Specifications Manual for Joint Commission National Quality Measures (v2020A2)
Posted: 10/30/2019
Home » Reason for Not Prescribing Antithrombotic Therapy at Discharge

Release Notes:
Data Element
Version 2020A2

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.
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?
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".
    • Documentation of "do not continue" or “do not convert” a home antithrombotic medication to an inpatient medication, or an inpatient antithrombotic medication to a discharge medication, does not count as a reason for not prescribing antithrombotic therapy at discharge. Do not infer that an antithrombotic medication was not prescribed or discontinued without explicit documentation of a reason for not prescribing an antithrombotic medication at discharge.
      Patient on Plavix 75 mg daily while an inpatient. During discharge medication reconciliation, physician checks “do not convert” box next to Plavix, select “No.”
    • 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.
      • “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).
  • 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:
    "Hx GI bleeding with ASA" documented in a transferring record.
  • For patients prescribed ticagrelor as antithrombotic therapy at discharge due to a history of acute coronary syndrome (ACS), NSTE-ACS treated with early invasive strategy and/or coronary stenting, or other indications, select “Yes.”
  • Prasugrel is inadvisable for patients with a history of transient ischemic attack or stroke. If prasugrel was prescribed at discharge, select "Yes".
  • 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
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
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Specifications Manual for Joint Commission National Quality Measures (v2020A2)
Discharges 01-01-20 (1Q20) through 6-30-20 (2Q20)


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