Specifications Manual for Joint Commission National Quality Measures (v2018A)
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Release Notes:
Data Element
Version 2018A

Data Element Name: Reason for Not Prescribing Antithrombotic Therapy at Discharge
Collected For: ASR-IP-3, STK-2
Definition:Reason for not prescribing antithrombotic therapy at hospital discharge.
  • Other reason documented by physician/APN/PA or pharmacist

Antithrombotic therapy is administered to reduce morbidity, mortality, and recurrence rate in stroke.
Suggested Data Collection Question:Is there documentation by a physician/advanced practice nurse/physician assistant (physician/APN/PA) or pharmacist in the medical record of a reason for not prescribing antithrombotic therapy at hospital discharge?
Format:
Length:1
Type:Alphanumeric
Occurs:1
Allowable Values:

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

N (No) There is no documentation of a reason for not prescribing antithrombotic therapy at hospital discharge, OR unable to determine from the medical record documentation.
Notes for Abstraction:
  • Reasons for not prescribing antithrombotic therapy at hospital discharge must be documented by a physician/APN/PA or pharmacist with one exception: Patient/family refusal of any form of antithrombotic therapy (e.g., “ASA refused,” “Patient refusing antithrombotic therapy”) may be documented by a nurse. .
  • If reasons are not mentioned in the context of antithrombotics, do not make inferences (e.g., do not assume that antithrombotic therapy was not prescribed because of a bleeding disorder unless documentation explicitly states so).
    • Reasons must be explicitly documented (e.g., “Active GI bleed – antithrombotic therapy contraindicated,” “H/O bleeding disorder – anticoagulation therapy contraindicated,” “Low platelet count – do not give antiplatelet medications,” “No ASA” [no reason given]).
    • Consider the terms "anticoagulant", "antiplatelet", and "blood thinners" synonymous with antithrombotic therapy. Physician/APN/PA or pharmacist documentation, (e.g., "no blood thinners", "no anticoagulant medications", "no antiplatelet medications"), select "Yes".
    • Physician/APN/PA or pharmacist documentation of a hold on an antithrombotic medication or discontinuation of an antithrombotic medication that occurs during the hospital stay constitutes a “clearly implied” reason for not prescribing antithrombotic therapy at discharge. A hold/discontinuation of all p.o. medications counts if an oral antithrombotic medication (e.g., Plavix) was on order at the time of the notation.
      EXCEPTIONS:
      • Documentation of a conditional hold or discontinuation of an antithrombotic medication does not count as a reason for not prescribing an antithrombotic medication at discharge (e.g., “Hold ASA if guaiac positive,” “Stop Plavix if rash persists,” “No ASA for 24 hours following thrombolytic therapy”).
      • Discontinuation of a particular antithrombotic medication documented in combination with the start of a different antithrombotic medication (i.e., switch type of antithrombotic medication) does not count as a reason for not prescribing an antithrombotic medication at discharge.
        Examples:
        “Stop Plavix” and “Start Plavix 75 mg po daily” in same physician order
        “Change Plavix to aspirin” in progress note
        “Do not continue after discharge” checked for Plavix and “Continue after discharge” checked for clopidogrel on a physician-signed discharge medication reconciliation form
      • Discontinuation of an antithrombotic medication at a particular dose documented in combination with the start of a different dose of that antithrombotic (i.e., change in dosage) does not count as a reason for not prescribing an antithrombotic medication at discharge.
        Examples:
        “Stop Ecotrin 300 mg po daily” and “Start Ecotrin 325 mg po daily” in same physician order
        “Increase Ecotrin 81 mg to 325 mg daily” in progress note
        “Do not continue after discharge” checked for Ecotrin 300 mg and “Continue after discharge” checked for Ecotrin 325 mg on a physician-signed discharge medication reconciliation form
    • Deferral of antithrombotic therapy from one physician/APN/PA or pharmacist to another does NOT count as a reason for not prescribing antithrombotic therapy at discharge unless the problem underlying the deferral is also noted.
      Examples:
      • “Consulting neurologist to evaluate pt. for warfarin therapy.” - select “No.”
      • “Rule out GI bleed. Start ASA if OK with gastroenterology.” - select “Yes.”
    • If there is documentation of a plan to initiate/restart antithrombotic therapy, and the reason/problem underlying the delay in starting/restarting antithrombotic therapy is also noted, this constitutes a “clearly implied” reason for not prescribing antithrombotic therapy at discharge.
      Acceptable examples (select “Yes”):
      - “Stool Occult Blood positive.
      - May start Coumadin as outpatient.”
      - “Start ASA if hematuria subsides.”
      Unacceptable examples (select “No”):
      - “Consider starting Coumadin in a.m.”
      - “May add Plavix 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 ASA due to rectal bleeding” - select “Yes,” even if documentation indicates that the rectal bleeding has resolved by the time of discharge and ASA was restarted).
    • Crossing out of an antithrombotic medication counts as a "clearly implied reason" for not prescribing antithrombotic therapy at discharge only if on a pre-printed form.
  • An allergy or adverse reaction to one type of antithrombotic would NOT be a reason for not administering all antithrombotics. Another medication can be ordered.
  • When conflicting information is documented in a medical record, select “Yes.”
  • When the current record includes documentation of a pre-arrival reason for no antithrombotic therapy, 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 hold/discontinuation or notation such as "No Coumadin" IF the underlying reason/problem is also noted (e.g., “Coumadin held in transferring hospital due to possible GI bleed”).
    • Pre-arrival "other reason" (other than hold/discontinuation or notation of "No ASA") (e.g., "Hx GI bleeding with ASA" in transferring ED record).
Suggested Data Sources:

ONLY PHYSICIAN/APN/PA OR PHARMACIST DOCUMENTATION OF A REASON FOR NOT PRESCRIBING ANTITHROMBOTIC THERAPY AT HOSPITAL DISCHARGE:
  • Consultation notes
  • Discharge summary
  • After Visit Summary (AVS)
  • Emergency Department record
  • History and physical
  • Medication administration record
  • Medication reconciliation form
  • Physician orders
  • Progress Notes

Excluded Data Sources:
Any documentation dated/timed after discharge, except discharge summary.
Additional Notes:
Guidelines for Abstraction:
Inclusion Exclusion
None
Refer to Appendix C, Table 8.2 for a comprehensive list of Antithrombotic Medications.
 Antithrombotic medication allergy described using one of the negative modifiers or qualifiers listed in Appendix H, Table 2.6, Qualifiers and Modifiers Table.

Reason for Not Prescribing Antithrombotic Therapy at Discharge
Specifications Manual for Joint Commission National Quality Measures (v2018A)
Discharges 07-01-18 (3Q18) through 12-31-18 (4Q18)
Questions? Ask Question to Joint Commission staff Copyright © 2018 by The Joint Commission.
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