eMeasure Title Intensive Care Unit Venous Thromboembolism Prophylaxis
eMeasure Identifier
(Measure Authoring Tool)
190 eMeasure Version number 1
NQF Number 0372 GUID fa91ba68-1e66-4a23-8eb2-baa8e6df2f2f
Measurement Period January 1, 20xx through December 31, 20xx
Measure Steward Joint Commission
Measure Developer Joint Commission
Endorsed By National Quality Forum
Description
This measure assesses the number of patients who received VTE prophylaxis or have documentation why no VTE prophylaxis was given the day of or the day after the initial admission (or transfer) to the Intensive Care Unit (ICU) or surgery end date for surgeries that start the day of or the day after ICU admission (or transfer).
Copyright
Measure specifications are in the Public Domain

LOINC(R) is a registered trademark of the Regenstrief Institute.  

This material contains SNOMED Clinical Terms(R) (SNOMED CT(c)) copyright 2004–2010 International Health Terminology Standards Development Organization. All rights reserved.
Disclaimer
None
Measure Scoring Proportion
Measure Type Process
Stratification
None
Risk Adjustment
None
Rate Aggregation
None
Rationale
The vast majority of patients admitted to a critical care unit (CCU) have a major risk factor for VTE, and many have multiple risk factors: advanced age, serious medical illness, and recent surgical procedures or trauma that are common in critically ill patients. The use of thromboprophylaxis has been demonstrated to be efficacious in preventing deep venous thrombosis in these patients. Accordingly, The Eighth American College of Chest Physicians Conference on Antithrombotic and Thrombolytic Therapy: Evidence-Based Guidelines recommends that all patients on admission to a critical care unit be assessed for their risk of VTE, with the expectation that appropriate thromboprophylaxis will be instituted.
Clinical Recommendation Statement
Failure to recognize and protect patients at risk for venous thromboembolism (VTE) increases the chances for critically ill hospitalized patients for developing a deep vein thrombosis or dying from a pulmonary emboli. Screening all patients is the only evidence based practice in reducing incidence of disease.  All intensive care  unit (ICU) patients should be evaluated for primary VTE prophylaxis, and given appropriate prophylaxis when indicated.
Improvement Notation
An increase in the rate
Reference
Geerts WH, Bergqvist D, Pineo GF, Heit JA, Samama CM, Lassen MR, Colwell CW. Prevention of venous thromboembolism. The Eighth ACCP Conference on antithrombotic and thrombolytic therapy. Chest. 2008; 133:381S-453S.
Reference
Geerts WH, Pineo GF, Heit JA, et al. Prevention of venous thromboembolism: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest. 2004 Sep;126(3 Suppl):338S-400S.
Reference
Attia J, Ray JG, Cook DJ, Douketis J, Ginsberg JS, Geerts WH. Deep vein thrombosis and its prevention in critically ill adults. Arch Intern Med. 2001 May 28;161(10):1268-79.
Reference
Geerts WH, Selby R. Prevention of venous thromboembolism in the ICU. Chest. 2003 Dec;124(6 Suppl):357S-363S.
Definition
None
Guidance
The unit of measurement for this measure is an inpatient episode of care. Each distinct hospitalization should be reported, regardless of whether the same patient is admitted for inpatient care more than once during the measurement period. In addition, the eMeasure logic intends to represent events within or surrounding a single occurrence of an inpatient hospitalization. 

The definition of an ICU for the purpose of the measures noted above is that used by the CDC in the NHSN Patient Safety Project. An intensive care unit can be defined as a nursing care area that provides intensive observation, diagnosis, and therapeutic procedures for adults and/or children who are critically ill. An ICU excludes nursing areas that provide step-down, intermediate care or telemetry only and specialty care areas.
Transmission Format
None
Initial Patient Population
Patients admitted to the hospital for inpatient acute care with no diagnosis of obstetrics or, venous thromboembolism (VTE), or obstetrics - VTE with hospital stays <= 120 days during the measurement period for patients age 18 and older at the time of hospital admission.
Denominator
Patients directly admitted or transferred to ICU during the hospitalization.
Denominator Exclusions
Patients who have a  hospital length of stay (LOS) less than two days.
Patients with comfort measures only documented during the specified date range.
Patients with ICU length of stay less than one day without VTE prophylaxis administered and documentation for no VTE prophylaxis.
Patients with a principal or other diagnosis code of obstetrics or VTE.
Patients with a principal procedure of surgical care improvement Project (SCIP) VTE selected surgeries that start the day of or the day after ICU admission or transfer.
Numerator
Patients who received VTE prophylaxis or have documentation why no VTE prophylaxis was given: 

-the day of or the day after ICU admission (or transfer) 
-the day of or the day after surgery end date for surgeries that start the day of or the day after ICU admission (or transfer)
Numerator Exclusions
Not Applicable
Denominator Exceptions
Patients with ICU LOS less than one day without VTE prophylaxis administered and documentation for no VTE prophylaxis.
Measure Population
Not Applicable
Measure Observations
Not Applicable
Supplemental Data Elements
For every patient evaluated by this measure also identify payer, race, ethnicity and sex.

Table of Contents


Population criteria

Data criteria (QDM Data Elements)

Reporting Stratification

Supplemental Data Elements




Measure Set
eMeasure Venous Thromboembolism (eVTE)