Prophylactic Antibiotic Selection for Surgical Patients (NQF 0528)

eMeasure Name Prophylactic Antibiotic Selection for Surgical Patients eMeasure Id 93E6705C-7579-4292-B290-55B878C55629
Version number 1 eMeasure Set Id Pending
Available Date No information Measurement Period January 1, 20xx through December 31, 20xx
Measure Steward Oklahoma Foundation for Medical Quality
Endorsed by None
Description Surgical patients who received prophylactic antibiotics consistent with current guidelines (specific to each type of surgical procedure).
Copyright
Measure scoring Proportion
Measure type Process
Stratification
None
Risk Adjustment
None
Data Aggregation
Rationale
A goal of prophylaxis with antibiotics is to use an agent that is safe, cost-effective, and has a spectrum of action that covers most of the probable intraoperative contaminants for the operation. First or second-generation cephalosporins satisfy these criteria for most operations, although anaerobic coverage is needed for colon surgery. Vancomycin is not recommended for routine use because of the potential for development of antibiotic resistance, but is acceptable if a patient is allergic to beta-lactams, as are fluoroquinolones and clindamycin in selected situations.
Clinical Recommendation Statement
National guidelines recommend specific classes of antibiotics for surgical procedures. First or second-generation cephalosporins satisfy the criteria (safe, cost-effective, and coverage for most probable contaminants) for most operations, although anaerobic coverage is needed for colon surgery.
Improvement notation
Higher score indicates better quality
Measurement duration
12 month(s)
Reference
Bratzler DW, Houck PM, for the Surgical Infection Prevention Guidelines Writers Group. Antimicrobial prophylaxis for surgery: An advisory statement from the National Surgical Infection Prevention Project. CID. 2004:38(15 June):1706-1715.
Reference
Mangram AJ, Horan TC, Pearson ML, et al. Guidelines for prevention of surgical site infection, 1999. Infect Control Hosp Epidemiol. 1999;20:247-280.
Reference
American Society of Health-System Pharmacists. ASHP therapeutic guidelines on antimicrobial prophylaxis in surgery. Am J Health Syst Pharm. 1999;56:1839-1888.
Reference
No author listed. The Medical letter.  Antimicrobial prophylaxis for Surgery. Med Lett Drugs Ther. 2009; 82: 47-52.
Reference
Dellinger EP, Gross PA, Barrett TL, et al. Quality standard for antimicrobial prophylaxis in surgical procedures. Clin Infect Dis. 1994;18:422-427.
Reference
Gilbert DN, Moellering RC Jr., Elipoulos GM, Chamber HF, Saag MS, eds. The Sanford Guide to Antimicrobial Therapy  2009. 39st ed. Sperryville, VA: Antimicrobial Therapy, Inc; 2009.
Reference
Itani KMF, Wilson SE, Awad SS, Jensen EH, Finn TS, Abramson MA. Ertapenem versus cefotetan prophylaxis in elective colorectal surgery. N Engl J Med. 2006 Dec 21; 355 (25): 2640-2651.
Reference
Page CP, Bohnen JM, Fletcher JR, et al. Antimicrobial prophylaxis for surgical wounds. Arch Surg. 1993;128:79-88.
Reference
American College of Obstetricians and Gynecologists (ACOG) Committee on Practice Bulletins ACOG Practice Bulletin No 104 Antibiotic prophylaxis for gynecologic procedures. Obstet Gynecol May 2009; 113(5) : 1180-1189.
Definition
Initial Patient Population(s): All hospital discharges for selective surgery with hospital stays <= 120 days during the measurement year for patients age 18 and older at the time of hospital admission with no evidence of prior infection.
The measure is divided into 8 populations by type of surgery. Each denominator provides criteria for the types of surgery.
Definition
Denominator(s): All selected surgical patients 18 years of age and older with no evidence of prior infection with an ICD-9-CM Hospital Measures-Principal Procedure Code of selected surgeries.
Denominator for population 1 - Coronary artery bypass graft (CAGB) procedures
Denominator for population 2 - Other cardiac surgery
Denominator for population 3 - Hip arthroplasty
Denominator for population 4 - Knee arthroplasty
Denominator for population 5 - Colon surgery
Denominator for population 6 - Abdominal hysterectomy
Denominator for population 7 - Vaginal hysterectomy
Denominator for population 8 - Vascular surgery
Definition
Denominator Exclusion(s): Patients who had a Hospital Measures-Principal diagnosis suggestive of preoperative infectious diseases.
Patients whose ICD-9-CM Hospital Measures-Principal procedure was performed entirely by Laparoscope.
Patients enrolled in clinical trials.
Patients whose ICD-9-CM Hospital Measures-Principal procedure occurred prior to the date of admission.
Patients with physician/advanced practice nurse/physician assistant (physician/APN/PA) documented infection prior to surgical procedure of interest.
Patients who expired perioperatively
Patients who were receiving antibiotics more than 24 hours prior to surgery (except colon surgery patients taking oral prophylactic antibiotics).
Patients who had other procedures requiring general or spinal anesthesia that occurred within 3 days (4 days for CABG or Other Cardiac Surgery) prior to or after the procedure of interest (during separate surgical episodes) during this hospital stay
Patients who were receiving antibiotics within 24 hours prior to arrival (except colon surgery patients taking oral prophylactic antibiotics).
Patients who did not receive any antibiotics before or during surgery, or within 24 hours after Anesthesia End Time (i.e., patient did not receive prophylactic antibiotics).
Patients who did not receive any antibiotics during this hospitalization.
Specifically for Populations 6 and 7: Patients who had a hysterectomy and a caesarean section performed during this hospitalization.
Definition
Numerator(s): Number of surgical patients who received prophylactic antibiotics recommended for their specific surgical procedure
Definition
Denominator Exception(s): N/A
Guidance
The measurement period is one calendar year but the reporting period is 3 months as a calendar quarter; Q1 = Jan – Mar, Q2 = Apr – Jun, Q3 = Jul – Sep, Q4 is Oct – Dec.

Patients for whom there are missing or inaccurate data (e.g., arrival time, medication administration, etc.) are considered to have failed the measure; the total number of patients with missing or erroneous (e.g., a time of 03:69 or a date of 10/26/2035) data (i.e., measure failures) must be reported with the results of the measure.

General guidance:

The original measure excludes patients who have had a laparoscopic procedure unless the laparoscopic incision has been extended during the procedure.  ICD-10 allows definition of such extension with procedure codes; ICD-9 does not. For those using ICD-9 any laparoscopic procedure that extends the incision should be included.
In this measure the code lists that describe types of surgical procedures remain only in ICD-9 or ICD-10 because the concepts that apply are limited to a very specific subset of all surgical procedures.

Numerator element guidance:

Vancomycin is acceptable for CABG, other cardiac procedures, hip arthroplasty, knee arthroplasty and vascular surgery if there is an increased MRSA rate facility-wide or operation-specific. For the purpose of using vancomycin for prophylaxis, it is expected that vancomycin is given ONLY if one of the allowable conditions is TRUE. Note also, that all numerators numbered using "x.1" (e.g., 1.1, 2.1, etc.) are to be used for calculating successful performance for the measure.  Numerators numbered using "x.2" (e.g ., 1.2, 2.2, 3.2, etc.) are to be used for reporting only and indicate the number excluded due to lack of documentation to justify vancomycin use. All instances that are described in Numerators "x.2" are non-compliant with Numerators "x.1" in calculating the measure performance.
Supplemental Data Elements
Report "Patient Characteristic: Gender" using "Gender HL7 Value Set (2.16.840.1.113883.1.11.1)"; Report "Patient Characteristic: Race" using "Race CDC Value Set (2.16.840.1.114222.4.11.836)"; Report "Patient Characteristic: Ethnicity" using "Ethnicity CDC Value Set (2.16.840.1.114222.4.11.837)"; Report "Patient Characteristic: Payer" using "Payer Source of Payment Typology Value Set (2.16.840.1.113883.3.221.5)".

Table of Contents


Population criteria

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Data criteria (QDM Data Elements)

Supplemental Data Elements




Measure set CLINICAL QUALITY MEASURE SET 2011-2012