Release Notes:
Data Element
Version 2010B
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.
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Suggested Data Collection Question: | Was there documentation of reasons for not prescribing a beta-blocker during the perioperative period?
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Format: | Length: | 1 | Type: | Alphanumeric | Occurs: | 1 |
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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.
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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: |
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Guidelines for Abstraction: |
Inclusion | Exclusion |
- Refer to Appendix C, Table 1.3 for a comprehensive list of Beta-Blockers.
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Contraindication to Beta-Blocker - Perioperative
Specifications Manual for Joint Commission National Quality Core Measures (2010B)
Discharges 10-01-10 (4Q10) through 03-31-11 (1Q11)
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