Date Last Known Well

Specifications Manual for Joint Commission National Quality Measures (v2016A1)

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Release Notes:
Data Element
Version 2016A1

Data Element Name:

Date Last Known Well

Collected For:

STK-4,

Definition:

The date prior to hospital arrival at which the patient was last known to be without the signs and symptoms of the current stroke or at his or her baseline state of health.

Suggested Data Collection Question:

What was the date associated with the time at which the patient was last known to be well or at his or her baseline state of health?

Format:

Length:	10 - MM-DD-YYYY (includes dashes) or UTD
Type:	Date
Occurs:	1

Allowable Values:

MM = Month (01-12)
DD = Day (01-31)
YYYY = Year (20xx)
UTD = Unable to Determine

Notes for Abstraction:

Enter the date associated with the Time Last Known Well.
If the date last known well is unable to be determined from medical record documentation, enter “UTD.”
The medical record must be abstracted as documented (taken at “face value”). When the date documented is obviously in error (not a valid date/format) and no other documentation is found that provides this information, the abstractor should select “UTD.”
Example:
Documentation indicates the Date Last Known Well was 03- 42 -20xx. No other documentation in the medical record provides a valid date. Since the Date Last Known Well is outside of the range listed in the Allowable Values for “Day,” it is not a valid date and the abstractor should select “UTD.”

Note: Transmission of a case with an invalid date as described above will be rejected from the CMS Clinical Warehouse and the Joint Commission’s Data Warehouse. Use of “UTD” for Date Last Known Well allows the case to be accepted into the warehouse.

If the date last known well is documented as a specific date and entered as Date Last Known Well on a “Code Stroke” form or stroke-specific electronic template, enter that date as the date last known well. Documentation of Date Last Known Well on a stroke-specific form or template should be selected regardless of other dates last known well documented elsewhere in the medical record.
References in relation to Arrival Date are acceptable (e.g., today, tonight, this evening, and this morning). The Date Last Known Well and the Arrival Date may be the same date or a different date.
Examples:
- “Wife reports patient normal this evening until approximately 9 PM.” Hospital arrival is 0030 on 12-10-20xx.” Date Last Known Well is 12-09-20xx.
- “Patient states he felt perfectly fine earlier today. At noon, he began to have trouble seeing.” Hospital arrival is 3:59 PM on 12-10-20xx.” Date Last Known Well is 12-10-20xx.
If a reference to date last known well is documented without a specific date, enter that date for the Date Last Known Well. If multiple dates are documented, select the earliest date.
Examples:
- “Patient last known well today (day of arrival).” Select Arrival Date for Date Last Known Well.
- “Patient normal yesterday (day before arrival) documented in H&P and consult note documents that patient was last known to be well on Monday (two days prior to arrival).” Select Monday’s date for Date Last Known Well.

Suggested Data Sources:

Emergency department record
History and physical
Nursing flow sheet
Progress notes
Medication administration record (MAR)
Transfer sheet
Ambulance record
Code Stroke form/template
IV flow sheets

Additional Notes:

Guidelines for Abstraction:

Inclusion

Exclusion

Signs and Symptoms of Stroke

Sudden numbness or weakness of the face, arm or leg, especially on one side of the body
Sudden confusion, trouble speaking or understanding
Sudden trouble seeing in one or both eyes
Sudden trouble walking, dizziness, loss of balance or coordination
Sudden severe headache

Code Stroke Form

Stroke Activation Form
Stroke Alert Form
Stroke Assessment Form
Stroke Intervention Form
Stroke Rapid Response Form
Thrombolysis Checklist
tPA Eligibility Form

Code Stroke Form

Stroke Education Form
Core Measure Form

Date Last Known Well

Specifications Manual for Joint Commission National Quality Measures (v2016A1)
Discharges 10-01-16 through 12-31-16 (4Q16)