The Joint Commission (TJC) and the Centers for Medicare and Medicaid Services (CMS) require accredited hospitals to collect and submit performance data so that they can review clinical trends that have a significant effect on patient outcomes. The core measure data requirement was established to allow TJC to use collected informationto work with hospitals to improve patient safety and quality of care and to support performance improvement.
Listed below are TJC instituted core measures for ensuring better outcomes for patients suffering from acute myocardial infarctions (AMI). Adherence to these guidelines will assist physicians to achieve positive patient outcomes and maintain compliance with TJC and CMS regulations.
1) Aspirin at Arrival
Patients without aspirin contraindications must be administered aspirin within 24 hours.
2) Aspirin Prescribed at Discharge
Acute myocardial infarction (AMI) patients without aspirin contraindications are prescribed aspirin at hospital discharge.
3) ACEI or ARB for LVSD
Acute myocardial infarction (AMI) patients with left ventricular systolic dysfunction (LVSD) and without both angiotensin converting enzyme inhibitor (ACEI) and angiotensin receptor blocker (ARB) contraindications should be prescribed an ACEI or ARB at hospital discharge.
For purposes of this measure, LVSD is defined as chart documentation of a left ventricular ejection fraction (LVEF) less than 40% or a narrative description of left ventricular function (LVF) consistent with moderate or severe systolic dysfunction.
4) Adult Smoking Cessation Advice/Counseling
Acute myocardial infarction (AMI) patients with a history of smoking cigarettes must be given smoking cessation advice or counseling during hospital stay.
For purposes of this measure, a smoker is defined as someone who has smoked cigarettes anytime during the year prior to hospital arrival.
5) Beta Blocker Prescribed at Discharge
Acute myocardial infarction (AMI) patients without beta blocker contraindications should be prescribed a beta blocker at hospital discharge.
6) Beta Blocker at Arrival
Acute myocardial infarction (AMI) patients without beta blocker contraindications should receive a beta blocker within 24 hours after hospital arrival unless contraindications are documented.
7) Fibrinolytic Agent Received Within 30 Minutes of Hospital Arrival
Acute myocardial infarction (AMI) patients must receivefibrinolytic therapy within 30 minutes or less from their arrival.
8) PCI received within 90 minutes of hospital arrival
Acute myocardial infarction (AMI) patients receiving primary percutaneous coronary intervention (PCI) during the hospital stay within a time frame of 90 minutes or less from hospital arrival to PCI.
Clinicians must be mindful to:
- Document any contraindications to Beta-blockers, Aspirin, ACEI or ARB
- Document patient’s smoking history
- Document patient refusal of any indicator on all measures
If you have any questions, contact Stella Wright, RN, at (504) 897-7919, or at firstname.lastname@example.org.