Snapshot: This document provides an overview of the Joint Commision’s “Core Measures,” including a definition of what they are and abbreviated guidelines to what Core Measures mandate in various clinical areas.
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What Are Core Measures? Why Should I Care About Core Measures? Acute Myocardial Infarction (AMI) Heart Failure (HF) Pneumonia (PN) Surgical Care Improvement Project (SCIP) Hospital Outpatients (HOP)
What are Core Measures?
Core Measures are evidence-based standards of care established by The Joint Commission (TJC) and the Centers for Medicare and Medicaid Services (CMS).- These measures specify best clinical practice in four areas: Heart Failure, Acute Myocardial Infarction (AMI, i.e. Heart Attack), Pneumonia, and Surgical Site Infection prevention.
- Health organizations’ performance on the Core Measures is assessed by examining documentation in patients’ medical records. Performance is reported as a percentage of patients whose care meets the Core Measures’ requirements in each clinical area, and is reported to CMS on a quarterly basis.
Why Should I Care About Core Measures?
- Core Measures have been validated to improve patient safety and outcomes of care. The Core Measures represent best clinical practice for some of the most commondisease processes and health events that Americans face today.
- Increasingly, health organizations’ reimbursement is tied to scores on Core Measures. This is one manifestation of the “pay for performance” movement in U.S. healthcare.
- Patients may now view health organizations’ scores on Core Measures by visiting CMS’s “Hospital Compare” website. Organizations who score poorly on Core Measures may not only be denied reimbursement, but may also lose business from patients and referring physicians who are reluctant to visit organizations with poor Core Measure scores.
- RN’s have an important role to play in implementing, auditing, and verifying compliance with Core Measures. Even if you are not a manager, your organization will likely expect you to comply with Core Measures, and may rely on you to ensure compliance with the implementation and documentation of Core Measures.
- Listed below are each of the major clinical areas covered by the Core Measures.
- Important: This is a summary of Core Measure requirements in each of the major clinical areas, not an exhaustive list of requirements. For more information, see the following websites and resources:
- Centers for Medicare and Medicaid Services (CMS): https://www.cms.gov/HospitalQualityInits/18_HospitalProcessOfCareMeasures.asp
- The Joint Commission: http://www.jointcommission.org/core_measure_sets.aspx
- For a good example of a Core Measures checklist, see: http://www.smh.com/forPhysicians/physicianResources/Nursing_core_measures_121009.pdf
- Note: Contraindications exist for the prescription or use of Core Measure requirements. A patient’s care may therefore meet Core Measure requirements even if not all measures are implemented. In all cases, documentation of contraindications must be provided.
- Important: This is a summary of Core Measure requirements in each of the major clinical areas, not an exhaustive list of requirements. For more information, see the following websites and resources:
Acute Myocardial Infarction (AMI)
- Aspirin prescribed within 24 hours of arrival, and at discharge
- Angiotensin II converting enzyme inhibitor (ACE-inhibitor) or Angiotensin II receptor blocker (ARB) prescribed for patients with Left Ventricular Systolic Dysfunction (LVSD), defined as an Ejection Fraction (EF) < 40%
- Adult smoking cessation advice or counseling for all patients with a history of tobacco consumption
- Beta blocker (BB) prescribed within 24 hours of arrival, and at discharge
- Thrombolytic agent received within 30 minutes of arrival for ST-elevation Myocardial Infarction (STEMI) or left bundle branch block (LBBB), if indicated by electrocardiogram (ECG)
- Percutaneous coronary intervention (PCI) within 120 minutes of arrival for ST-elevation Myocardial Infarction (STEMI) or left bundle branch block (LBBB), if indicated by electrocardiogram (ECG)
- Statin prescribed at discharge
- Contraindications for the prescription or use of any of the above measures must be documented.
Heart Failure (HF)
- Left ventricular systolic (LVS) function assessment performed before arrival, during hospital stay, or planned after discharge
- Angiotensin II converting enzyme inhibitor (ACE-inhibitor) or Angiotensin II Receptor Blocker (ARB) prescribed at discharge for patients with left ventricular systolic dysfunction (LVSD), defined as an Ejection Fraction (EF) < 40%
- Adult smoking cessation advice/counseling for all patients with a history of tobacco use
- Discharge instructions must include education (written or other) about recommended activity levels, diet, weight monitoring, symptom management, and all discharge medications
- Contraindications for the prescription or use of any of the above measures must be documented.
Pneumonia (PN)
- Initial antibiotics received within 4 hours of arrival for patients with pneumonia diagnosis upon admission
- Assessment of arterial oxygenation (by blood gas measurement or pulse oximetry) within 24 hours of admission for patients with pneumonia diagnosis upon admission
- All patients 65 years of age and older screened for pneumonia and vaccine administered upon discharge if indicated
- All patients 50 years and older diagnosed with pneumonia and admitted from October – February annually are screened for influenza vaccination, or provided with an influenza vaccination prior to discharge
- Adult smoking cessation advice/counseling for all patients with a history of tobacco use
- Blood cultures drawn before (not during or after) antibiotics are administered for all patients admitted through the emergency room
- Appropriate antibiotics prescribed for all patients diagnosed with pneumonia
- Contraindications for the prescription or use of any of the above measures must be documented.
Surgical Care Improvement Project (SCIP)
- Prophylactic antibiotics given 1 hour or less prior to surgical incision
- Prophylactic antibiotic selection consistent with current clinical guidelines
- Prophylactic antibiotics discontinued 24 hours or less after surgery
- Cardiac surgery patients have controlled early morning glucose (defined as glucose < or = 200 mg/dL at 6 am) on post-operative days 1 and 2
- Clippers (not shavers or razors) used for hair removal prior to surgery
- Urinary catheters removed by the first of second day post-operatively
- Surgical patients who required active warming during surgery or had a body temperature greater than or equal to 98.6 degrees F perioperatively documented; intentional perioperative hypothermia documented
- Beta blocker given perioperatively for patients already prescribed beta blockers prior to admission
- Patients who meet recommended prophylactic venous thromboembolism (VTE) receive VTE therapy perioperatively (24 hours prior to surgery and 24 hours after surgery)
- Contraindications for the prescription or use of any of the above measures must be documented.
Hospital Outpatients (HOP)
- Antibiotics (abx’s) within 1 hour of outpatient incision
- Proper antibiotic selection. (Be sure to document name, dose, route, date and time of administration).