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Release Notes:
Data Element
Version 2013B

Data Element Name: Appropriate Justification for Multiple Antipsychotic Medications
Collected For: HBIPS-5,
Definition:Documentation in the medical record of appropriate justification for discharging the patient on two or more routine antipsychotic medications.
Suggested Data Collection Question:Is there documentation in the medical record of appropriate justification for the patient being discharged on two or more antipsychotic medications?
Format:
Length:1
Type:Alphanumeric
Occurs:1
Allowable Values:

1    The medical record contains documentation of a history of a minimum of three failed multiple trials of monotherapy.

2    The medical record contains documentation of a recommended plan to taper to monotherapy due to previous use of multiple antipsychotic medications OR documentation of a cross-taper in progress at the time of discharge.

3    The medical record contains documentation of augmentation of Clozapine.

4    The medical record contains documentation of a justification other than those listed in Allowable Values 1-3.

5    The medical record does not contain documentation supporting the reason for being discharged on two or more antipsychotic medications OR unable to determine from medical record documentation.

Notes for Abstraction:If the patient was in an acute-care hospital and had multiple admissions to the psychiatric unit during his or her hospitalization, this information should be abstracted only once at the time of discharge from the hospital or at the time of final discharge from the psychiatric unit.

The recommended plan to taper to monotherapy must appear in the continuing care plan transmitted to the next level of care provider. All other justifications may be documented anywhere in the medical record.

"Failed multiple trials of monotherapy" comprises a history of three or more failed trials by history in which there was a lack of sufficient improvement in symptoms or functioning. The documentation should include at a minimum the names of the antipsychotic medications that previously failed.

A cross-taper plan is defined as a plan to decrease the dosage of one or more antipsychotic medications while increasing the dosage of another antipsychotic medication to a level which results in controlling the patient's symptoms with one antipsychotic medication. The cross-taper plan must list the names of the medications intended to increase and taper off. The recommended plan must include the name(s) of the medication(s) to be tapered.

Only allowable values 1, 2 and 3 are supported by an evidence base which will allow the case to pass the measure. Allowable value 4 can be used as part of an internal performance improvement activity, but the case will not pass the measure.

Suggested Data Sources:

  • Aftercare discharge plan
  • Continuing care plan
  • Discharge plan
  • Final discharge summary
  • History and physical
  • Interim discharge summary
  • Medication reconciliation form
  • Physician discharge orders
  • Physician progress notes
  • Referral form
Additional Notes:

Guidelines for Abstraction:
Inclusion Exclusion
  • None
  • None

Appropriate Justification for Multiple Antipsychotic Medications
Specifications Manual for Joint Commission National Quality Measures (v2013B)
Discharges 07-01-13 (3Q13) through 12-31-13 (4Q13)