NIHSS Score Documented Closest to IA t-PA or MER Initiation

Specifications Manual for Joint Commission National Quality Measures (v2016B1)

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Release Notes:
Data Element
Version 2016B1

Data Element Name:

NIHSS Score Documented Closest to IA t-PA or MER Initiation

Collected For:

CSTK-05,

Definition:

The NIHSS score documented closest to IA thrombolytic (t-PA) therapy or mechanical endovascular reperfusion (MER) therapy initiation is the last NIHSS score documented prior to IA t-PA or MER initiation (i.e., the initiation time of the intervention performed first) at this hospital. The NIHSS measures several aspects of brain function, including consciousness, vision, sensation, movement, speech, and language.

Suggested Data Collection Question:

What is the last NIHSS score documented prior to initiation of IA t-PA or MER at this hospital?

Format:

Length:	3
Type:	Alphanumeric
Occurs:	1

Allowable Values:

Score = 0-42
UTD = Unable to Determine

Notes for Abstraction:

The NIHSS score may be documented by the physician/APN/PA or nurse (RN).
Look for the last NIHSS score documented prior to IA t-PA or MER initiation at this hospital.
Examples:
- “Initial NIHSS score 4 documented by the ED nurse at this hospital. No other NIHSS scores were documented prior to IA t-PA or MER initiation.” Select ‘4’.
- “NIHSS score 6 prior to transfer to this hospital. IV t-PA ‘drip and ship’. Arrival Time at this hospital 2319. NIHSS score 8 at 2325 and NIHSS score 10 at 2340. IA Thrombolytic Initiation Time 0015.” Select ‘10’.
- “NIHSS score 10 on arrival. IV t-PA given at 0800. NIHSS score 8 at 0900. IA infusion start time 0950.” Select ‘8’.
- “IV t-PA given at a transferring hospital. Nurse documented NIHSS score 18 via telemedicine prior to arrival at this hospital. Patient went directly to OR for mechanical thrombectomy procedure. No NIHSS score documented at this hospital prior to intervention.” Select ‘18’.
For purposes of this data element, score documentation between 0 and 42 is acceptable. Only one score may be selected. Select the last NIHSS score documented prior to the start time of IA t-PA OR first pass of a mechanical reperfusion device whichever intervention is performed first, i.e. “IA t-PA first then MER” or “MER first then IA t-PA”, at this hospital.
If only one NIHSS score is documented prior to IA t-PA or MER initiation and no other score(s) are available for comparison, enter the value for that score.
If no NIHSS score is documented prior to IA t-PA or MER initiation, select UTD.
If unable to determine the last NIHSS score documented prior to IA t-PA or MER initiation, select UTD.

Suggested Data Sources:

Consultation notes
History and physical
Nursing flow sheet
Progress notes
Transfer sheet
Admitting note
Ambulance record
Emergency room records
Nursing assessment

Additional Notes:

Guidelines for Abstraction:

Inclusion	Exclusion
None	Modified NIHSS scores Estimated NIHSS scores Scoring methodologies other than NIHSS

NIHSS Score Documented Closest to IA t-PA or MER Initiation

Specifications Manual for Joint Commission National Quality Measures (v2016B1)
Discharges 01-01-17 (1Q17) through 06-30-17 (2Q17)