Home » Contraindication to Beta-Blocker - Perioperative
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Release Notes:
Data Element
Version 2010A1

Data Element Name: Contraindication to Beta-Blocker - Perioperative
Collected For: SCIP-Card-2,
Definition:Reasons for not prescribing a beta-blocker during the perioperative period are clearly documented in the medical record. Reasons for not prescribing beta-blockers may include bradycardia (heart rate less than 50 beats per minute [bpm]) or other reasons documented by physician/advanced practice nurse/physician assistant (physician/APN/PA) or pharmacist.
  • Bradycardia (heart rate less than 50 bpm)
  • Other reasons documented by physician/APN/PA or pharmacist

Beta-blockers are agents which block beta-adrenergic receptors, thereby decreasing the rate and force of heart contractions, and reducing blood pressure. Over time beta-blockers improve the heart’s pumping ability.

Note:
The perioperative period for the SCIP cardiac measures is defined as 24 hours prior to surgical incision through discharge from the post anesthesia care/recovery area.

Suggested Data Collection Question:Was there documentation of reasons for not prescribing a beta-blocker during the perioperative period?

Format:
Length:1
Type:Alphanumeric
Occurs:1
Allowable Values:

Y    (Yes)   There is documentation that the patient has one or more of the following reasons for not prescribing a beta-blocker during the perioperative period:

  • Bradycardia (heart rate less than 50 bpm)
  • Other reasons documented by physician/APN/PA or pharmacist

N    (No)   There is no documentation of reasons for not prescribing a beta-blocker during the perioperative period or unable to determine from medical record documentation.

Notes for Abstraction:
  • Documentation of reasons for not prescribing a beta-blocker must apply to the perioperative period. The documentation does NOT need to be found only within the perioperative period.
  • Documentation of “bradycardia” alone is not acceptable. Bradycardia must be substantiated by documentation of a heart rate of less than 50 bpm. Vital signs obtained while patient is on cardiopulmonary bypass machine cannot be used to determine bradycardia.
  • If the physician writes an order to hold the beta-blocker when the patient’s vital signs are outside certain parameters and there is documentation that the beta-blocker was held because the vital signs were outside the parameters during the perioperative period, answer “Yes.”
    Example:
    • The physician writes the order, “Hold atenolol for SBP < 100” and the nurse documents that the atenolol was held for a blood pressure of 90/50 during the perioperative period, answer “Yes.”
  • To determine when the end of the perioperative period occurred for patients discharged from surgery and admitted to the Post Anesthesia Care Unit (PACU): The end of the perioperative period occurs when the patient is discharged from the PACU.
  • To determine when the end of the perioperative period occurred for patients discharged from surgery and admitted to locations other than the PACU (e.g., ICU):
    • The recovery period would end a maximum of six hours after arrival to the recovery area unless the anesthesiologist signs off before the six hours has elapsed.
    • If the anesthesiologist signs off before the patient enters the non-PACU recovery area, allow up to six hours for the recovery period.
      Examples:
      -The anesthesiologist signed off at 08:45. The patient arrived in ICU for recovery at 09:00. The post anesthesia care/recovery area period would end a maximum of six hours later or 15:00. Select “Yes” if the physician/APN/PA or pharmacist documented a reason for not prescribing a beta-blocker for the perioperative period.
      -The patient arrived in the ICU for recovery at 23:00 on 01-04-2008. After allowing six hours for the recovery period, the recovery end time would be 05:00 on 01-05-2008. Select “Yes” if the physician/APN/PA or pharmacist documented a pulse rate less than 50 bpm during the perioperative period.
Suggested Data Sources:
  • Anesthesia record
  • Consultation notes
  • Emergency department record
  • History and physical
  • Vital signs graphic record
  • Nursing notes
  • Progress notes
  • Physician orders
  • Discharge summary
  • Medication administration record (MAR)
  • ECG reports
  • Additional Notes:
    Guidelines for Abstraction:
    Inclusion Exclusion
    • Refer to Appendix C, Table 1.3 for a comprehensive list of Beta-Blockers.
    • None

    Contraindication to Beta-Blocker - Perioperative
    Specifications Manual for Joint Commission National Quality Core Measures (2010A1)
    Discharges 04-01-10 (2Q10) through 09-30-10 (3Q10)