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Question: Graduated Compression Stockings as VTE Prophylaxis for Stroke Patients (STK-1)

I have a two part question: 1. The 3.0b data element definition for VTE prophylaxis lists GCS as an allowable value for prophylaxis. Are GCS considered VTE prophylaxis for stroke patients?

2. If an order for ambulation is written in the medical record (activity as tolerated, up ad lib, etc.), indicating that the patient does not need to be on bedrest, must documentation also reflect that the patient is up and walking around? Or,is the order sufficient to exclude the case from the measure.

Answer:

1. Graduated compression stockings "alone" without another form of VTE prophylaxis are not "sufficient" prophylaxis for the high-risk stroke patient.

VTE Prophylaxis is a shared data element definition for the SCIP, STK, and VTE measure sets. Graduated compression stockings is allowable value "4" in Version 3.0b specifications. There are separate Notes for Abstraction for SCIP, VTE, and STK. For the STROKE patient, allowable value "4" should only be selected when GCS are the sole form of prophylaxis administered to the patient. If GCS are the only form of prophylaxis (e.g., no other prophylaxis, such as heparin or LMWH, administered along with GCS), then a documented "Reason for No VTE Prophylaxis - Hospital Admission" must be present in the medical record to include the case in the numerator. When GCS is the only prophylaxis administered and a reason not documented as to why it was the only prophylaxis, the case will fail the algorithm.

Stroke patients are considered higher risk for DVT/VTE than other medical patients. Pharmacological prophylaxis is recommended unless contraindicated.

2. The data element "Patient Ambulatory By End of Hospital Day 2" has been eliminated. Ambulation is not considered prophylaxis and is listed as an exclusion - see Appendix H, Table 2.2, VTE Exclusion Table, Version 3.0b. 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: VTE-01, STK-1,
File:

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