Perioperative Care: Selection of Prophylactic Antibiotic - First OR Second Generation Cephalosporin (NQF 0268)

eMeasure Name Perioperative Care: Selection of Prophylactic Antibiotic - First OR Second Generation Cephalosporin eMeasure Id 83CAF236-5C70-4565-8D22-3C30F404CD8E
Version number 1 eMeasure Set Id F67E1F41-EBC5-4454-86BC-CC49392A33FE
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 surgical patients aged 18 years and older undergoing procedures with the indications for a first OR second generation cephalosporin prophylactic antibiotic who had an order for cefazolin OR cefuroxime for antimicrobial prophylaxis
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
Current published evidence supports the use of either cefazolin, a first generation cephalosporin, or cefuroxime, a second generation cephalosporin, for many surgical procedures, in the absence of β-lactam allergy. An alternative antimicrobial regimen may be appropriate depending on the antimicrobial susceptibility pattern in an individual institution (potentially a medical reason for excluding patients treated at that institution from this measure.)  Data elements required for the measure can be captured and the measure is actionable by the physician.
Clinical Recommendation Statement
For most procedures, cefazolin should be the agent of choice because of its relatively long duration of action, its effectiveness against the organisms most commonly encountered in surgery, and its relatively low cost. (ASHP) In operations for which cephalosporins represent appropriate prophylaxis, alternative antimicrobials should be provided to those with a high likelihood of serious adverse reaction or allergy on the basis of patient history or diagnostic tests such as skin testing. The preferred antimicrobials for prophylaxis in patients undergoing hip or knee arthroplasty are cefazolin and cefuroxime . Vancomycin or clindamycin may be used in patients with serious allergy or adverse reactions to β-lactams.  The recommended antimicrobials for cardiothoracic and vascular operations include cefazolin or cefuroxime. For patients with serious allergy or adverse reaction to β-lactams, vancomycin is appropriate, and clindamycin may be an acceptable alternative. (SIPGWW)
Improvement notation
Higher score indicates better quality
Measurement duration
12 month(s)
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 procedures with the indications for a first OR second generation cephalosporin prophylactic antibiotic
Definition
Denominator(s): All surgical patients aged 18 years and older undergoing procedures with the indications for a first OR second generation cephalosporin prophylactic antibiotic
Definition
Denominator Exclusion(s): N/A
Definition
Numerator(s): Surgical patients who had an order for cefazolin OR cefuroxime for antimicrobial prophylaxis
Definition
Denominator Exception(s): Documentation for medical reason(s) for not ordering cefazolin OR cefuroxime for antimicrobial prophylaxis
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 providers ordered the appropriate antibiotic for the procedure performed (in this case cefazolin or cefuroxime).  Although the focus of the measure is not the timing of the order, we have included a time window for the order of prophylactic antibiotics of <=14 days prior to the procedure through the end of the procedure to effectively associate the order of the prophylactic antibiotic with the procedure being performed.  Standing orders or verbal orders for cefazolin or cefuroxime are also considered to be numerator compliant.
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