1. Post OP Glucose Control For Cardiac Surgery The Society of Thoracic Surgeons Workforce guidelines (Lazar, 2009) recommended cardiac surgery patients, with and without diabetes, maintain serum glucose of < 180 mg/dL. It is acknowledged that controlling the blood glucose in the immediate time period after surgery may be challenging (due to changing medications, use of inotropes, etc.), however, cardiac care teams should be able to reasonably control the blood sugar to levels of 180 mg/dL or less within the 18 – 24 hour post-operative time frame. *These changes will be effective with January 2014 Discharges. Reason for the Change:

2. 1. All blood glucose levels collected were ≤ 180 mg/dL in the specified timeframe. 2. A single blood glucose level collected was > 180 mg/dL but ALL other values after the higher value were ≤ 180 mg/dL prior to the endpoint of 24 hours after Anesthesia End Time. Passes Measure Does NOT Pass Measure 3. A single blood glucose level collected was > 180 mg/dL and NO other values after the higher value were ≤ 180 mg/dL prior to the endpoint of 24 hours after Anesthesia End Time OR Two or more blood glucose levels were > 180 mg/dL in the specified timeframe. 4.No blood glucose levels were collected in the specified timeframe OR Any blood glucose level was unable to be determined from medical record documentation. For abstraction: Look at the blood glucose levels collected between 18 and 24 hours after Anesthesia End Time If No blood glucose levels were collected during this timeframe, use blood glucose levels collected between 12 and 18 hours after Anesthesia End Time.

3. VTE Prophylaxis options for Total Knee, Total Hip and Partial Hip Replacement and General Surgery *These changes will be effective with January 2014 Discharges Reason for the Change: The measure specifications are being revised to maintain consistency with the updated American College of Chest Physicians’ guidelines on prevention of VTE in surgical patients. Reference: Guyatt G, Akl E, Crowther M, Gutterman D, Schuünemann H. Executive summary: antithrombotic therapy and prevention of thrombosis. The Ninth ACCP edition: ACCP evidence-based clinical practice guidelines. Chest 2012; 141;7S-47S. PMID: 22315257

4. Elective Total Knee or Total Hip Replacement Any of the following: Low molecular weight heparin (LMWH) Factor Xa Inhibitor Oral Factor Xa Inhibitor1 Warfarin Intermittent pneumatic compression devices (IPC) Venous foot pump (VFP) Low-dose unfractionated heparin (LDUH) Aspirin Hip Fracture Surgery Any of the following: Low-dose unfractionated heparin (LDUH) Low molecular weight heparin (LMWH) Factor Xa Inhibitor Warfarin Intermittent pneumatic compression devices (IPC) Aspirin General Surgery Any of the following: Low-dose unfractionated heparin (LDUH) Low molecular weight heparin (LMWH) Factor Xa Inhibitor Intermittent pneumatic compression devices (IPC) For abstraction:

5. ACCEPTABLE Documentation of Infection Abscess Acute abdomen Aspiration pneumonia Bloodstream infection Bone infection Cellulitis Chronic Obstructive Pulmonary Disease (COPD) acute exacerbation Crohn’s Disease Endometritis Fecal Contamination Free air in abdomen Gangrene H. pylori Necrosis Necrotic/ischemic/infarcted bowel Osteomyelitis Other documented infection (ex. appendicitis, diverticulitis) Perforation of bowel Penetrating abdominal trauma Purulence/pus Pneumonia or other lung infection Sepsis Surgical site or wound infection Systemic Inflammatory Response Syndrome (SIRS) Ulcerative colitis Urinary tract infection (UTI) *Changes effective with January 2014 Discharges

6. Reasons to extend antibiotics beyond 24 hours postop (PA/NP/MD documentation within 2 days (3 for CABG and Valves) Erythromycin given postop for the purpose of increasing gastric motility Giving an antibiotic for the treatment of hepatic encephalopathy Giving an antibiotic as prophylaxis of pneumocystis pneumonia to AIDS pt Documentation the patient had an infection Documentation the patient has a current malignancy of the lower extremity involving the same extremity that was a joint revision surgery Documentation of a joint revision surgery that a culture was taken of the operative site after incision, prior to administration of the prophylactic antibiotic The use of antibiotics postoperatively for the treatment of pulmonary fibrosis and acne or rosacea *Changes effective with January 2014 Discharges