Perioperative Care: Discontinuation of Prophylactic Antibiotics (Non-Cardiac Procedures) (NQF 0271)

eMeasure Name Perioperative Care: Discontinuation of Prophylactic Antibiotics (Non-Cardiac Procedures) eMeasure Id C759FD24-9777-4424-8F58-A33D50FC90E4
Version number 1 eMeasure Set Id 1BA8D271-127E-4825-BCD3-93F1304A9F9D
Available Date No information Measurement Period January 1, 20xx through December 31, 20xx
Measure Steward American Medical Association - Physician Consortium for Performance Improvement
Endorsed by National Quality Forum
Description Percentage of non-cardiac surgical patients aged 18 years and older undergoing procedures with the indications for prophylactic antibiotics AND who received a prophylactic antibiotic, who have an order for discontinuation of prophylactic antibiotics within 24 hours of surgical end time.
Copyright
© 2010 American Medical Association and/or National Committee for Quality Assurance. All Rights Reserved
Measure scoring Proportion
Measure type Process
Stratification
None
Risk Adjustment
None
Data Aggregation
Rationale
There is no evidence there is added benefit of prolonged prophylactic antibiotic use. Prolonged use may increase antibiotic resistant organisms.  Data elements required for the measure can be captured and the measure is actionable by the physician.
Clinical Recommendation Statement
At a minimum, antimicrobial coverage must be provided from the time of incision to closure of the incision.  For most procedures, the duration of antimicrobial prophylaxis should be 24 hours or less, with the exception of cardiothoracic procedures (up to 72 hours' duration) and ophthalmic procedures (duration not clearly established). (ASHP)  Prophylactic antimicrobials should be discontinued within 24 hours after the operation. (SIPGWW)
Improvement notation
Higher score indicates better quality
Reference
American Society of Health-System Pharmacists (ASHP). ASHP Therapeutic Guidelines on Antimicrobial Prophylaxis in Surgery. Am J Health Syst Pharm 1999; 56:1839-1888.
Reference
Bratzler DW, Houck PM for the Surgical Infection Prevention Guidelines Writers Workgroup (SIPGWW). Clinical Infectious Diseases 2004;38 (15 June): 1706-15.
Definition
Initial Patient Population(s): Patient Age: Patients aged 18 years and older before the start of the measurement period.
Procedure Performed: Patients undergoing non-cardiac procedures with the indications for prophylactic antibiotics during the measurement period.
Definition
Denominator(s): All non-cardiac surgical patients aged 18 years and older undergoing procedures with the indications for prophylactic antibiotics AND who received a prophylactic antibiotic.
Definition
Denominator Exclusion(s): N/A
Definition
Numerator(s): Non-cardiac surgical patients who have an order for discontinuation of prophylactic antibiotics within 24 hours of surgical end time.
Definition
Denominator Exception(s): Documentation of medical reason(s) for not discontinuing prophylactic antibiotics within 24 hours of surgical end time.
Guidance
For this measure, the source of the clinical data will be located in both the hospital EHR and the physician practice EHR.  The denominator is identified by the procedures that are performed by the physician, whereas the clinical data required for the numerator and exceptions will be located in the hospital EHR.  In order to calculate the measure, there may be some abstraction required from the inpatient record to the ambulatory (physician) EHR before the measure can be calculated.  The intent of this measure is to assess whether or not the provider ordered the prophylactic antibiotic to be discontinued within 24 hours after the procedure end time.  Although the eMeasure specifies "medication administration end time," this should also include the intent to end the medication administration in the absence of actually stopping the medication administration. For example, if the provider orders the medication to be discontinued within 24 hours after procedure end time, yet the medication is not discontinued within that timeframe, the provider would still be compliant with the numerator.  Standing orders or verbal orders for prophylactic antibiotics to be discontinued within 24 hours after procedure end time are also considered to be numerator compliant.

Numerator Guidance: Anesthesia end time is used as a proxy for surgical end time in this measure. 
The anesthesia is related to the procedure by the fact that it started within 2 hours of the start of the surgery.

Exclusion Guidance: There should be a documented reason why the antibiotic was not discontinued within 
24 hours after anesthesia end time.
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

Data criteria (QDM Data Elements)

Supplemental Data Elements




Measure set CLINICAL QUALITY MEASURE SET 2011-2012