Reason for No Mineralocorticoid Receptor Antagonist (MRA) Prescribed in the Outpatient Setting (v2024B)

Specifications Manual for Joint Commission National Quality Measures (v2024B)

Posted: 02/02/2024

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Release Notes:
Data Element
Version 2024B

Name:

Reason for No Mineralocorticoid Receptor Antagonist (MRA) Prescribed in the Outpatient Setting

Collected For:

ACHFOP-03

Definition:

Documentation of a reason for not prescribing a mineralocorticoid receptor antagonist (MRA) 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 a mineralocorticoid receptor antagonist (MRA) 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 a mineralocorticoid receptor antagonist (MRA) 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 a mineralocorticoid receptor antagonist (MRA) 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 a mineralocorticoid receptor antagonist (MRA) must be documented by a physician/APN/PA or pharmacist with one exception: Patient/family refusal of a mineralocorticoid receptor antagonist (MRA) (e.g., “Patient refusing MRA”) may be documented by a nurse.
Reasons for no mineralocorticoid receptor antagonist (MRA) must be explicitly documented or clearly implied.
- If reasons are not mentioned in the context of mineralocorticoid receptor antagonist (MRA), do not make inferences (e.g., do not assume that an MRA is not prescribed because of the patient's chronic renal disease alone).
  
  Examples
  - “Cr 2.6 mg/dL – No mineralocorticoid receptor antagonist” * “Severe hyperkalemia with MRA in past”
  - "No MRA – patient non-compliant with labs"
  - “MRA contraindicated”
  - “Supportive care only – no medications”
  - “MRA therapy not indicated”
  - “No mineralocorticoid receptor antagonist (MRA)” (reason not given).
Physician/APN/PA or pharmacist documentation of a hold on a mineralocorticoid receptor antagonist or discontinuation of an MRA constitutes a “clearly implied” reason for not prescribing an MRA.
- A hold/discontinuation of all p.o. medications counts if an MRA p.o. was on order at the time of the notation.
- If there is documentation of a plan to initiate/restart an MRA, and the reason/problem underlying the delay in starting/restarting the MRA is also noted, this constitutes a “clearly implied” reason for not prescribing an MRA at discharge.
- Documentation of a conditional hold/discontinuation of an MRA does not count as a reason for not prescribing an MRA.
- Deferral of an MRA from one physician/APN/PA or pharmacist to another does NOT count as a reason for not prescribing an MRA, unless the problem underlying the deferral is also noted.
A mineralocorticoid receptor antagonist (MRA) “allergy” or “sensitivity” documented in the medical record counts as an allergy regardless of what type of reaction might be noted (e.g., “Allergies: mineralocorticoid receptor antagonist – select “Yes”).
- Documentation of an allergy/sensitivity to one particular mineralocorticoid receptor antagonist (MRA) is acceptable to take as an allergy to the entire class of MRAs (e.g., "Allergic to Spironolactone").
Mineralocorticoid receptor antagonist (MRA) (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 mineralocorticoid receptor antagonist (MRA) (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 mineralocorticoid receptor antagonist. Reason documentation must mention mineralocorticoid receptor antagonist (MRA) as a class or a specific MRA medication.

Suggested Data Sources:

Discharge summary
Outpatient medical record

Additional Notes:

Guidelines for Abstraction:

Inclusion

Exclusion

Aldactone
Aldactazide (Hydrochlorothiazide + Spironolactone)
Eplerenone
Inspra
Spironolactone

All other mineralocorticoid receptor antagonist (MRA) medications other than those listed as inclusions.

Specifications Manual for Joint Commission National Quality Measures (v2024B)
Discharges 07-01-24 (3Q24) through 12-31-2024 (4Q24)

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