Last Known Well (v2023A1)

Specifications Manual for Joint Commission National Quality Measures (v2023A1)

Posted: 10/17/2022

Print this page

Home » Last Known Well

Release Notes:
Data Element
Version 2023A1

Name:

Last Known Well

Collected For:

ASR-IP-1, ASR-OP-1, STK-4

Definition:

The date and time prior to hospital arrival at which it was witnessed or reported that the patient was last known to be without the signs and symptoms of the current stroke or at his or her baseline state of health.

Question:

Is there documentation that the date and time of last known well was witnessed or reported?

Format:

Length:	1
Type:	Alphanumeric
Occurs:	1

Allowable Values:

Y (Yes) There is documentation that the date and time of last known well was witnessed or reported.

N (No) There is no documentation that the date and time of last known well was witnessed or reported, OR unable to determine from medical record documentation.

Notes for Abstraction:

Select “Yes” if BOTH a date and time Last Known Well are documented.
Select “No” if there is ANY physician/APN/PA documentation that Last Known Well is “UNKNOWN.” Documentation must explicitly state that the Last Known Well is unknown/uncertain/unclear. Documentation that time of symptom onset is unknown/uncertain/unclear is also acceptable when Time Last Known Well is not documented. If Last Known Well is not explicitly documented as unknown, do not make inferences (e.g. do not assume that patient woke with stroke so Last Known Well unknown unless explicitly documented).
- If one physician documents a Time Last Known Well and another documents time of symptom onset unknown, select “Yes.”
- If physician documents a Time Last Known Well and nurse/EMS documents Last Known Well unknown, select “Yes.”
- If one physician documents Last Known Well unknown and another documents a Time Last Known Well, select “No.”
  EXCEPTION:
- If the physician documents Last Known Well as unknown and the same physician crosses out unknown or mentions in a later note that Last Known Well is now known with a time documented, select “Yes.”
- If the physician documents Last Known Well or stroke/symptom onset unknown as a Reason for Not Initiating IV Thrombolytic and the Time Last Known Well is also documented on a Code Stroke Form or elsewhere in the medical record, "unknown" should be disregarded and “Yes” selected.
If the Time Last Known Well is clearly greater than 2 hours prior to hospital arrival AND no time is documented, select “No.”
Example:
“Patient OK last night.” Select “No” because no other documentation of a specific time/time range/time reference was present in the medical record and the time is required for the Time Last Known Well.
If the only Time Last Known Well is documented as a time immediately before hospital arrival without a specific time range in minutes, e.g., “symptoms started just prior to ED arrival,” select “Yes.”
If there is no documentation that Last Known Well or stroke signs/symptoms occurred prior to hospital arrival but there is documentation that Last Known Well first occurred after Arrival Time (e.g., in-house stroke), select “No.”

Suggested Data Sources:

Emergency department record
History and physical
Nursing notes
Nursing flow sheet
Progress notes
Medication administration record (MAR)
Transfer sheet
Ambulance record
Code Stroke form/template
IV flow sheets

Additional Notes:

Guidelines for Abstraction:

Inclusion

Exclusion

Signs and Symptoms of Stroke

Sudden numbness or weakness of the face, arm or leg, especially on one side of the body
Sudden confusion, trouble speaking or understanding
Sudden trouble seeing in one or both eyes
Sudden trouble walking, dizziness, loss of balance or coordination
Sudden severe headache
Syncope
Seizure

Delay in stroke diagnosis

Specifications Manual for Joint Commission National Quality Measures (v2023A1)
Discharges 01-01-23 (1Q23) through 06-30-23 (2Q23)

LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION (“CPT®”)

You, your employees and agents are authorized to use CPT® only as contained in The Joint Commission performance measures solely for your own personal use in directly participating in healthcare programs administered by The Joint Commission. You acknowledge that the American Medical Association (“AMA”) holds all copyright, trademark and other rights in CPT®.

Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CPT® for resale and/or license, transferring copies of CPT® to any party not bound by this Agreement, creating any modified or derivative work of CPT®, or making any commercial use of CPT®. License to use CPT® for any use not authorized herein must be obtained through the American Medical Association, Intellectual Property Services, AMA Plaza, 330 North Wabash Avenue, Suite 39300, Chicago, Illinois 60611-5885. Applications are available at the American Medical Association Web site, www.ama- assn.org/go/cpt.

U.S. Government Rights This product includes CPT® which is commercial technical data, which was developed exclusively at private expense by the American Medical Association, 330 North Wabash Avenue, Chicago, Illinois 60611. The American Medical Association does not agree to license CPT® to the Federal Government based on the license in FAR 52.227-14 (Data Rights - General) and DFARS 252.227-7015 (Technical Data - Commercial Items) or any other license provision. The American Medical Association reserves all rights to approve any license with any Federal agency.

Disclaimer of Warranties and Liabilities. CPT® is provided “as is” without warranty of any kind, either expressed or implied, including but not limited to the implied warranties of merchantability and fitness for a particular purpose. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT®, and the (AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The responsibility for the content of this product is with The Joint Commission, and no endorsement by the AMA is intended or implied. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this product.

This Agreement will terminate upon notice if you violate its terms. The AMA is a third party beneficiary to this Agreement.

Should the foregoing terms and conditions be acceptable to you, please indicate your agreement and acceptance by clicking below on the button labeled “accept”.