Core Measures

Just looking for some assistance on core measures...Recently it has been designated to the primary nurse to make the patient a core and follow through on documentation, which is passed on from shift to shift. Just trying to figure out the best process improvement so we don't fall out...best way to keep nurses accountable, education, etc. One of our biggest grey areas is SCIP....it seems that it's constantly debated as to what surgery is a SCIP and which isn't...and VTE with SCIP...do SCDs count or does the Dr have to specify why the patient doesn't need lovenox/heparin. Does anyone have any suggestions?! Thanks so much in advance!

Are you using Clinical Practice Guidelines to drive your measures? These would assist you with your measures. We have a EBP coordinator that monitors these on all the patient's but the bedside RN's are expected to monitor and keep the information straight. We also use "cheat sheets" on each of the groups. So for example we have a color paper that has all the SCIP measures on it and the nurses can use it to see what else they need to do or chart for the patients. It goes in the chart but not in the medical record. We also have checked all of our order sets against the CPG's to make sure that the orders are in keeping with the measures.

Good luck.

~Kris

When I worked in hospital quality, I helped with the development of core measure cue cards that would be placed on the front of the chart for the physician and nurse accountability. As the quality director, I would collect the cards and if we had a fallout, I would pull the card to see what, who and how the fallout happened and coordinate one-on-one training from there. It was an ongoing PI project and I loved it. Our core measure scores soared from 50-75% to 90-100%. Make everyone that touches that chart accountable. The physicians loved it. On discharge the LVSD, ACE/ARB's were never missed and the discharge instructions were documented as given. If your facility utilizes agency nurses, that may be an issue of non-compliance or forgetfulness. I really hate the charts that started as a CHF, but ended up being coded as a Pneumonia; there is nothing that you can do in those instances.

As for your VTE question, SCD's count! Per the abstraction data dictionary for SCIP VTE prophylaxis "mechanical VTE prophylaxis does not require a physician order to be abstracted; there is no order or copy of hospital protocol required. Abstract any form of mechanical VTE prophylaxis that is documented as ordered or as placed on the patient at any time from hospital arrival to 24 hours after Anesthesia End Time."

I hope that this helps!!