Release Notes:
Data Element
Version 2010B
| Data Element Name: | IV Thrombolytic Therapy Administered |
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| Collected For: | , |
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| Definition: | The patient received intravenous (IV) thrombolytic therapy at this hospital during this hospitalization. |
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| Suggested Data Collection Question: | Does documentation exist in the medical record stating that the patient received IV thrombolytic therapy at this hospital during the present hospitalization?
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| Format: | | Length: | |
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| Type: | Alphanumeric |
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| Occurs: | |
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| Allowable Values: |
Y (Yes, IV thrombolytic was administered in this hospital during this hospitalization)
N (No, IV thrombolytic was not administered in this hospital during this hospitalization, OR unable to determine from medical record documentation)
NC (No, IV thrombolytic was not administered in this hospital during this hospitalization. A documented reason exists for not administering this therapy)
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| Notes for Abstraction: | This data element applies only to patients for whom IV thrombolytic therapy was initiated at this hospital. Do not abstract this data element if IV thrombolytic therapy was initiated at another hospital and patient was subsequently transferred to this hospital.
Reasons for not administering IV thrombolytic therapy must be explicitly documented or clearly implied (e.g., contraindicated) by a physician, nurse practitioner, or physician assistant. Conditions or factors making the administration of IV thrombolytic inadvisable, inappropriate and/or undesirable are documented. Such conditions may include:
Contraindications
- IV or IA t-PA given at outside hospital
- Systolic blood pressure > 185 or diastolic blood pressure > 110 mm hg.
- Suspicion of subarachnoid hemorrhage
- CT findings (intracranial hemorrhage, subarachnoid hemorrhage, or major infarct signs)
- Seizure at onset
- Recent surgery/trauma (<15 days)
- Recent intracranial or spinal surgery, head trauma, or stroke (<3 mo.)
- History of intracranial hemorrhage or brain aneurysm or vascular malformation or brain tumor
- Active internal bleeding (<22 days)
- Platelets <100,000, PTT > 40 sec after heparin use, or PT > 15 or INR > 1.7, or unknown bleeding diathesis
- No IV access
-Care-team unable to determine eligibility
- Pt./Family refused
Warnings:
Conditions that might lead to increased risk of bleeding or unfavorable outcomes
- Advanced age
- Rapid improvement
- Stroke severity – Too mild
- Stroke severity – Too severe (e.g., NIHSS >22)
- Glucose < 50 or > 400 mg/dl
- Life expectancy < 1 year or severe co-morbid illness
- Left heart thrombus
- Patient currently receiving oral anticoagulants (e.g. Warfarin sodium, Coumadin)
- Diabetic hemorrhagic retinopathy or other ophthalmic bleeding
- Subacute bacterial endocarditis
- Acute pericarditis
- Pregnancy
- Septic thrombophlebitis or occluded AV cannula at seriously infected site
- Hemostatic defects including those secondary to severe renal or hepatic disease
If reasons are not mentioned in the context of thrombolytics, do not make inferences (e.g., do not assume that thrombolytics are not being administered due to recent intracranial surgery unless documentation explicitly states so.)
Currently, t-PA is the only FDA-approved IV thrombolytic.
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| Suggested Data Sources: |
- Progress notes
- Emergency room records
- Medication records
- Transfer forms
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| Additional Notes: |
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| Guidelines for Abstraction: |
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IV Thrombolytic Therapy Administered
Specifications Manual for Joint Commission National Quality Core Measures (2010B)
Discharges 10-01-10 (4Q10) through 03-31-11 (1Q11)
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