11 measures Antibiotic

Stewardship• #66: Pharyngitis patients

given an abx who had strep test performed

• #91: Patients with Otitis Externa given a topical abx

• #93: Patients with Otitis Externa not given a systemic abx

• #116: 18-64 y/o with bronchitis not given abxwithin 3 days of encounter

Choosing Wisely:Head CT Utilization

• #416: 2-17 y/o with appropriate head CT for blunt head trauma (PECARN rules)

• #415: 18+ y/o with appropriate head CT ordering for blunt head trauma

PregnancyMeasures

• #254: US localization of pregnancy in pregnant pts with abd pain

• #255: Rhogam for Rh negative patients at risk

Miscellaneous

• #54: EKG for non-traumatic chest pain

• #76: Proper sterile technique for CVC placement

• #317: BP Screening and follow up documented

#254 Ultrasound determination of pregnancy

location for pregnant patients with abdominal

pain

Week 6

#254:Ultrasound determination of pregnancy location for pregnant patients with abdominal pain

Pregnant females with abdominal pain or vaginal bleeding should

have evaluation to exclude ectopic pregnancy

#254:Inclusion

Numerator:Patient received abdominal or vaginal ultrasound

Denominator:1. Patient is 14-50 years old2. Patient with documentation of

pregnancy in medical record3. Chief complaint of abdominal pain or

vaginal bleeding

#254:Note

Exclusions follow on the next slide. However, as always, follow your clinical judgment. While the

listed exclusions may exclude requirement for ultrasound, an

ultrasound may still be indicated for other reasons such as to look for gallstones or other pathology

of patient’s pain.

#254:Exclusion(ultrasound not required)

1. Pain not felt pregnancy related

2. Documented IUP

3. Pregnancy felt to be too early for ultrasound to be of value

4. Essentially any reasonable statement could exclude this measure

Best PracticesRemember good documentation!

Best practice:1. “Patient with abdominal pain (or vaginal bleeding) in pregnancy, pelvic ultrasound ordered.”

2. “Patient with epigastric pain felt to be gastritis.” (exclusion from measure)

3. “Patient states ultrasound done two days prior at OB office displayed normal pregnancy.” (exclusion from measure)

4. “Patient three weeks by dates and bHCG is 65, too early for visibility of pregnancy by ultrasound.” (exclusion from measure)

5. “Patient with FHT by doppler, no ultrasound indicated.” (exclusion from measure)

Not Acceptable:1. "Patient with mild abdominal pain (or mild vaginal bleeding), no abdominal ultrasound indicated."