Prophylactic Antibiotics Discontinued Within 24 Hours After Surgery End Time (NQF 0529)

eMeasure Name Prophylactic Antibiotics Discontinued Within 24 Hours After Surgery End Time eMeasure Id A6ADAC4A-94F7-4040-9B70-77AA3746CB94
Version number 1 eMeasure Set Id C73CA049-A721-4338-93F8-2978D7F5242D
Available Date No information Measurement Period January 1, 20xx through December 31, 20xx
Measure Steward Oklahoma Foundation for Medical Quality
Endorsed by National Quality Forum
Description Surgical patients whose prophylactic antibiotics were discontinued within 24 hours after Anesthesia End Time. The Society of Thoracic Surgeons (STS) Practice Guideline for Antibiotic Prophylaxis in Cardiac Surgery (2006) indicates that there is no reason to extend antibiotics beyond 48 hours for cardiac surgery and very explicitly states that antibiotics should not be extended beyond 48 hours even with tubes and drains in place for cardiac surgery.
Copyright
Measure scoring Proportion
Measure type Process
Stratification
None
Risk Adjustment
None
Data Aggregation
Rationale
A goal of prophylaxis with antibiotics is to provide benefit to the patient with as little risk as possible. It is important to maintain therapeutic serum and tissue levels throughout the operation. Intraoperative re-dosing may be needed for long operations. However, administration of antibiotics for more than a few hours after the incision is closed offers no additional benefit to the surgical patient. Prolonged administration does increase the risk of Clostridium difficile infection and the development of antimicrobial resistant pathogens.
Clinical Recommendation Statement
National guidelines maintain that prolonged administration of antibiotics does increase the risk of Clostridium difficile infection and the development of antimicrobial resistant pathogens.
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
Crabtree TD, Pelletier SJ, Gleason TG, et al. Clinical characteristics and antibiotic utilization in surgical patients with Clostridium difficile-associated diarrhea. Am Surg. 1999;65:507-511.
Reference
Edwards FH, Engelman RM, Houck P, Shahian DM, Bridges CR. The Society of Thoracic Surgeons Practice Guideline Series: Antibiotic prophylaxis in cardiac surgery, Part I: Duration, 2006. Ann Thoracic Surg 2006; 81: 397-404.
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
McDonald M, Grabsch E, Marshall C, et al. Single- versus multiple-dose antimicrobial prophylaxis for major surgery: a systemic review. Aust N Z J Surg. 1988;68:388-396.
Reference
Scher KS. Studies on the duration of antibiotic administration for surgical prophylaxis. Am Surg. 1997;63:59-62.
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 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 principal diagnosis suggestive of preoperative infectious diseases. 
Patients whose ICD-9-CM principal procedure was performed entirely by Laparoscope. 
Patients enrolled in clinical trials. 
Patients whose ICD-9-CM 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 preoperatively. 
Patients who had other procedures requiring general or spinal anesthesia that occurred within three days (four 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 more than 24 hours prior to surgery (except colon surgery patients taking oral prophylactic antibiotics). 
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 during this 
hospitalization. 
Patients who received urinary antiseptics only Patients with Reasons to Extend Antibiotics. 
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 whose prophylactic antibiotics were discontinued within 24 hours after Anesthesia End Time (48 hours for CABG or Other Cardiac Surgery).
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: 

For calculation of antibiotic duration post-operatively, duration is a derived element calculated from the number of doses and frequency of doses administered post operatively. 

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 valid reasons for continuing antibiotics longer than the 24 hours expected.  All occurrences that are described in Numerators "x.2" are also represented in exclusions. The Numerators "x.1" are intended to capture the number of procedures excluded for the purposes identified and are not to be included in the final summary calculation. 

Exclusion element guidance: 

The exclusion for patients who are clinical trial participants is limited to patients participating in a clinical trial for the same conditions as covered by the measure. Other clinical trials are not valid reasons for exclusions. 

Additional reasons for exclusion that represent "medical reasons" for continuation of antibiotics for longer than 24 hours (or 48 hours for CABG or Other cardiac surgery) include erythromycin for gastric motility disorder, or antibiotics for hepatic encephalopathy, antibiotics for Pneumocystis carinii pneumonia with a diagnosis of AIDS, current malignancy of the lower extremity involving the same extremity that had joint revision surgery, documentation that a culture was taken of the operative site prior to the administration of the prophylactic antibiotic during joint revision surgery.
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