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  • Measure Summary
  • NQMC:004294

Hospital outpatient surgery: percentage of surgical patients who received prophylactic antibiotics consistent with current guidelines (specific to each type of surgical procedure).

Centers for Medicare & Medicaid Services (CMS). Specifications manual for hospital outpatient department quality measures (v 2.1a). Baltimore (MD): Centers for Medicare & Medicaid Services (CMS); 2009. 245 p.

This is the current release of the measure.

Primary Measure Domain

Process

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Secondary Measure Domain

Does not apply to this measure

Description

This measure is used to assess the percentage of surgical patients who received prophylactic antibiotics consistent with current guidelines (specific to each type of surgical procedure).

Rationale

A goal of prophylaxis with antibiotics is to use an agent that is safe, cost-effective, and has a spectrum of action that covers most of the probable intraoperative contaminants for the operation. First- or second-generation cephalosporins satisfy these criteria for most operations, although quinolones are recommended for some urologic operations. Vancomycin is not recommended for routine use because of the potential for development of antibiotic resistance, but is acceptable if a patient is allergic to beta-lactams, as are fluoroquinolones and clindamycin in selected situations.

Primary Clinical Component

Surgery; prophylactic antibiotics

Denominator Description

All selected surgical patients 18 years and older with no evidence of prior infection (see the related "Denominator Inclusions/Exclusions" field)

Numerator Description

All selected surgical patients who received prophylactic antibiotics recommended for their specific operation*

*Refer to the original measure documentation for "Prophylactic Antibiotic Regimen Selection for Surgery."

Evidence Supporting the Criterion of Quality

A clinical practice guideline or other peer-reviewed synthesis of the clinical evidence

One or more research studies published in a National Library of Medicine (NLM) indexed, peer-reviewed journal

Need for the Measure

Use of this measure to improve performance

Variation in quality for the performance measured

Evidence Supporting Need for the Measure

American Society of Health-System Pharmacists. ASHP therapeutic guidelines on antimicrobial prophylaxis in surgery. American Society of Health-System Pharmacists. Am J Health Syst Pharm. 1999 Sep 15;56(18):1839-88. [559 references] PubMed External Web Site Policy

Antimicrobial prophylaxis for surgery. Treat Guidel Med Lett. 2006 Dec;4(52):83-8. [42 references] PubMed External Web Site Policy

Bratzler DW, Houck PM, Surgical Infection Prevention Guidelines Writers Workgroup, American Academy of Orthopaedic Surgeons, American Association of Critical Care Nurses, American Association of Nurse Anesthetists, American College of Surgeons, American College of Osteopathic Surgeons, American Geriatrics Society, American Society of Anesthesiologists, American Society of Colon and Rectal Surgeons, American Society of Health-System Pharmacists, American Society of PeriAnesthesia Nurses, Ascension Health, Association of periOperative Registered Nurses, Association for Professionals in Infection Control and Epidemiology, Infectious Diseases Society of America, Medical Letter, Premier, Society for Healthcare Epidemiology of America, Society of Thoracic Surgeons, Surgical Infection Society. Antimicrobial prophylaxis for surgery: an advisory statement from the National Surgical Infection Prevention Project. Clin Infect Dis. 2004 Jun 15;38(12):1706-15. [90 references] PubMed External Web Site Policy

Dellinger EP, Gross PA, Barrett TL, Krause PJ, Martone WJ, McGowan JE Jr, Sweet RL, Wenzel RP. Quality standard for antimicrobial prophylaxis in surgical procedures. Infectious Diseases Society of America. Clin Infect Dis. 1994 Mar;18(3):422-7. [49 references] PubMed External Web Site Policy

Gilbert DN, Moellering RC Jr, Eliopoulos GM, Sande MA, editor(s). The Sanford guide to antimicrobial therapy. 37th ed. Hyde Park (VT): Antimicribial Therapy, Inc.; 2007. 160-1 p.

Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR, Hospital Infection Control Practices Advisory Committee. Guideline for prevention of surgical site infection, 1999. Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol. 1999 Apr;20(4):250-78; quiz 279-80. [497 references] PubMed External Web Site Policy

Page CP, Bohnen JM, Fletcher JR, McManus AT, Solomkin JS, Wittmann DH. Antimicrobial prophylaxis for surgical wounds. Guidelines for clinical care. Arch Surg. 1993 Jan;128(1):79-88. PubMed External Web Site Policy

Wolf JS Jr, Bennett CJ, Dmochowski RR, Hollenbeck BK, Pearle MS, Schaeffer AJ, Urologic Surgery Antimicrobial Prophylaxis Best Practice Policy Panel. Best practice policy statement on urologic surgery antimicrobial prophylaxis. J Urol. 2008 Apr;179(4):1379-90. PubMed External Web Site Policy

State of Use

Current routine use

Current Use

External oversight/Medicare

Internal quality improvement

National reporting

Care Setting

Hospitals

Professionals Responsible for Health Care

Measure is not provider specific

Lowest Level of Health Care Delivery Addressed

Single Health Care Delivery Organizations

Target Population Age

Age greater than or equal to 18 years

Target Population Gender

Either male or female

Stratification by Vulnerable Populations

Unspecified

Source(s)

Centers for Medicare & Medicaid Services (CMS). Specifications manual for hospital outpatient department quality measures (v 2.1a). Baltimore (MD): Centers for Medicare & Medicaid Services (CMS); 2009. 245 p.

Incidence/Prevalence

Unspecified

Association with Vulnerable Populations

Unspecified

Burden of Illness

Unspecified

Utilization

Unspecified

Costs

Unspecified

IOM Care Need

Getting Better

Staying Healthy

IOM Domain

Effectiveness

Safety

Case Finding

Users of care only

Description of Case Finding

All selected surgical patients 18 years and older with no evidence of prior infection

Denominator Sampling Frame

Patients associated with provider

Denominator Inclusions/Exclusions

Inclusions
Patients with a CPT® Code of selected surgeries as defined in Appendix A, OP Table 6.0*

Exclusions

  • Patients who are less than 18 years of age
  • Patients whose procedure is canceled prior to incision as defined in the Data Dictionary*
  • Patients enrolled in a Clinical Trial as defined in the Data Dictionary*
  • Patients with an Infection Prior to Anesthesia as defined in the Data Dictionary*
  • Patients who do not receive any antibiotics during the encounter

*Refer to the original measure documentation for details.

Relationship of Denominator to Numerator

All cases in the denominator are equally eligible to appear in the numerator

Denominator (Index) Event

Encounter

Therapeutic Intervention

Denominator Time Window

Time window is a single point in time

Numerator Inclusions/Exclusions

Inclusions
Surgical patients who received prophylactic antibiotics recommended for their specific operation*

*Refer to the original measure documentation for "Prophylactic Antibiotic Regimen Selection for Surgery".

Exclusions
None

Measure Results Under Control of Health Care Professionals, Organizations and/or Policymakers

The measure results are somewhat or substantially under the control of the health care professionals, organizations and/or policymakers to whom the measure applies.

Numerator Time Window

Encounter or point in time

Data Source

Administrative data

Medical record

Level of Determination of Quality

Individual Case

Pre-existing Instrument Used

Unspecified

Scoring

Rate

Interpretation of Score

Better quality is associated with a higher score

Allowance for Patient Factors

Unspecified

Standard of Comparison

External comparison at a point in time

External comparison of time trends

Internal time comparison

Original Title

OP-7: hospital outpatient surgery: prophylactic antibiotic selection for surgical patients.

Measure Collection Name

Hospital Outpatient Department Quality Measures

Measure Set Name

Hospital Outpatient Surgery

Submitter

Centers for Medicare & Medicaid Services

Developer

Centers for Medicare & Medicaid Services

Funding Source(s)

United States Department of Health and Human Services

Composition of the Group that Developed the Measure

Centers for Medicare & Medicaid (CMS) Contractor

Financial Disclosures/Other Potential Conflicts of Interest

None

Adaptation

Measure was not adapted from another source.

Release Date

2008 Apr

Revision Date

2009 Jan

Measure Status

This is the current release of the measure.

Measure Availability

The individual measure, "OP-7: Hospital Outpatient Surgery: Prophylactic Antibiotic Selection for Surgical Patients," is published in the "Specifications Manual for Hospital Outpatient Department Quality Measures (Version 2.1a)." This document is available from the QualityNet Web site External Web Site Policy. Check the QualityNet Web site regularly for the most recent version of the specifications manual and for the applicable dates of discharge.

NQMC Status

This NQMC summary was completed by ECRI Institute on February 20, 2009. The information was verified by the measure developer on May 8, 2009.

Copyright Statement

No copyright restrictions apply.

The Specifications Manual for Hospital Outpatient Department Quality Measures (Version 2.1a, January 2009) is periodically updated by the Centers for Medicare & Medicaid Services. Users of the Specifications Manual for Hospital Outpatient Department Quality Measures must update their software and associated documentation based on the published manual production timelines.

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