CMS172 (NQF 528) version 3 Prophylactic Antibiotic Selection for Surgical Patients. This question is regarding the logic using the data element Medication, Administered: Vancomycin with the attributes of route IV and reason of request of physician.

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    • Type: Annual Update
    • Resolution: Delivered
    • Priority: Minor
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      Thank you for your question. The intent of this logic is indeed to capture order and administration of Vancomycin due to an increased MRSA rate within the facility.

      After discussion with the measure steward it was decided to change the logic using your recommendation in order to capture the act of ordering the medication as well as administering it.

      AND: “Medication, Order: Hospital measures – IV Vancomycin (route: 'Hospital measures-Route IV', reason: 'Hospital measures - Request of physician')"
      AND: "Medication, Administered: Hospital measures-IV Vancomycin (route: 'Hospital measures-Route IV')”

      This change to CMS172v3/NQF0528 was made during the April 2014 annual update.
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      Thank you for your question. The intent of this logic is indeed to capture order and administration of Vancomycin due to an increased MRSA rate within the facility. After discussion with the measure steward it was decided to change the logic using your recommendation in order to capture the act of ordering the medication as well as administering it. AND: “Medication, Order: Hospital measures – IV Vancomycin (route: 'Hospital measures-Route IV', reason: 'Hospital measures - Request of physician')" AND: "Medication, Administered: Hospital measures-IV Vancomycin (route: 'Hospital measures-Route IV')” This change to CMS172v3/NQF0528 was made during the April 2014 annual update.

      CMS172 (NQF 528) version 3 Prophylactic Antibiotic Selection for Surgical Patients. This question is regarding the logic using the data element Medication, Administered: Vancomycin with the attributes of route IV and reason of request of physician. The logic is used in 6 numerators, included is the logic from numerator 1. This was added with the updates in April 2013.
      The value set for Request of physician is one value: SNOMEDCT code 103321005 Request by physician.
      What is the overall intent of this piece of logic? Is it intended to capture the indication described in the numerator section of the guidance of ordering Vancomycin because of an increase risk due to an increased MRSA rate within the facility/organization? If so, then capturing this at the point of medication administration is inadequate. We recommend changing this to the medication, order workflow with an added attribute of system reason.
      Current logic:
      OR:
       OR: "Medication, Administered: Hospital measures-IV Vancomycin (route: 'Hospital measures-Route IV', reason: 'Hospital measures - Request of physician')"
       OR: "Medication, Administered: Hospital Measures-IV Cardiac or Vascular Antibiotics (route: 'Hospital measures-Route IV')"
       <= 1440 minute(s) starts before start of "Occurrence A of Procedure, Performed: Hospital measures-CABG (incision datetime)"
       OR:
       OR: "Medication, Administered: Hospital measures-IV Vancomycin (route: 'Hospital measures-Route IV', reason: 'Hospital measures - Request of physician')"
       OR: "Medication, Administered: Hospital Measures-IV Cardiac or Vascular Antibiotics (route: 'Hospital measures-Route IV')"
       <= 1440 minute(s) starts after end of "Occurrence A of Procedure, Performed: Hospital measures-Joint Commission evidence of a surgical procedure requiring general or neuraxial anesthesia"
      Recommended change:
      OR:
      AND: “Medication, Order: Hospital measures – IV Vancomycin (route: 'Hospital measures-Route IV', reason: 'Hospital measures - Request of physician')"
      AND: "Medication, Administered: Hospital measures-IV Vancomycin (route: 'Hospital measures-Route IV')”
      <= 1440 minute(s) starts before start of "Occurrence A of Procedure, Performed: Hospital measures-CABG (incision datetime)"
      OR:
      OR: "Medication, Administered: Hospital Measures-IV Cardiac or Vascular Antibiotics (route: 'Hospital measures-Route IV')"
      <= 1440 minute(s) starts before start of "Occurrence A of Procedure, Performed: Hospital measures-CABG (incision datetime)"
      OR:
      AND: “Medication, Order: Hospital measures – IV Vancomycin (route: 'Hospital measures-Route IV', reason: 'Hospital measures - Request of physician')"
      AND: "Medication, Administered: Hospital measures-IV Vancomycin (route: 'Hospital measures-Route IV')”
      <= 1440 minute(s) starts after end of "Occurrence A of Procedure, Performed: Hospital measures-Joint Commission evidence of a surgical procedure requiring general or neuraxial anesthesia"
      OR:
      OR: "Medication, Administered: Hospital Measures-IV Cardiac or Vascular Antibiotics (route: 'Hospital measures-Route IV')"
      <= 1440 minute(s) starts after end of "Occurrence A of Procedure, Performed: Hospital measures-Joint Commission evidence of a surgical procedure requiring general or neuraxial anesthesia"

            Assignee:
            Abt Associate (Inactive)
            Reporter:
            Anne Coultas (Inactive)
            eldred (Inactive)
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