• 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.

• 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.