Performance Measurement Network

Question: Reason for not prescribing antithrombotic therapy at hospital discharge

Is the following adequate documentation as reason for not prescribing antithrombotic therapy at discharge? "She is a very poor candidate for long-term anticoagulation." "Patient was seen by pulmonary consultation regarding the patient's use of coumadin since she is significantly non-compliant, unsteady on her legs with frequent history of falls and being a high risk." Antithrombotics were not documented specifically only referenced anticoagulants and coumadin specifically.

Answer:

Select 'Yes' for Reason for Not Precribing Antithrombotic at Discharge. Both anticoagulants and antiplatelet agents are considered antithrombotics. Coumadin is listed in Appendix C, Table 8.2 Antithrombotic Agents for Stroke (refer to medication table 8.2). The physician note states that the patient is not a candidate because high risk for falls (i.e., risk of bleeding post fall with any antithrombotic).

However, if the patient is 'allergic' to one of the antithromboitc medications listed on Table 8.2, another medication may be prescribed because of the number of choices in this category. An allergy to Coumadin would not be a Reason for Not Prescribing Antithrombotics at Discharge. Another antithromboitc medication can be ordered.

http://www.jointcommission.org/PerformanceMeasurement/PerformanceMeasurement/Current+NHQM+Manual.htm

Question Details
Focus area(s): Chart Abstracted Measure Specifications – Clinical, Related Manual - Data Quality Manual
Related documents: STK, STK-2 Discharged on Antithrombotic Therapy
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