2015 Core Measures Perinatal Unit Review Slides Answer questions Pertains to L & D, Post Partum, Antepartum, Nursery, NICU

OBMC Core Measures January 2015 Immunization (IMM) CMS/TJC MEASURE RATIONALE Immunization- (Oct 1st-March 31st) Complete influenza vaccine assessment on all patients 6 months and older and administer vaccine prior to discharge to all eligible patients Influenza vaccine is recommended by the CDC for patients 6 months and older unless contraindicated Document refusal if patient does not want vaccine prior to discharge Do not give: Hypersensitivity to eggs or other components of vaccine Bone Marrow Transplant within past 6 months History of Guillain-Barre Syndrome within 6 weeks after a previous flu vaccination Anaphylactic latex allergy Already immunized during the current flu season Page 1 of 3

Perinatal Care (PC) CMS/TJC Perinatal Care cont. MEASURE RATIONALE Patients with elective vaginal deliveries or elective cesarean sections at ≥ 37 and < 39 weeks of gestation completed (Patient not in Labor) Goal is to see decrease in number. Elective inductions result in more cesarean deliveries and longer maternal length of stay. Elective induction doubles the cesarean delivery rate. Repeat elective cesarean sections before 39 weeks gestation also result in higher rates of adverse respiratory outcomes, mechanical ventilation, sepsis and hypoglycemia for the newborns Nulliparous women with a term, singleton baby in a vertex position delivered by cesarean section Goal is decrease in number. The removal of any pressure to not perform a cesarean birth has led to a skyrocketing of hospital, state and national cesarean section (CS) rates. Some hospitals now have CS rates over 50%. Hospitals with CS rates at 15-20% have infant outcomes that are just as good and better maternal outcomes Patients at risk of preterm delivery at ≥ 24 and <34 weeks gestation receiving antenatal steroids prior to delivering preterm newborns Reduces the risk of respiratory distress syndrome, prenatal mortality, and other morbidities. This measure looks at initiating the steroid Perinatal Care cont. MEASURE RATIONALE Staphylococcal and gram negative septicemias or bacteremia in high-risk newborns Increased mortality, length of stay, and hospital costs. Effective preventive measures available Exclusive breast milk feeding during the newborn's entire hospitalization – Excludes newborns admitted to NICU Consider mother’s initial feeding plan. Can include mother’s medical reason for not choosing to exclusively breast feed. Exclusive breast milk feeding for the first 6 months of neonatal life has long been the expressed goal of World Health Organization (WHO), Department of Health and Human Services (DHHS), American Academy of Pediatrics (AAP) and American College of Obstetricians and Gynecologists (ACOG). Numerous benefits for newborn and mother. Drops of water to stimulate latching are ok Documentation must indicate mother’s initial feeding plan and date/time of discussion prior to newborn’s first feeding. MD must acknowledge awareness of the choice. Document formula instead of “bottle” Page 2 of 3

Stroke (STK) CMS/TJC Stroke cont. MEASURE RATIONALE MD MUST Document a reason for not prescribing IV t-PA or a reason for delay if it was administered after 3 hrs of symptom onset. The FDA approved the use of IV t-PA for the treatment of acute ischemic stroke when given within 3 hrs of stroke symptom onset. Provide VTE prophylaxis on Day1 or Day 2 of Hospital admission or document reason Stroke patients are at increased risk of developing venous thromboembolism (VTE) Measure LDL-c or full lipid panel within 48 hrs of arrival on all ischemic stroke patients who are not on lipid lowering medication Intensive lipid lowering therapy using statin medication was associated with a dramatic reduction in the rate of recurrent ischemic stroke and major coronary events Prescribe statin at discharge to ischemic stroke patients with LDL greater than 100 mg/dL, or LDL not measured, or who were on a statin prior to hospital arrival Stroke cont. MEASURE RATIONALE Prescribe anticoagulation for all pts with AFib/ Aflutter or document contraindication Thromboembolic events are greatly reduced for AFib/ AFlutter patients treated with anticoagulant therapy MD Must order an evaluation by the Rehab team or document reason why evaluation was not indicated (i.e. if patient at baseline by discharge) Effective rehabilitation interventions initiated early following stroke can enhance the recovery process and minimize functional disability. Provide written discharge instructions on when to call 911, follow-up after discharge, medications, risk factors for stroke and warning signs and symptoms of stroke Patient education programs for specific chronic conditions have increased healthful behaviors, improved health status, and/or decreased health care costs of their participants Reconcile medications correctly (Discharge Summary, Orders, and Instructions MUST match) Signed copy of instructions must be on chart. Reduce medication errors Page 3 of 3