Specifications Manual for Joint Commission National Quality Measures (v2020B2)
Posted: 9/2/2020
Home » Bisoprolol, Carvedilol, or Sustained-Release Metoprolol Succinate Prescribed for LVSD at Discharge

Release Notes:
Data Element
Version 2020B2

Name:Bisoprolol, Carvedilol, or Sustained-Release Metoprolol Succinate Prescribed for LVSD at Discharge
Collected For: ACHF-01
Definition:Documentation that bisoprolol, carvedilol, or sustained-release metoprolol succinate was prescribed at discharge. Beta-blockers are agents which block beta-adrenergic receptors, thereby decreasing the rate and force of heart contractions, and reducing blood pressure. Over time beta-blockers improve the heart's pumping ability. The marked beneficial effects of beta blockade has been well demonstrated in large-scale clinical trials of symptomatic patients with New York Heart Association (NYHA) class II-IV heart failure and reduced LVEF using bisoprolol, carvedilol, and sustained-release metoprolol succinate.
Question:Was bisoprolol, carvedilol, or sustained-release metoprolol succinate prescribed for LVSD at discharge?
Format:
Length:1
Type:Alphanumeric
Occurs:1
Allowable Values:

Y (Yes) Bisoprolol, carvedilol, or sustained-release metoprolol succinate was prescribed for LVSD at discharge.

N (No) Bisoprolol, carvedilol, or sustained-release metoprolol succinate was not prescribed for LVSD at discharge or unable to determine from medical record documentation.
Notes for Abstraction:
  • Only select "Yes" for those beta-blockers identified in the list of inclusions. No other beta-blockers will be accepted for this data element
  • In determining whether bisoprolol, carvedilol, or sustained-release metoprolol succinate was prescribed at discharge, it is not uncommon to see conflicting documentation amongst different medical record sources. For example, the discharge summary may list one of these beta-blockers that is not included in any of the other discharge medication sources (e.g., discharge orders). All discharge medication documentation available in the chart should be reviewed and taken into account by the abstractor.
    • In cases where there is bisoprolol, carvedilol, or sustained-release metoprolol succinate in one source that is not mentioned in other sources, it should be interpreted as a discharge medication (select "Yes") unless documentation elsewhere in the medical record suggests that it was NOT prescribed at discharge - Consider it a discharge medication in the absence of contradictory documentation.
    • If documentation is contradictory (e.g., physician noted “d/c carvedilol” in the discharge orders, but carvedilol is listed in the discharge summary's discharge medication list), or after careful examination of circumstances, context, timing, etc, documentation raises enough questions, the case should be deemed unable to determine" (select "No").
    • Consider documentation of a hold on bisoprolol, carvedilol, or sustained-release metoprolol succinate after discharge in one location and a listing of that beta-blocker as a discharge medication in another location as contradictory ONLY if the timeframe on the hold is not defined (e.g., “Hold bisoprolol”). Examples of a hold with a defined timeframe include “Hold Toprol-XL x 2 days” and “Hold Coreg until after stress test.”
    • If bisoprolol, carvedilol, or sustained-release metoprolol succinate is NOT listed as a discharge medication, and there is only documentation of a hold or plan to delay initiation/restarting of the beta-blocker after discharge (e.g., “Hold Toprol-XL x 2 days,” “Start Zebeta as outpatient,” “Hold Coreg”), select “No”.
    • If two discharge summaries are included in the medical record, use the one with the latest date/time. If one or both are not dated or timed, and you cannot determine which was done last, use both. This also applies to discharge medication reconciliation forms. Use the dictated date/time over transcribed date/time, file date/time, etc.
      Examples:
    • Two discharge summaries, one dictated 5/22 (day of discharge) and one dictated 5/27 - Use the 5/27 discharge summary.
    • Two discharge medication reconciliation forms, one not dated and one dated 4/24 (day of discharge) - Use both.
    • Disregard bisoprolol, carvedilol, or sustained-release metoprolol succinate documented only as a recommended medication for discharge (e.g., “Recommend sending patient home on Coreg”). Documentation must be more clear that the beta-blocker was actually prescribed at discharge.
  • Disregard documentation of bisoprolol, carvedilol, or sustained-release metoprolol succinate prescribed at discharge when noted only by medication class (e.g., “Beta-Blocker Prescribed at Discharge: Yes” on a core measures form). The beta-blocker prescribed must be listed by name.
Suggested Data Sources:
  • Nursing notes
  • Progress notes
  • Physician orders
  • Physician's notes
  • Discharge summary
  • Medication administration record (MAR)
  • Transfer sheet
  • Discharge instruction sheet
  • Medication reconciliation form
Additional Notes:
Guidelines for Abstraction:
Inclusion Exclusion
  • Bisoprolol
  • Bisoprolol/fumarate
  • Bisoprolol/hydrochlorothiazide
  • Carvedilol
  • Carvedilol phosphate
  • Coreg
  • Coreg CR
  • Metoprolol succinate
  • Toprol-XL
  • Zebeta
  • Ziac

All other beta-blocker medications other than those listed as inclusions.

Bisoprolol, Carvedilol, or Sustained-Release Metoprolol Succinate Prescribed for LVSD at Discharge
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Specifications Manual for Joint Commission National Quality Measures (v2020B2)
Discharges 07-01-20 (3Q20) through 12-31-20 (4Q20)

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