CORE MEASURES

Measure Documentation Tips: 1) Use the Widget for Documentation ) Measures App!"
to #npatients and O$SER%AT#O& 'atients
Acute M"ocardia! #nfarction (AM#)
1. PCI within 90 minutes of arrival
time.
2. Aspirin on arrival.
3. Aspirin at discharge
4. tatin prescri!ed at discharge.
". AC# or AA$% at discharge.
&. %eta %loc'er at discharge.
(ocument reason for PCI dela).
*rder AA on arrival or document contraindication in all patients.
(ocument if pre+hospital AA was ta'en at home earlier that da) or given !) #,.
*rder AA at discharge or document contraindication.
*rder -(- test within 24 hours of arrival.
(ocument #. / 400 or narrative of moderate to severe -1 d)sfunction.
If an) recommended medications are not prescri!ed2 document the reason3rationale.
(ocument all discharge medications and give the complete discharge medication list to
the patient with the written discharge instructions.
)eart *ai!ure
4ritten (ischarge Instructions must
address all of the following5
Activit) recommendations
(ietar) restrictions
.ollow up appointments
Prescri!ed medication regimen
4eight monitoring2 and
)mptoms worsening
-eft ventricular function assessed
AC#I or A$% prescri!ed at discharge for
-1#. / 400
6se the (ischarge Instruction $ecord2 document a!! discharge medications as listed in
the #,$. 7ive a comp!ete discharge medication !ist to the patient with the written
discharge instructions.

Document the +%* on e,er" encounter2 even if from a prior encounter8 planned for
after discharge2 or document a reason for not assessing the -1..
If neither AC#I nor A$% is prescri!ed2 document the specific reason2 addressing -oth
the AC#I and the A$%.
'neumonia
.or pts. admitted or transferred to IC6
within 24 hours2 !lood cultures must have
!een drawn within 24 hours of arrival or
within 24 hours !efore IC6 transfer.
#( !lood cultures must !e drawn !efore
an) anti!iotics are administered.
Initial anti!iotics administered within first
24 hours must meet C, guidelines for
IC6 and non+IC6 pneumonia patients
4rite the actual time that !lood cultures are collected on the actual specimen la!el.

Place order for !lood culture prior to placement of anti!iotic order. (ocument !lood
culture draw time in the #,$ -efore the prescri!ed anti-iotic is scanned.

$evised 9une 2014 (,C Corporate :ualit) ; <enet =ome *ffice (. 7oodwin2 ,. .ernande>
CORE MEASURES
'neumonia Anti-iotic Recommendations
&O&.#CU patients

1. Ceftria?one @I1 or I,A B do?)c)cline I13P* preferred/ or
2. Antipneumococcal Cuinolone monotherap) I13P* such as
,o?iflo?acin I1 or P* if severe %+lactam allerg) preferred2 or
3. %+lactam I13I, 0 macrolide I13P* or
4. <igec)cline monotherap) @I1A
11111111111111111111111
$.!actam (#% or #M) D ceftria?one2 cefota?ime2 ertapenem2
ampicillin3sul!actam2 ceftaroline2 ampicillin
Macro!ide (#% or 'O) Der)throm)cin2 clarithrom)cin2 a>ithrom)cin
Antipneumococca! 2uino!one (#% or 'O) D levoflo?acin2 mo?iflo?acin2
gemiflo?acin
&O&.#CU 'atient 3ith 'seudomona! Ris4
1. Piperacillin3ta>o!actam I1 B do?)c)cline I13P* B3+ to!ram)cin
I1 preferred2 or
2. Antipneumococcal3antipseudomonal %+lactam @I1A B
Antipseudomonal Cuinolone I13P*
or
3. Antipneumococcal3antipseudomonal %+lactam @I1A B
Aminogl)coside I1 0 either antipneumococcal Cuinolone
@I13P*A or ,acrolide @I13P*A
&O& #CU patient 3ith 'seudomona! Ris4 AND
15 $.+actam A!!erg":
A>treonam I1 B ,o?iflo?acin I13P* B3+ <o!ram)cin I1 or
A>treonam I13I, B antipneumococcal Cuinolone I13P* B
aminogl)coside I1
5 Rena! #nsufficienc"
A>treonam @I1 or I,A B levoflo?acin or mo?iflo?acin @I13P*A
EEEEEEEEEEEEEEEEEEEE
Antipseudomona! 2uino!one (#% or 'O) 6 ciproflo?acin2 levoflo?acin
Antipneumococca!7antipseudomona! $.!actam @I1A D
cefepime2 imipenem2 meropenem2 piperacillin3ta>o!actam2 doripenem
Aminog!"coside (#%)D gentamicin2 to!ram)cin2 ami'acin
Antipneumococca! 2uino!one (#% or 'O) D levoflo?acin2 mo?iflo?acin2
gemiflo?acin
Macro!ide (#% or 'O) D er)throm)cin2 clarithrom)cin2
a>ithrom)cin
#CU patients
1. Ceftria?one @I1A B a>ithrom)cin @I1A preferred/
F,acrolide @I1A B either %+lactam @I1A or
antipneumococcal3antipseud. %+lactam @I1AG
or
2. FAntipseudomonal Cuinolone @I1A B either %+lactam@I1A
or antipneumococcal3 antipseudomonal %+lactam @I1AG
or
3. FAntipneumococcal Cuinolone @I1A Beither %+lactam @I1A
or antipneumococcal3 antipseudomonal %+lactam @I1AG
or
4. FAntipneumococcal 3antipseudomonal %+lactam @I1A B
aminogl)coside @I1A B either antipneumococcal Cuinolone
@I1A or macrolide @I1AG
or
". If the patient has sic'le cell disease2 Ceftria?one @I1A B
mo?iflo?acin @I1A preferred.
If the patient has .rancisella tularensis or Hersinia pestis
as possi!le source of infection the following is
accepta!le5
(o?)c)cline I1 B either %+-actam @I1A or
antipneumococcal3antipseudomonal %+lactam @I1)
1111111111111111
$.!actam (#%) D ceftria?one2 cefota?ime2 ampicillin3
sul!actam
Antipneumococca!7Antipseudomona! $.!actam (#%)6
cefepime2 imipenem2 meropenem2 piperacillin3
ta>o!actam2 doripenem
Macro!ide (#%) D er)throm)cin2 a>ithrom)cin
Antipneumococca! 2uino!ones (#%) Dlevoflo?acin2
mo?iflo?acin
Antipseudomona! 8uino!one (#%)6 ciproflo?acin2
levoflo?acin
Aminog!"coside (#%) D gentamicin2 to!ram)cin2
Ami'acin
$evised 9une 2014 (,C Corporate :ualit) ; <enet =ome *ffice (. 7oodwin2 ,. .ernande>
CORE MEASURES
%enous Throm-oem-o!ism (%TE)
1. 1<# proph)la?is ordered3administered within
24 hours
for all inpatients and *% patients
for all IC6 admissions or transfers
for all surgical patients
2. .or Patients with (iagnosed 1<#5
Appropriate Anticoagulation *verlap
<herap)
6nfractionated =eparin have (ose ;
platelet monitoring !) protocol or
nomogram
1<# 4arfarin therap) (ischarge
Instructions
(ocumentation around =ospital+ AcCuired2
Possi!l)+Preventa!le 1enous
<hrom!oem!olism
Provider @ph)sician or ,-PA must Isu!mitI Caprini 1<# ris' score for A--
patients.
*rder3administer 1<# proph)la?is on the da) of or da) after admission2
surger) end time2 or transfer into the IC6.
(ocument all contraindications to 1<#P in widget ; order C(.
(ocument reason for using .actor Ja inhi!itor.

Patients 3ith diagnosed 1<# must have overlap of I1 or su!+: anticoagulation
4I<= warfarin therap) until IK$ is L 2 or are discharged on !oth t?.2 or have
documented reason for discontinuation of parenteral therap).
1<# patients on @I1A 6.= therap) have pharmac) heparin dosing order placed
for weight+!ased dosing ; monitoring of platelets.
1<# patients discharged home on warfarin must have written (C instructions
to address a!! the fo!!o3ing:
compliance issues
dietar) advice
follow+up monitoring2 and
ad,erse drug reaction information5
Patients with hospital+acCuired 1<# must have this diagnosis placed on their
#,$ pro!lem list2 and the reason 1<#P was not provided during 24 h prior to
d?. must !e documented.
(ocument the reason for not prescri!ing an)3all of the recommended therapies
as listed @including C( placementA in the widget.
STRO9E
1. <hrom!ol)tic <herap)
2. 1<# Proph)la?is
3. Antithrom!otic <herap) %) #nd of
=ospital (a) 2
4. (ischarged on Antithrom!otic
<herap)
". (ischarged on Anticoagulation
<herap) for atrial3fi!rillation3flutter
&. (ischarged on tatin ,edication
M. tro'e #ducation
N. Assessed for $eha!ilitation
9. (ocument a reason for not appl)ing
the recommended therapies as listed.
Ischemic stro'e patients have I1 throm!ol)tic therap) !egun within 3 hours of last time
'nown well. (ocument -<O4 and an) contraindication.
Provider @ph)sician or ,-PA must Isu!mitI Caprini 1<# ris' score for A--
ischemic3hemorrhagic stro'e patients.
Administer 1<# proph)la?is or on the da) of or the da) after admission @for !oth
ischemic ; hemorrhagic stro'eA or list contraindications in widget and order C(s.
Administer antithrom!otic therap) to ischemic stro'e patients !) the end of =osp (a) 2.
Prescri!e antithrom!otic therap) at hospital d3c or document contraindication for pts. with
ischemic stro'e.
Prescri!e anticoagulation therap) at d3c for ischemic stro'e patients with a+ fi!3flutter.

Prescri!e ischemic stro'e patients statin medication at d3c if -(-L100 @order -(-A.
P,;$ consult must !e placed or document in #,$ that will occur as outpatient.
(ocumentation of stro'e education during sta)+ must address5
1A activation of #, 2A need for follow+up after discharge 2A (3C medications
prescri!ed2 3A ris' factors for stro'e2 and 4A warning signs and s)mptoms of stro'e.
$evised 9une 2014 (,C Corporate :ualit) ; <enet =ome *ffice (. 7oodwin2 ,. .ernande>
CORE MEASURES
'ER#&ATA+ CARE
1. $ate of patients with elective vaginal deliveries or elective
cesarean sections at LD 3M and / 39 wee's of gestation
completed
2. $ate of nulliparous women with a term2 singleton !a!) in a
verte? position delivered !) cesarean section
3. Patients at ris' of preterm deliver) at LD24 and /32 wee's
gestation receiving antenatal steroids prior to delivering
preterm new!orns
4. $ate of staph)lococcal and gram negative septicemias or
!acteremias in high+ris' new!orns
". #?clusive !reast mil' feeding during the new!ornPs entire
hospitali>ation
&. #?clusive !reast mil' feeding during the new!ornQs entire
hospitali>ation considering motherQs choice
(ocument elective deliver) information in widget powerforms
in maternal chart. 6se as a chec'list to ensure all appropriate
documentation is in medical record.
(ocument gestational age in widget powerforms and reason for
c+section in maternal chart.
Provider must complete documentation in widget powerforms in
maternal chart. (ocument 12 mg !etamethasone I, or & mg
de?amethasone I, initiated !efore deliver).
Provider must complete fetal weight and %I attestation in
discharge power form alert in !a!)Qs chart.
Provider must complete discharge attestation power form alert
after reviewing neonatal inta'e form and !a!) feeding histor).
@#?ceptions are medications2 vitamins2 minerals2 or sucrose and
water solution given to the new!orn for the purpose of reducing
discomfort during a painful procedureA.

Chi!dren:s Asthma Care (CAC)
1. 6se of relievers in pediatric patients admitted
for inpatient treatment of asthma. @<his
measure is stratified !) age and includes
patients age 2+1MA.
2. 6se of s)stemic corticosteroids in pediatric
patients admitted for inpatient treatment of
asthma.
3. An assessment that there is documentation in
the medical record that a =ome ,anagement
Plan of Care @=,PCA document was given to
the pediatric asthma patient3caregiver.
Providers should order relievers and corticosteroids or document
contraindications for not ordering these medications.
=ome ,anagement Plan of Care (ocument Addresses
R Arrangements for .ollow+up Care
R =ome ,anagement Plan of Care (ocument Addresses #nvironmental
Control and Control of *ther <riggers
R =ome ,anagement Plan of Care (ocument Addresses ,ethods and <iming
of $escue Actions
R =ome ,anagement Plan of Care (ocument Addresses 6se of Controllers
R =ome ,anagement Plan of Care (ocument Addresses 6se of $elievers
R =ome ,anagement Plan of Care (ocument 7iven to Patient3Caregiver

;+O$A+ MEASURES: App!" to A!! #npatient Discharges
#MM: Influen>a Immuni>ation measure includes inpatients age & months and older who were assessed for seasonal
influen>a immuni>ation status and vaccinated prior to discharge if indicated. %oth activities must occur8 screening
and vaccination when indicated. Patients with documented contraindications2 or who were offered and declined2 or
who received the vaccine during the current season prior to the current hospitali>ation meet this measure.
$evised 9une 2014 (,C Corporate :ualit) ; <enet =ome *ffice (. 7oodwin2 ,. .ernande>
#mmuni<ation Measure Set:
#MM15 Pneumococcal Immuni>ation includes inpatients &" )ears and older AK( inpatients !etween " and &4 )ears
who are high ris'8 who were assessed and vaccinated !efore discharge if indicated. %oth activities must occur8
screening and vaccination when indicated. Patients with documented contraindications2 or who were offered and
declined2 or who received pneumococcal vaccine an)time in the past meet this measure.