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Release Notes:
Data Element
Version 2010A1

Data Element Name: ARB Prescribed at Discharge
Collected For: AMI-3, HF-3,
Definition:Documentation that an angiotensin receptor blocker (ARB) was prescribed at hospital discharge. ARBs widen or dilate blood vessels, lowering blood pressure and making it easier for the heart to pump blood. They also inhibit the adverse effects of neurohormonal activation on the heart. These effects help reduce the risk of adverse outcomes such as death or hospitalization.
Suggested Data Collection Question:Was an angiotensin receptor blocker (ARB) prescribed at discharge?
Format:
Length:1
Type:Alphanumeric
Occurs:1
Allowable Values:

Y   (Yes)   ARB prescribed at discharge.

N   (No)   ARB not prescribed at discharge, or unable to determine from medical record documentation.

Notes for Abstraction:In determining whether an ARB was prescribed at discharge, it is not uncommon to see conflicting documentation amongst different medical record sources. For example, the discharge summary may list an ARB 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 an ARB 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/advanced practice nurse [physician/APN/PA] noted discontinuation of the ARB in the discharge medication orders, but it 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").
  • If an ARB is listed as a discharge medication, select "Yes" unless contradictory documentation exists (see above). If an ARB is not listed as a discharge medication, and there is only documentation of a plan to delay initiation/restarting of an ARB for a time period after discharge, select “No.”

Suggested Data Sources:
  • Physician orders
  • Discharge summary
  • Transfer sheet
  • Discharge instruction sheet
  • Medication reconciliation form
  • Nursing discharge notes
Additional Notes:
Guidelines for Abstraction:
Inclusion Exclusion
  • Refer to Appendix C, Table 1.7 for a comprehensive list of ARBs.
  • None

ARB Prescribed at Discharge
Specifications Manual for Joint Commission National Quality Core Measures (2010A1)
Discharges 04-01-10 (2Q10) through 09-30-10 (3Q10)