Reason for No Aldosterone Receptor Antagonist Prescribed in the Outpatient Setting (v2021B2)

Specifications Manual for Joint Commission National Quality Measures (v2021B2)

Posted: 9/29/2021

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Release Notes:
Data Element
Version 2021B2

Name:

Reason for No Aldosterone Receptor Antagonist Prescribed in the Outpatient Setting

Collected For:

ACHFOP-03

Definition:

Documentation of a reason for not prescribing an aldosterone antagonist in the outpatient setting by a physician/APN/PA or pharmacist.

Question:

Did a physician/APN/PA or pharmacist document a contraindication to or a reason against an aldosterone antagonist prescription in the outpatient setting?

Format:

Length:	1
Type:	Alphanumeric
Occurs:	1

Allowable Values:

Y (Yes) There is documentation by a physician/APN/PA or pharmacist of a contraindication to or a reason for not prescribing an aldosterone receptor antagonist in the outpatient setting.

N (No) There is no documentation by a physician/APN/PA or pharmacist of a contraindication to or a reason for not prescribing an aldosterone receptor antagonist in the outpatient setting or unable to determine from medical record documentation.

Notes for Abstraction:

All medication documentation available in the chart should be reviewed and taken into account by the abstractor.
Reasons for not prescribing an aldosterone antagonist must be documented by a physician/APN/PA or pharmacist.
Reasons for no aldosterone antagonist must be explicitly documented or clearly implied.
- If reasons are not mentioned in the context of aldosterone antagonist, do not make inferences (e.g., do not assume that an aldosterone antagonist is not prescribed because of the patient's chronic renal disease alone).
  
  Examples
  - “Cr 2.6 mg/dL – No aldosterone antagonist” * “Severe hyperkalemia with aldosterone antagonist in past”
  - "No aldosterone – patient non-compliant with labs"
  - “Aldosterone antagonist contraindicated”
  - “Supportive care only – no medications”
  - “Aldosterone antagonist therapy not indicated”
  - “No aldosterone antagonist” (reason not given).
Physician/APN/PA or pharmacist documentation of a hold on an aldosterone antagonist or discontinuation of an aldosterone antagonist constitutes a “clearly implied” reason for not prescribing an aldosterone antagonist.
- A hold/discontinuation of all p.o. medications counts if an aldosterone antagonist p.o. was on order at the time of the notation.
- If there is documentation of a plan to initiate/restart an aldosterone antagonist, and the reason/problem underlying the delay in starting/restarting the aldosterone antagonist is also noted, this constitutes a “clearly implied” reason for not prescribing an aldosterone antagonist at discharge.
- Documentation of a conditional hold/discontinuation of a aldosterone antagonist does not count as a reason for not prescribing a aldosterone antagonist
- Deferral of an aldosterone antagonist from one physician/APN/PA or pharmacist to another does NOT count as a reason for not prescribing an aldosterone antagonist, unless the problem underlying the deferral is also noted.
An aldosterone antagonist “allergy” or “sensitivity” documented in the medical record counts as an allergy regardless of what type of reaction might be noted (e.g., “Allergies: aldosterone antagonist – select “Yes”).
- Documentation of an allergy/sensitivity to one particular aldosterone antagonist is acceptable to take as an allergy to the entire class of aldosterone antagonist (e.g., "Allergic to Spironolactone").
Aldosterone antagonist (along with ACEI and ARBs) are sometimes described as RAS (reninangiotensin system) or RAAS (renin-angiotensin-aldosterone system) blockers/inhibitors. Documentation of a reason for not prescribing "RAS" or "RAAS" blockers or inhibitors should be considered implicit documentation of a reason for no aldosterone antagonist (e.g., "Hold all RAS blockers").
Documentation that refers to a more general medication class, such as "avoid all nephrotoxic medications" or "Hold BP Meds" is not acceptable as a reason for not prescribing aldosterone antagonist. Reason documentation must mention aldosterone antagonist as a class or a specific aldosterone antagonist medication.

Suggested Data Sources:

Discharge summary
Outpatient medical record

Additional Notes:

Guidelines for Abstraction:

Inclusion

Exclusion

Aldactone
Aldactazide (Hydrochlorothiazide + Spironolactone)
Eplerenone
Inspra
Spironolactone

None

Specifications Manual for Joint Commission National Quality Measures (v2021B2)
Discharges 10-1-21 through 12-31-21 (4Q21)

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