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Question: Reason for Not Prescribing Antithrombotic / Anticoagulation at Discharge

The STK specifications for discharges April 1,2011 - December 31, 2011 have additional abstraction guidelines for "Reason for Not Prescribing Anticoagulation at Discharge" and "Reason for Not Prescribing Antithrombotic at Discharge". Physician documentation of a hold or discontinuation of an antithrombotic/anticoagulant medication that occurs anytime during the hospital stay constitutes a "clearly implied" reason for not prescribing anticoagulation therapy at discharge with the Exception of a conditional hold, e.g., "Hold Coumadin if guaiac positive".

Our EHR has a post t-PA order set containing an order with the header, "No Antithrombotics - 24 Hours Post Thrombolytic Therapy". In the "Comments Field" it states: "No aspirin, warfarin, heparin, low molecular weight heparin, dipyridamole, clopidogrel, non-steroid anti-inflammatory agents for 24 hours following thrombolytic infusion."

Nearly all of our t-PA patients who have this order are discharged on an antithrombotic, unless complicated by ICH or systemic bleeding. Would this order along with its associated comments be considered an acceptable "Reason for Not Prescribing an Antithrombotic" (STK-2) and "Anticoagulant Therapy at Discharge"(STK-3)?

Answer:

The data element definitions for Antithrombotic and Anticoagulant Therapy Prescribed at Discharge were revised to maintain consistency with abstraction guidelines across similar data elements. The abstraction bullets added to "Antithrombotic and Anticoagulant Therapy Prescribed at Discharge" have always been present in the data element definition for "Reason for Not Prescribing Statin Medication", as well as, AMI and HF discharge medication measures.

Physician documentation of a conditional hold on an antithrombotic or anticoagulant medication is not an accepable reason for not prescribing it at discharge. "No aspirin, warfarin, heparin, low molecular weight heparin, dipyridamole, clopidogrel, non-steroid anti-inflammatory agents for 24 hours following thrombolytic infusion," documented the day of or after arrival will meet "Reason for Not Administering Antithrombotic Therapy by End of Hospital Day 2" (STK-5). It is written similar to a conditional hold in that antithrombotic medications should not be administered for 24 hours post t-PA administration; however, prescription / administration may be appropriate after this period unless otherwise documented in the medical record. Select 'No' for Reason for Not Prescribing at Antithrombotic and Anticoagulant Therapy at Discharge. Further clarification may need to be to the next version of the manual.

Question Details
Focus area(s): Chart Abstracted Measure Specifications – Clinical
Related documents: STK-02,
File:

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