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 Statin Medication at Discharge
Collected For: STK-6
Definition:Reasons for not prescribing a statin medication at discharge:
  • Statin medication allergy
  • LDL-c less than 70 mg/dL
  • Other reasons documented by physician/advanced practice nurse/physician assistant (physician/APN/PA) or pharmacist

Statins are a class of pharmaceutical agents that modify LDL cholesterol by blocking the action of an enzyme in the liver which is needed to synthesize cholesterol thereby decreasing the level of cholesterol circulating in the blood.
Suggested Data Collection Question:Is there documentation of a reason for not prescribing a statin medication at discharge?
Format:
Length:1
Type:Alphanumeric
Occurs:1
Allowable Values:

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

N (No) There is no documentation of a reason for not prescribing a statin medication at discharge, OR unable to determine from medical record documentation.
Notes for Abstraction:
  • A statin medication “allergy” or “sensitivity” documented at any time during the hospital stay counts as an allergy regardless of what type of reaction might be noted (e.g., “Allergies: Atorvastatin – Nausea” – select “Yes”).
  • Documentation of an allergy/sensitivity to one particular statin medication is acceptable to take as an allergy to the entire class of statin medications (e.g., “Allergic to Lipitor”).
  • Documentation of a LDL-c less than 70 mg/dL anytime during the hospital stay is an acceptable stand-alone reason for not prescribing statin medication at discharge – Linkage with statin is not needed. If more than one LDL value is documented, the highest value must be less than 70 mg/dL. Direct or calculated fasting or non-fasting values are both acceptable. LDL values obtained within 30 days prior to hospital arrival are acceptable to select “Yes.”
  • When conflicting information is documented in a medical record, select “Yes.”
  • Reasons for not administering statin therapy must be documented by a physician/APN/PA or pharmacist with one exception: Patient/family refusal of any form of statin therapy (e.g., “Lipitor refused,” “Patient refusing statin therapy”) may be documented by a nurse.
  • In determining whether there is a reason documented by physician/APN/PA or pharmacist for not prescribing a statin medication at discharge:
    • Reasons must be explicitly documented (e.g., “Chronic liver failure – Statins contraindicated,” “Hx muscle soreness with statins in past”) or clearly implied (e.g., “No evidence of atherosclerosis – no statin therapy,” “Pt. refusing all medications,” “Supportive care only – no medication,” statin medication on pre-printed order form is crossed out, “Statins not indicated,” “No statin medications” [no reason given]). If reasons are not mentioned in the context of statin medications, do not make inferences (e.g., do not assume that a statin medication is not being prescribed because of the patient’s history of alcoholism or severe liver disease alone).
    • Physician/APN/PA or pharmacist documentation of a hold on a statin medication or discontinuation of a statin medication that occurs during the hospital stay constitutes a “clearly implied” reason for not prescribing a statin medication at discharge. A hold/discontinuation of all p.o. medications counts if statin medication p.o. was on order at the time of the notation.
      EXCEPTIONS:
      • Documentation of a conditional hold or discontinuation of a statin medication does not count as a reason for not prescribing a statin medication at discharge (e.g., “Hold Zocor if severe diarrhea persists,” “Stop atorvastatin if myalgias persist”).
      • Discontinuation of a particular statin medication documented in combination with the start of a different statin medication (i.e., switch in type of statin medication) does not count as a reason for not prescribing a statin medication at discharge.
        Examples:
        − “Stop lovastatin” and “Start atorvastatin 80 mg po q hs” in same physician order
        − “Change Crestor to Lipitor” in progress note
        − “Do not continue after discharge” checked for Vytorin and “Continue after discharge” checked for Advicor on a physician-signed discharge medication reconciliation form * Discontinuation of a statin medication at a particular dose documented in combination with the start of a different dose of that statin (i.e., change in dosage) does not count as a reason for not prescribing a statin medication at discharge.
        Examples:
        − “Stop Simvastatin 20 mg po q hs” and “Start Simvastatin 40 mg po q hs” in same physician order
        − “Increase Pravachol 40 mg to 80 mg” in progress note
        − “Do not continue after discharge” checked for Zocor 40 mg and “Continue after discharge” checked for Zocor 80 mg on a physician-signed discharge medication reconciliation form
    • Reason documentation which refers to a more general medication class is not acceptable (e.g., “No cholesterol-reducers,” “Hold all lipid-lowering medications”).
    • Deferral of statin medication from one physician/APN/PA or pharmacist to another does NOT count as a reason for not prescribing a statin medication unless the problem underlying the deferral is also noted.
      Examples:
      • “Consulting neurologist to evaluate pt. for statin therapy” - select “No.”
      • “Severe diarrhea. Start statin if OK with neurology.” - select "Yes.”
    • If there is documentation of a plan to initiate/restart a statin medication, and the reason/problem underlying the delay in starting/restarting the medication is also noted, this constitutes a “clearly implied” reason for not prescribing a statin medication at discharge.
      Acceptable examples (select “Yes”):
      - “Liver enzymes high. May start lovastatin as outpatient.”
      - “Add statin if myalgias resolve”
      Unacceptable examples (select “No”):
      - “Consider starting statins in a.m.”
      - “May add Zocor 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 statin medications due to abnormal liver enzymes” - select “Yes,” even if documentation indicates that the liver enzyme levels normalized by the time of discharge and the lipid-lowering medication was restarted).
    • Crossing out of a statin medication counts as a "clearly implied reason" for not prescribing statin medication at discharge only if on a pre-printed form.
    • Statin medications may also be referred to as HMG CoA reductase inhibitors
  • When the current record includes documentation of a pre-arrival reason for no statin medication, 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 statin medication allergy.
    • Pre-arrival hold/discontinuation or notation such as "No stain medications" IF the underlying reason/problem is also noted (e.g., “Lipitor discontinued in transferring hospital secondary to severe diarrhea”).
    • Pre-arrival "other reason" (other than hold/discontinuation or notation of "No statin medications") (e.g., "Hx muscle soreness to statins in past" in transferring ED record).
Suggested Data Sources:

  • Consultation notes
  • Emergency department record
  • History and physical
  • Progress notes
  • Physician orders
  • Discharge summary
  • Medication administration record (MAR)
  • After Visit Summary (AVS)
  • Medication reconciliation form

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 8.1 for a comprehensive list of Statin Medications. 		Statin 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 Statin Medication 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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