Utilization of APPE Students in Electronic Rounds for

Joint Commission Core Measures for Stroke Therapy in a

Community Hospital

Amber M. Hutchison, PharmD, BCPSAssistant Clinical Professor

Auburn University Harrison School of Pharmacy

Joint Commission Core Measures• The Joint Commission is a not-for-profit

organization– The accrediting body for many health-care

organizations

• National quality measures developed by the Joint Commission and the Centers of Medicare and Medicaid Services– Data on measure compliance is provided for

quality information to the public

The Joint Commission [homepage on the Internet]. Illinois: The Joint Commission; c2013 [updated 2013; cited 2013 June 9]. Available from: http://www.jointcommission.org/.

Core Measures• Examples of current core measures:

– Venous thromboembolism– Acute myocardial infarction– Heart failure– Surgical care improvement project– Pneumonia– Children’s asthma care

• Specifications Manual for National Hospital Inpatient Quality Measures– Lists accountability measures– Defines data elements

The Joint Commission [homepage on the Internet]. Illinois: The Joint Commission; c2013 [updated 2013; cited 2013 June 9]. Specifications Manual for National Hospital Inpatient Quality Measures. Available from: http://www.jointcommission.org/specifications_manual_for_national_hospital_inpatient_quality_measures.aspx

Stroke Core Measure List• Venous thromboembolism prophylaxis• Discharged on antithrombotic therapy• Anticoagulation therapy for atrial

fibrillation/flutter• Thrombolytic therapy• Antithrombotic therapy by end of

hospital day 2• Discharged on statin medication• Stroke education• Assessed for rehabilitation

Practice Setting• East Alabama Medical

Center– 340 bed acute care

regional referral hospital

– Preceptor covers hospitalist service on a medical telemetry floor

– 1-2 advanced pharmacy practice students per rotation block

Electronic Stroke Rounds• Prepared by an RN who functions as an

Improvement Specialist• Completed Tuesdays and Thursdays• Assembled based on information provided

by case managers• List is emailed to a group which includes

pharmacists, case managers, dieticians, and therapists– Once reviewed, an update on patients is

sent back to the group

Preparing Students for Stroke Rounds• Integrated Pharmacotherapy course

– Problem-based learning course utilizing team-based learning

– Acute ischemic stroke case: includes introduction to Core Measures

• APPE rotation– Orientation to computer systems– Topic discussions– Review of standardized patient

monitoring sheet

Topic Discussions• Have utilized:

– Review of current stroke management guidelines– Pharmacotherapy Self-Assessment Program chapter

for Management of Acute Ischemic Stroke and TIA

• Explanation of Specifications Manual for National Hospital Inpatient Quality Measures– Core Measure lists– Alpha-data dictionary

Patient Monitoring Sheet

• Three patients per sheet• Includes elements for

Joint Commission stroke Core Measures

• Extra elements not evaluated by Core Measures but good practice– Blood glucose control– Blood pressure control

Students Completing Stroke Rounds• Preceptor receives list in the morning

– List consists of both hemorrhagic and ischemic stroke patients

• Students divide up the list and have the afternoon to review patients– Students contacts preceptor for urgent matters

• Patients are presented to the preceptor the next day – Monitoring sheet guides presentation

Students Completing Stroke Rounds

• Students and preceptor discuss possible interventions and decide best course of action

• Physicians are contacted via phone, note in chart, or in person

• Interventions are documented in Quantifi®

Stevenson TL. Am J Pharm Educ. 2011; 75(5): 90.

Common Interventions• Initiation of statin therapy• Venous thromboembolism prophylaxis

initiation• Antithrombotic recommendations

– Prevention of dual/triple antiplatelet therapy

• Lipid panel ordered• Blood pressure management

recommendations

Stroke Rounds• Over a 12 month period

– 399 chart reviews were performed• 5.4 patients reviewed per rounding session

– 276 individual patients• 146 patients reviewed by Stroke Team met criteria

for Core Measure evaluation after discharge

– 44 interventions made• 18.5%: initiated statin medication• 8.2%: optimization of antithrombotic therapy

Ideas for Incorporating Students for Core Measures

• Determine which Core Measures are monitored by your facility

• Reports can be built to help determine which patients should be reviewed

• Develop a “quick rounds” sheet targeted at your measure

• Incorporate introduction to this process during orientation