ALERT! Warning: your browser isn't supported. Please install a modern one, like Firefox, Opera, Safari, Chrome or the latest Internet Explorer. Thank you!
Specifications Manual for Joint Commission National Quality Measures (v2015A)
Home » Reason for No Aspirin at Discharge

Release Notes:
Data Element
Version 2015A

Data Element Name: Reason for No Aspirin at Discharge
Collected For: AMI-2,
Definition:Reasons for not prescribing aspirin at discharge:
  • Aspirin allergy
  • One or more of the medications listed in the Inclusion list were prescribed at discharge
  • Other reasons documented by physician/advanced practice nurse/physician assistant (physician/APN/PA) or pharmacist
Aspirin reduces the tendency of blood to clot by blocking the action of a type of blood cell involved in clotting. Aspirin improves chances of surviving a heart attack and reduces the risk of recurrence in patients who have experienced a heart attack.
Suggested Data Collection Question:Is there documentation of a reason for not prescribing aspirin at discharge?
Format:
Length:1
Type:Alphanumeric
Occurs:1
Allowable Values:

Y   (Yes)   There is documentation of a reason for not prescribing aspirin at discharge.

N   (No)   There is no documentation of a reason for not prescribing aspirin at discharge or unable to determine from medical documentation.
Notes for Abstraction:
  • Aspirin "allergy"” or “"sensitivity"” documented at anytime during the hospital stay counts as an allergy regardless of what type of reaction might be noted (e.g., "“Allergies: ASA – Upsets stomach"” – select “"Yes"”).
  • Documentation of an allergy/sensitivity to one particular type of aspirin is acceptable to take as an allergy to the entire class of aspirin-containing medications (e.g., "“Allergic to Empirin"”).
  • When determining whether a medication listed in the Inclusion list was prescribed at discharge (i.e., a reason for not prescribing aspirin at discharge):
    • Include a medication on hold at discharge but there is documentation of a plan to restart it after discharge. E.g., “"Resume Coumadin after INR normalizes.”"
    • If two discharge summaries are included in the medical record, use the one with the latest date/time. If one or both are not dated or timed, and you cannot determine which was done last, use both. This also applies to discharge medication reconciliation forms. Use the dictated date/time over transcribed date/time, file date/time, etc.
      Examples:
      • Two discharge summaries, one dictated 5/22 (day of discharge) and one dictated 5/27 - Use the 5/27 discharge summary.
      • Two discharge medication reconciliation forms, one not dated and one dated 4/24 (day of discharge) - Use both.
  • When conflicting information is documented in a medical record, select "“Yes.”"
  • When determining whether there is a reason documented by a physician/APN/PA or pharmacist for not prescribing aspirin at discharge:
    • Reasons must be explicitly documented (e.g., "“Chronic hepatitis -– No ASA"”) or clearly implied (e.g., "“GI bleeding with aspirin in past,"” "“ASA contraindicated,"” "“Pt. refusing all medications,"” "“Supportive care only -– no medications," "“Aspirin not indicated,"” aspirin on pre-printed order form is crossed out, "“No aspirin”" [no reason given]). If reasons are not mentioned in the context of aspirin, do not make inferences (e.g., Do not assume that aspirin is not being prescribed because of the patient's history of PUD alone).
    • Physician/APN/PA or pharmacist documentation of a hold on aspirin or discontinuation of aspirin that occurs during the hospital stay constitutes a “"clearly implied"” reason for not prescribing aspirin at discharge. A hold/discontinuation of all p.o. medications counts if aspirin p.o. was on order at the time of the notation.
      EXCEPTIONS:
      • Documentation of a conditional hold or discontinuation of aspirin does not count as a reason for not prescribing aspirin at discharge (e.g., "“Hold ASA if positive Occult Blood stool,"” “"Stop aspirin if blood in urine recurs"”).
      • Discontinuation of a particular aspirin medication documented in combination with the start of a different aspirin medication (i.e., switch in type of aspirin medication) does not count as a reason for not prescribing aspirin at discharge.
        Examples:
        • "“Stop aspirtab"” and “"Start Ecotrin 81 mg po q am”" in same physician order
        • "“Change ASA to buffered baby ASA”" in progress note
        • “"Do not continue after discharge"” checked for aspirin and "“Continue after discharge"” checked for Aspirin Low Dose on a physician-signed discharge medication reconciliation form
      • Discontinuation of an aspirin medication at a particular dose documented in combination with the start of a different dose of that aspirin (i.e., change in dosage) does not count as a reason for not prescribing aspirin at discharge.
        Examples:
        • "“Stop aspirin 325 mg po q am"” and “"Start aspirin 81 mg po q am”" in same physician order
        • "“Increase aspirin 81 mg to 325 mg”" in progress note
        • "“Do not continue after discharge"” checked for aspirin 325 mg and “"Continue after discharge"” checked for aspirin 81 mg on a physician-signed discharge medication reconciliation form
    • Reason documentation which refers to a more general medication class is not acceptable (e.g., "“Hold all anticoagulants"”). Exception: Documentation of a reason for not prescribing "“antiplatelets"” should be considered implicit documentation of a reason for no aspirin at discharge (e.g. "“Antiplatelet therapy contraindicated"”).
    • Deferral of aspirin from one physician/APN/PA or pharmacist to another does NOT count as a reason for not prescribing aspirin at discharge unless the problem underlying the deferral is also noted.
      Examples:
      • “"Consulting cardiologist to evaluate pt. for ASA."” - select "“No.”"
      • "“Rule out intracranial bleed. Start ASA if OK with neurology."” - select "Yes.”"
    • If there is documentation of a plan to initiate/restart aspirin, and the reason/problem underlying the delay in starting/restarting aspirin is also noted, this constitutes a "“clearly implied"” reason for not prescribing aspirin at discharge.
      Acceptable examples (select “"Yes"”):
      • “"Stool Occult Blood positive. May start Bayer EC as outpatient."”
      • “"Add buffered aspirin if hematuria subsides"”
        Unacceptable examples (select "“No"”):
      • "“Consider starting Ecotrin in a.m.”"
      • "“May add ASA when pt. can tolerate”"
    • Reasons do NOT need to be documented at discharge or otherwise linked to the discharge timeframe: Documentation of reasons anytime during the hospital stay are acceptable (e.g., mid-hospitalization note stating "“no aspirin due to rectal bleeding"” - select "“Yes,"” even if documentation indicates that the rectal bleeding has resolved by the time of discharge and aspirin was restarted).
    • Crossing out of aspirin counts as a "clearly implied reason" for not prescribing aspirin at discharge only if on a pre-printed form.
  • When the current record includes documentation of a pre-arrival reason for no aspirin, the following counts regardless of whether this documentation is included in a pre-arrival record made part of the current record or whether it is noted by hospital staff during the current hospital stay:
    • Pre-arrival aspirin allergy
    • Pre-arrival hold/discontinuation or notation such as "No aspirin" IF the underlying reason/problem is also noted (e.g., "“ASA held in transferring hospital due to possible GI bleed"”).
    • Pre-arrival "other reason" (other than hold/discontinuation or notation of "No aspirin") (e.g., "Hx GI bleeding with aspirin" in transferring ED record).
Suggested Data Sources:

  • Consultation notes
  • Discharge instruction sheet
  • Discharge summary
  • Emergency Department record
  • History and physical
  • Medication administration record
  • Medication reconciliation form
  • Nursing notes
  • Physician orders
  • Progress notes
  • Transfer sheet

Excluded Data Sources:
Any documentation dated/timed after discharge, except discharge summary and operative/procedure/diagnostic test reports (from procedure done during hospital stay).

Additional Notes:
Guidelines for Abstraction:
Inclusion Exclusion
Discharge medications that count as an automatic reason for no aspirin:
  • Apixaban
  • Coumadin
  • Dabigatran
  • Eliquis
  • Jantoven
  • Pradaxa
  • Rivaroxiban
  • Warfarin
  • Warfarin Sodium
  • Xarelto

Refer to Appendix C, Table 1.1 for a comprehensive list of Aspirin and Aspirin-Containing medications.

Aspirin allergy described using one of the negative modifiers or qualifiers listed in Appendix H, Table 2.6, Qualifiers and Modifiers Table.

Reason for No Aspirin at Discharge
Specifications Manual for Joint Commission National Quality Measures (v2015A)
Discharges 01-01-15 (1Q15) through 09-30-15 (3Q15)
Questions? Ask Question to Joint Commission staff Copyright © 2014 by The Joint Commission.
^