Specifications Manual for Joint Commission National Quality Measures (v2020B2)
Posted: 9/2/2020
Home » Reason for Not Prescribing Antithrombotic Therapy at Discharge

Release Notes:
Data Element
Version 2020B2

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?
Format:
Length:1
Type:Alphanumeric
Occurs:1
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.
      Example:
      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.
      Examples:
      • “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:
    Example:
    "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".
Suggested Data Sources: ONLY PHYSICIAN/APN/PA OR PHARMACIST DOCUMENTATION OF A REASON FOR NOT PRESCRIBING ANTITHROMBOTIC THERAPY AT HOSPITAL DISCHARGE:
  • 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
None
Refer to Appendix C, Table 8.2 for a comprehensive list of Antithrombotic Medications.
None

Reason for Not Prescribing Antithrombotic Therapy 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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