Core Measures

[TX_nurse_08]

Is anybody else out there frustrated with the "core measures" movement? I understand the idea behind it, but the application has been.....over-administrationed to put it politely. Where I work, we have at least 5 core measures; only 1 of which is supposed to apply to pediatric patients. The pedi unit I work on is also a med overflow depositing area for adults so we now deal with most of these core measures. The issues that I'm having now involve the VTE for adults and the Asthma for pedi. The adult VTE drives me nuts because it's necessitating lovenox, teds/scd for EVERY SINGLE ADULT PATIENT in the hospital! The long checklist has an area where someone could potentially be given reprieve from daily lovenox if they are marked as a bleeding risk. If I was an ambulatory "walkie/talkie" patient, I would refuse the Lovenox and I would be pretty unhappy about being required to wear teds/scd. For the pedi patients, the asthma education was clearly developed around the use of a peak flow meter. This would not create issues except that many of our pedi patients are too young to use one, or do not have one and it is not being ordered. There is a blank in each of the asthma "zones" for peak flow readings that are supposed to help parents and patients assess the status. Well, I can't put a number if there is no meter use but administration disagrees apparently. I have to attend a personal meeting for my core measure fall out on one of these asthma sheets because I did not put numbers on the peak flow spots. Also, just curious - who does asthma education where you work? At my current place of employment the RN is responsible for the core measure education; at my previous place of employment (a fairly large children's hospital) the RT was required to complete the asthma education at discharge.

[Altra, BSN, RN]

It helps to understand that healthcare is a highly regulated industry.

Demonstration of compliance with standards for VTE prophylaxis and pediatric asthma care is required for Joint Commission accreditation. Reimbursement from CMS for Medicare/Medicaid patients is also dependent on meeting these standards.

I would ask your unit educator or charge nurse how to handle completion of your documentation for pedi patients unable to use a peak flow meter.

[TX_nurse_08]

I do understand that regulations are steadily increasing, and I understand the need for core measures compliance. My issues are with the specifics and the implementation.

Am I to understand that the current regulations require all patients 18 years and older to receive daily injections of blood thinners regardless of their ambulatory status? This does not seem appropriate in the least. Also, the measure was rolled out without any prior education (someone in administration must have sent a memo to ER though, because all of a sudden every adult rolled upstairs with the VTE checklist in chart) and the classes which are supposed to inform us about it are not for another week or two.

As far as asking about the peak flow meters, our unit is small (less than 10 patient rooms, one of which is a private room) and we have no educator. Our nurse manager does not have an answer for us. Our director does not have an answer for us. I did suggest that they go ahead and have all of the nurses from our unit attend together since we all are going to have fall outs due to the lack of peak flow meters, but was told it will just be me since mine was pulled first and they have not gotten the rest yet. From what I can tell, the personal meeting with administration that I am mandated to attend on my day off will be my only opportunity to have this adressed.

We also asked for the form to be translated into Spanish because a large percentage of our patients are Spanish speaking only, this has not been attended to, so we are currently using the translator phone line to read the entire page of information and having them sign and recieve a copy of educational materials that are not even in the language that they understand. This is the kind of thing that is frustrating to me, it seems counterproductive/inadequate/whatever term you'd like to use for "not good enough".

[Altra, BSN, RN]

With some clicking around the Joint Commission site I did find the patient population required for inclusion of reporting on VTE prophylaxis, and it is patients 18 years or older, with hospital stays greater than 2 days but less than 120 days, who are not designated as "comfort measures only", are not enrolled in a clinical trial, or do not have certain psychiatric or surgical diagnoses which exclude them from reporting.

http://www.jointcommission.org/specifications_manual_for_national_hospital_inpatient_quality_measures.aspx

[classicdame, MSN, EdD]

Our case managers work with the nurses to provide tools to help remember each of the measures. The core standards are evidence-based, so it is hard to argue their existence. It would be better for you to provide input to the case managers regarding what you need to help get it all done. Good luck!

[RNewbie]

The facility I work at uses a scale (like the Braden scale) to see if the pt is at risk. Depending on the number the dr will order proper anticoagulant therapy. The other options on the form are scds, teds, and early ambulation. So all of our pts do not get anticoagulants. I thought that vte prophylaxis just had to be addressed for every pt, not meaning that everyone gets anticoagulants. Is my facility doing this correctly?

[TX_nurse_08]

I reviewed the JC data, they have a pretty extensive list for what qualifies as a VTE prophylaxis. I can't find anywhere that indicates that multiple prophylaxes are required, or that a pharmacological intervention is necessary for all patients. There also seems to be some types of patients who ARE able to be excluded, namely those whose length of stay is less than 2 days but also those at "low risk". Perhaps judging the level of risk is too tedious? It's too bad it's not 3 days, most of my adult appy/chole and medical patients are d/c'd in 3 days or less. Just FYI for anybody else who's interested....

Data Element Name: VTE Prophylaxis

Collected For: CMS/The Joint Commission: SCIP-VTE-2, STK-1, VTE-1

Definition: The type of venous thromboembolism (VTE) prophylaxis documented in the medical record.

Suggested Data Collection Question: What type of VTE prophylaxis was documented in the medical record?

Format:

Length: 1

Type: Alphanumeric Occurs: 1-8

Allowable Values: Select all that apply:

1 Low dose unfractionated heparin (LDUH)

2 Low molecular weight heparin (LMWH)

3 Intermittent pneumatic compression devices (IPC)

4 Graduated compression stockings (GCS)

5 Factor Xa Inhibitor

6 Warfarin

7 Venous foot pumps (VFP)

8 Oral Factor Xa Inhibitor

[FloridaT]

We too were having a difficult time tracking and trying to remember all the core measures. We recently installed a system that automatically tracks everything in a dashboard in a red light/green light manner so with a quick glance, I can see which patients are out of compliance. It eliminates the need for me to go back and research all the nuances of each measure and better yet, the system will automatically send out an email or text to the physician when the red light is a result of waiting on them. It has really made a huge difference in our stress levels around CM and we have increased compliance to 100% in several key target measures.