CMS-10431 SCIP Measures Paper Submission

PPS-exempt Cancer Hospital Quality Reporting (PCHQR) Program

Data Collection Paperbased form SCIP 4.17.2014

PPS-exempt Cancer Hosptital Quality Reporitng (PCQR) Program

OMB: 0938-1175

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PPS-Exempt Cancer Hospital Quality Reporting (PCHQR) Program

Surgical Care Improvement (SCIP) Measures

Paper Submission for FY2015 and Subsequent Years


(NQF 0218) Surgery Patients who Received Appropriate Venous Thromoembolism Prophylaxis within 24 Hours Prior to Surgery to 24 Hours after Surgery

Shape1 Q1 Q2 Q3 Q4

Shape2

Surgery patients who received appropriate Venous Thromboembolism prophylaxis (VTE) within 24 hours prior to Anesthesia Start Time to 24 hours after Anesthesia End Time

NUMERATOR







Shape3 DENOMINATOR

Shape4

All selected surgical patients





(NQF 0300) Cardiac Surgery Patients with Controlled Postoperative Blood Glucose

Q1 Q2 Q3 Q4

Shape6 Shape5

Cardiac surgery patients with controlled postoperative blood glucose (less than or equal to 180mg/dL) in the timeframe of 18 to 24 hours after Anesthesia End Time

NUMERATOR





Shape7

DENOMINATOR

Shape8

Cardiac surgery patients with no evidence of prior infection





(NQF 0453) Urinary Catheter Removed on Postoperative Day 1 or Postoperative Day 2 with Day of Surgery Being Day Zero

Shape9 Q1 Q2 Q3 Q4

NUMERATOR

Shape10

Number of surgical patients whose urinary catheter is removed on postoperative day 1 or postoperative day 2 with day of surgery being day zero









Shape11 DENOMINATOR

Shape12

All selected surgical patients with a catheter in place postoperatively










(NQF 0527) Prophylactic Antibiotic Received within One Hour Prior to Surgical Incision

Shape13 Q1 Q2 Q3 Q4

Shape14

Number of surgical patients with prophylactic antibiotics initiated within one hour prior to surgical incision (two hours if receiving vancomycin, in Appendix C, Table 3.8, or a fluroquinolone, in Appendix C, Table 3.10)

NUMERATOR









Shape15 DENOMINATOR

Shape16

All selected surgical patients with no evidence of prior infection





(NQF 0528) Prophylactic Antibiotic Selection for Surgical Patients

Shape17 Q1 Q2 Q3 Q4

NUMERATOR

Shape18

Number of surgical patients who received prophylactic antibiotics recommended for their specific surgical procedure







Shape20 Shape19

All selected surgical patients with no evidence of prior infection

DENOMINATOR







(NQF 0529) Prophylactic Antibiotics Discontinued within 24 Hours
after Surgery End Time

Shape21 Q1 Q2 Q3 Q4

Shape22

Number of surgical patients whose prophylactic antibiotics were discontinued within 24 hours after Anesthesia End Time (48 hours for CABG or Other Cardiac Surgery)

NUMERATOR





Shape23

Shape24

All selected surgical patients with no evidence of prior infection

DENOMINATOR






* Facility Name:

* CEO Signature: * Date:

* CEO Email Address:


Complete and submit this form via email to: [email protected].


Following receipt of the request form, an email acknowledgement will be sent confirming the form has been received.



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File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
File TitlePCHQR Surgical Care Improvement Measures
SubjectPCHQR Surgical Care Improvement Measures
AuthorCMS
File Modified0000-00-00
File Created2021-01-25

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