Specifications Manual for Joint Commission National Quality Measures (v2020B)
Posted: 2/5/2020
Home » Reason for Not Prescribing Anticoagulation Therapy at Discharge

Release Notes:
Data Element
Version 2020B

Name:Reason for Not Prescribing Anticoagulation Therapy at Discharge
Collected For: STK-3
Definition:Reason for not prescribing anticoagulation therapy at hospital discharge.
  • Other reason documented by physician/APN/PA or pharmacist

The administration of anticoagulation therapy, unless there are contraindications, is an established effective strategy in preventing recurrent stroke in high stroke risk-atrial fibrillation patients with TIA or prior 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 anticoagulation therapy at hospital discharge?
Format:
Length:1
Type:Alphanumeric
Occurs:1
Allowable Values:

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

N (No)     There is no documentation of a reason for not prescribing anticoagulation therapy at hospital discharge, OR unable to determine from the medical record documentation.
Notes for Abstraction:
  • Reasons for not prescribing anticoagulation therapy at hospital discharge must be documented by a physician/APN/PA or pharmacist with one exception: Patient/family refusal of any form of anticoagulation therapy (e.g., “Coumadin refused,” “Patient refusing anticoagulation therapy”) may be documented by a nurse.
  • If reasons are not mentioned in the context of anticoagulation therapy, do not make inferences (e.g., do not assume that anticoagulation therapy was not prescribed because of a bleeding disorder unless documentation explicitly states so).
    • Reasons must be explicitly documented (e.g., “Active GI bleed – anticoagulation therapy contraindicated,” “No warfarin” [no reason given]).
    • Consider the term "blood thinners" synonymous with anticoagulant therapy. Physician/APN/PA or pharmacist documentation, e.g., "no blood thinners", select "Yes".
    • Documentation of "do not continue" or “do not convert” a home anticoagulant medication to an inpatient medication, or an inpatient anticoagulant medication to a discharge medication, does not count as a reason for not prescribing anticoagulation therapy at discharge. Do not infer that an anticoagulant medication was not prescribed or discontinued without explicit documentation of a reason for not prescribing an anticoagulant medication at discharge.
      Example:
      Patient on Coumadin 2.5 mg while an inpatient. During discharge medication reconciliation, physician checks “do not convert” box next to Coumadin, select “No.”
    • Deferral of anticoagulation therapy from one physician/APN/PA or pharmacist to another does NOT count as a reason for not prescribing anticoagulation 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 Coumadin if OK with gastroenterology” - select "Yes.”
    • If there is documentation of a plan to initiate/restart anticoagulation therapy, and the reason/problem underlying the delay in starting/restarting anticoagulation therapy is also noted, this constitutes a “clearly implied” reason for not prescribing anticoagulation therapy at discharge.
      Acceptable examples (select “Yes”):
      - “Stool Occult Blood positive. May start Coumadin as outpatient.”
      - “Start warfarin if hematuria subsides.”
      Unacceptable examples (select “No”):
      - “Consider starting Coumadin in a.m.”
      - “May add warfarin 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 warfarin due to rectal bleeding” - select “Yes,” even if documentation indicates that the rectal bleeding has resolved by the time of discharge and warfarin was restarted).
  • An allergy or adverse reaction to one type of anticoagulant would NOT be a reason for not administering all anticoagulants. 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:
    Example:
    "Hx GI bleeding with warfarin" documented in a transferring record.
Suggested Data Sources: ONLY PHYSICIAN/APN/PA OR PHARMACIST DOCUMENTATION OF A REASON FOR NOT PRESCRIBING ANTICOAGULATION THERAPY AT HOSPITAL DISCHARGE:
  • Consultation notes
  • Emergency department record
  • History and physical
  • Progress notes
  • Physician orders
  • Discharge summary
  • After Visit Summary (AVS)
  • Medication administration record (MAR)

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 8.3 for a comprehensive list of Anticoagulant Medications.

None

Reason for Not Prescribing Anticoagulation Therapy at Discharge
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Specifications Manual for Joint Commission National Quality Measures (v2020B)
Discharges 07-01-20 (3Q20) through 12-31-20 (4Q20)

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