time.

      Questions:

      1. Do the current RX Norm codes include PCA infusions with a basal rate?
      2. If so, why is the logic picking up the a PCA infusion with a 0 basal rate?
      3. If not, should there be consideration for an RX Norm code for PCA infusions with a basal rate with a numeric value > 0mg?

            Assignee:
            Mathematica EH eCQM Team
            Reporter:
            Angela Maggipinto
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