Perioperative Care: Timing of Prophylactic Antibiotics - Ordering Physician (NQF 0270)

EMeasure Name Perioperative Care: Timing of Prophylactic Antibiotics - Ordering Physician EMeasure Id FC46B7BB-4D6C-4A3B-986B-5C29505E4EEA
Version number 1 Set Id 62B297EF-8763-48F5-AB3B-E8A8D933114D
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 prophylactic parenteral antibiotics who have an order for an antibiotic to be given within one hour (if fluoroquinolone or vancomycin, two hours) prior to the surgical incision (or start of procedure when no incision is required)
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
The appropriate timing of administration of prophylactic antibiotics has been demonstrated to reduce the incidence of surgical wound infections.  Specifying the time of administration in the order is critical as available evidence suggests that the drug should be received within one hour before incision for maximum antimicrobial effect.  Data elements required for the measure can be captured and the measure is actionable by the physician.
Clinical Recommendation Statement
The anti-infective drug should ideally be given within 30 minutes to 1 hour before the initial incision to ensure its presence in an adequate concentration in the targeted tissues.  For most procedures, scheduling administration at the time of induction of anesthesia ensures adequate concentrations during the period of potential contamination.  Exceptions: cesarean procedures (after cross clamping of the umbilical cord); colonic procedures (starting 19 hours before the scheduled time of surgery). (ASHP) Infusion of the first antimicrobial dose should begin within 60 min before incision.  However, when a fluoroquinolone or vancomycin is indicated, the infusion should begin within 120 min before incision to prevent antibiotic-associated reactions.  Although research has demonstrated that administration of the antimicrobial at the time of anesthesia induction is safe and results in adequate serum and tissue drug levels at the time of incision, there was no consensus that the infusion must be completed before incision. (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
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 administered within one hour prior to incision (or within 2 hours if vancomycin or fluoroquinolones).  Although the eMeasure specifies "medication administered," this should also include the intent to administer the medication in the absence of actual administration. For example, if the provider orders the medication to be administered within one hour prior to incision (or within 2 hours if vancomycin or fluoroquinolones), yet it is not administered, the provider would still be compliant with the numerator.

Table of Contents


Population criteria

Data criteria (QDS Data Elements)

Summary Calculation

Calculation is generic to all measures:



Measure set CLINICAL QUALITY MEASURE SET 2011-2012