Specifications Manual for Joint Commission National Quality Measures (v2018B1)
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Release Notes:
Data Element
Version 2018B1

Name:Last Known Well
Collected For: ASR-IP-1, ASR-OP-1, STK-4
Definition:The date and time prior to hospital arrival at which it was witnessed or reported that 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.
Question:Is there documentation that the date and time of last known well was witnessed or reported?
Format:
Length:1
Type:Alphanumeric
Occurs:1
Allowable Values:

Y (Yes) There is documentation that the date and time of last known well was witnessed or reported.

N (No) There is no documentation that the date and time of last known well was witnessed or reported, OR unable to determine from medical record documentation.
Notes for Abstraction:
  • Select “Yes” if BOTH a date and time Last Known Well are documented.
  • Select “No” if there is ANY physician/APN/PA documentation that Last Known Well is “UNKNOWN.” Documentation must explicitly state that the Last Known Well is unknown/uncertain/unclear. Documentation that time of symptom onset is unknown/uncertain/unclear is also acceptable when Time Last Known Well is not documented. If Last Known Well is not explicitly documented as unknown, do not make inferences (e.g. do not assume that patient woke with stroke so Last Known Well unknown unless explicitly documented).
    • If one physician documents a Time Last Known Well and another documents time of symptom onset unknown, select “Yes.”
    • If physician documents a Time Last Known Well and nurse/EMS documents Last Known Well unknown, select “Yes.”
    • If one physician documents Last Known Well unknown and another documents a Time Last Known Well, select “No.”
      EXCEPTION:
    • If the physician documents Last Known Well as unknown and the same physician crosses out unknown or mentions in a later note that Last Known Well is now known with a time documented, select “Yes.”
    • If the physician documents Last Known Well or stroke/symptom onset unknown as a Reason for Not Initiating IV Thrombolytic and the Time Last Known Well is also documented on a Code Stroke Form or elsewhere in the medical record, "unknown" should be disregarded and “Yes” selected.
  • If the Time Last Known Well is clearly greater than 2 hours prior to hospital arrival AND no time is documented, select “No.”
    Example:
    “Patient OK last night.” Select “No” because no other documentation of a specific time/time range/time reference was present in the medical record and the time is required for the Time Last Known Well.
  • If the only Time Last Known Well is documented as a time immediately before hospital arrival without a specific time range in minutes, e.g., “symptoms started just prior to ED arrival,” select “Yes.”
  • If there is no documentation that Last Known Well or stroke signs/symptoms occurred prior to hospital arrival but there is documentation that Last Known Well first occurred after Arrival Time (e.g., in-house stroke), select “No.”
Suggested Data Sources:
  • Emergency department record
  • History and physical
  • Nursing notes
  • 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

Delay in stroke diagnosis

Last Known Well
Specifications Manual for Joint Commission National Quality Measures (v2018B1)
Discharges 01-01-19 (1Q19) through 06-30-19 (2Q19)

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