CMS-10431 SCIP Measures Paper Submission

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

Q1 Q2 Q3 Q4

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

DENOMINATOR

All selected surgical patients

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

Q1 Q2 Q3 Q4

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

DENOMINATOR

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

Q1 Q2 Q3 Q4

NUMERATOR

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

DENOMINATOR

All selected surgical patients with a catheter in place postoperatively

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

Q1 Q2 Q3 Q4

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

DENOMINATOR

All selected surgical patients with no evidence of prior infection

(NQF 0528) Prophylactic Antibiotic Selection for Surgical Patients

Q1 Q2 Q3 Q4

NUMERATOR

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

All selected surgical patients with no evidence of prior infection

DENOMINATOR

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

Q1 Q2 Q3 Q4

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

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.

PRA Disclosure Statement
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0938-1175 . The time required to complete this information collection is estimated to average 10 minutes per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: CMS, 7500 Security Boulevard, Attn: PRA Reports Clearance Officer, Mail Stop C4-26-05, Baltimore, Maryland 21244-1850.