11 measures Antibiotic

Stewardship• #66: Pharyngitis patients

given an abx who had strep test performed

• #91: Patients with Otitis Externa given a topical abx

• #93: Patients with Otitis Externa not given a systemic abx

• #116: 18-64 y/o with bronchitis not given abxwithin 3 days of encounter

Choosing Wisely:Head CT Utilization

• #416: 2-17 y/o with appropriate head CT for blunt head trauma (PECARN rules)

• #415: 18+ y/o with appropriate head CT ordering for blunt head trauma

PregnancyMeasures

• #254: US localization of pregnancy in pregnant pts with abd pain

• #255: Rhogam for Rh negative patients at risk

Miscellaneous

• #54: EKG for non-traumatic chest pain

• #76: Proper sterile technique for CVC placement

• #317: BP Screening and follow up documented

#317 Screening for High Blood Pressure

and Follow-Up Documented

Week 9

#317: Screening for High Blood Pressure and Follow Up Documented

1. Hypertension is one of the most important risk factors for Heart Disease, Stroke, and other vascular disease.

2. ACEP recommends follow up with PCP for patients with SBP>140 systolic or DBP>90.

3. PQRS #317 recommends a tiered decision making based on escalating blood pressures of SBP>=120 or DBP>=80. Documented PCP follow up will meet this measure for all tiers.

#317: Inclusion

Numerator (following elements documented):

• SBP>=120 or DBP>=80. (Which reading used not clear by guideline, but we will use the last recorded blood pressure.)

• Recommended follow up documented.

Denominator:• All patients >= 18 years old.

#317:Specifics

• Depending on BP level, recommending lifestyle changes (weight reduction, dietary modifications, sodium restriction, increased physical activity, decreased alcohol consumption) or secondary interventions (EKG, blood work, BP medications) may be satisfy measure

• OR referral to Primary Care Provider would satisfy the measure

#317:Exclusion

• History of hypertension

• Patient refusal to participate in follow up/care plan

• Patient urgent or emergent (this excludes level 4, level 5 and critical care patients)

Best PracticesAs always, documentation is the key!

Best practice is to document follow up for all discharged patients with PCP in addition to other required follow up:1. Best practice: “Follow up with your PCP or Dr. Smith <on call physician> for your blood

pressure .”2. Acceptable: “Follow up with your PCP or Dr. Smith <on call physician> as needed” would

technically meet the measure as a PCP follow up is given.

Not Acceptable:1. No follow up given.