+-----+-------+------------+------------+-------+-------------------+
| **P | **As  | **Des      | **Codes**  | **    | **Definition**    |
| ati | sessm | cription** |            | Findi |                   |
| ent | ent** |            |            | ngs** |                   |
| I   |       |            |            |       |                   |
| D** | **    |            |            |       |                   |
|     | Varia |            |            |       |                   |
|     | ble** |            |            |       |                   |
+-----+-------+------------+------------+-------+-------------------+
|     | **AD  | **Date**   | Use        | \_\_  | Exact date must   |
|     | MDT** | of         | DD/MM/YYYY | \_/\_ | be entered. The   |
|     |       | admission  | format     | \_\_/ | use of default 01 |
|     |       | to         |            | \_\_\ | to indicate       |
|     |       | inpatient  |            | _\_\_ | missing day or    |
|     |       | care       |            |       | month is not      |
|     |       |            |            |       | acceptable.       |
|     |       |            |            |       |                   |
|     |       |            |            |       | **Note:** **admit |
|     |       |            |            |       | date is hospital  |
|     |       |            |            |       | day 1**           |
|     |       |            |            |       | regardless of     |
|     |       |            |            |       | time of           |
|     |       |            |            |       | admission.        |
|     |       |            |            |       | Hospital day 2 is |
|     |       |            |            |       | the next calendar |
|     |       |            |            |       | day.              |
|     |       |            |            |       |                   |
|     |       |            |            |       | **Example: Admit  |
|     |       |            |            |       | day 5-10-08, end  |
|     |       |            |            |       | of day two        |
|     |       |            |            |       | 5-11-08           |
|     |       |            |            |       | mid-night.**      |
+-----+-------+------------+------------+-------+-------------------+
|     | **PTA | Does the   | 1: Yes     |       | **Ambulatory      |
|     | MB2** | medical    |            |       | includes:**       |
|     |       | record     | 2: No      |       |                   |
|     |       | document   |            |       | -   Ambulating    |
|     |       | the        | If yes,    |       |     w/o           |
|     |       | patient    | patient    |       |     assistance    |
|     |       | was        | not        |       |     (w/ or w/o a  |
|     |       | ambulatory | eligible   |       |     device)       |
|     |       | by the end | for DVT    |       |                   |
|     |       | of day     | pr         |       | -   Ambulating to |
|     |       | two?       | ophylaxis. |       |     and from the  |
|     |       |            |            |       |     bathroom w/o  |
|     |       |            |            |       |     assistance    |
|     |       |            |            |       |                   |
|     |       |            |            |       | **Non-ambulatory  |
|     |       |            |            |       | includes:**       |
|     |       |            |            |       |                   |
|     |       |            |            |       | -   Patients on   |
|     |       |            |            |       |     bed rest      |
|     |       |            |            |       |                   |
|     |       |            |            |       | -   Patients out  |
|     |       |            |            |       |     of bed only   |
|     |       |            |            |       |     to bedside    |
|     |       |            |            |       |     commode or up |
|     |       |            |            |       |     in chair only |
|     |       |            |            |       |                   |
|     |       |            |            |       | > • Patients up   |
|     |       |            |            |       | > to bathroom     |
|     |       |            |            |       | > with assistance |
+-----+-------+------------+------------+-------+-------------------+
|     | **    | Is there   | 1: Yes     |       | Comfort measures  |
|     | COMFO | doc        |            |       | only (code 1)     |
|     | NLY** | umentation | 2: No      |       | includes          |
|     |       | by a       |            |       | referrals to      |
|     |       | physician, | If yes,    |       | palliative care,  |
|     |       | APN, or PA | patient    |       | hospice.          |
|     |       | of comfort | not        |       |                   |
|     |       | measures   | eligible   |       | Patients with a   |
|     |       | only       | for DVT    |       | DNR order are NOT |
|     |       | during     | pr         |       | coded 1 unless    |
|     |       | hospital   | ophylaxis. |       | there is a        |
|     |       | stay?      |            |       | specific order    |
|     |       |            |            |       | for comfort       |
|     |       |            |            |       | measures.         |
+-----+-------+------------+------------+-------+-------------------+
|     | **    | Were any   | 1: Yes     |       | Categories of DVT |
|     | WICTH | of these   |            |       | pharmacological   |
|     | ROM** | m          | 2: No      |       | prophylaxis:      |
|     |       | edications |            |       |                   |
|     |       | prescribed |            |       | -   **Warfarin**  |
|     |       | by the end |            |       |     such as:      |
|     |       | of         |            |       |     Coumadin,     |
|     |       | hospital   |            |       |     Jantoven,     |
|     |       | day 2?     |            |       |     Panwarfin,    |
|     |       |            |            |       |     Warfilone     |
|     |       | -          |            |       |                   |
|     |       |   Warfarin |            |       | -   **Low dose    |
|     |       |            |            |       |                   |
|     |       | (Coumadin) |            |       |    unfractionated |
|     |       |            |            |       |     heparin**     |
|     |       | -   Low    |            |       |     (LDUH) --     |
|     |       |     dose   |            |       |     **only        |
|     |       |     unfr   |            |       |     include       |
|     |       | actionated |            |       |     heparin       |
|     |       |            |            |       |     administered  |
|     |       |    heparin |            |       |     by            |
|     |       |     (SQ    |            |       |     [subcutan     |
|     |       |     only)  |            |       | eous]{.underline} |
|     |       |            |            |       |     route** (SC,  |
|     |       | -   Intrav |            |       |     SQ, SubQ)     |
|     |       | enous (IV) |            |       |     LDUH such as: |
|     |       |            |            |       |     heparin,      |
|     |       |    heparin |            |       |     calcilean,    |
|     |       |            |            |       |     calciparine   |
|     |       | -   Low    |            |       |                   |
|     |       |            |            |       | -   **Intravenous |
|     |       |  molecular |            |       |     heparin**     |
|     |       |     weight |            |       |                   |
|     |       |            |            |       | -   **Low         |
|     |       |    heparin |            |       |     molecular     |
|     |       |            |            |       |     weight        |
|     |       | -   A      |            |       |     heparin**     |
|     |       | lternative |            |       |     (LMWH) such   |
|     |       |     anti   |            |       |     as:           |
|     |       | coagulants |            |       |     enoxaparin    |
|     |       |            |            |       |     (Lovenox),    |
|     |       |            |            |       |     fragmin,      |
|     |       |            |            |       |     innohep       |
|     |       |            |            |       |                   |
|     |       |            |            |       | > **Alternative   |
|     |       |            |            |       | >                 |
|     |       |            |            |       |  anticoagulants** |
|     |       |            |            |       | > such as         |
|     |       |            |            |       | > danaparoid      |
|     |       |            |            |       | > (Organon),      |
|     |       |            |            |       | > hirudin         |
|     |       |            |            |       | > (Lepirudin),    |
|     |       |            |            |       | > bivalirudin     |
|     |       |            |            |       | > (Angiomax),     |
|     |       |            |            |       | > other           |
|     |       |            |            |       | > heparinoids.    |
+-----+-------+------------+------------+-------+-------------------+
|     | *     | Was        | 1: Yes     |       | **Mechanical      |
|     | *VTEM | mechanical |            |       | prophylaxis** =   |
|     | ECH** | venous     | 2: No      |       | compression       |
|     |       | throm      |            |       | devices used to   |
|     |       | boembolism | 95: Not    |       | prevent VTE       |
|     |       | (VTE)      | applicable |       |                   |
|     |       | p          |            |       | **Examples of     |
|     |       | rophylaxis |            |       | mechanical        |
|     |       | ad         |            |       | prophylaxis such  |
|     |       | ministered |            |       | as:**             |
|     |       | by the end |            |       |                   |
|     |       | of         |            |       | **Intermittent    |
|     |       | hospital   |            |       | pneumatic         |
|     |       | day 2?     |            |       | compression       |
|     |       |            |            |       | devices** (IPC):  |
|     |       |            |            |       | AE pumps          |
|     |       |            |            |       | (anti-embolic     |
|     |       |            |            |       | pumps)            |
|     |       |            |            |       | calf/thigh,       |
|     |       |            |            |       | venodynes, DVT    |
|     |       |            |            |       | boots-calf/thigh, |
|     |       |            |            |       | sequential        |
|     |       |            |            |       | compression       |
|     |       |            |            |       | device (SCD)      |
|     |       |            |            |       |                   |
|     |       |            |            |       | **Note:** Use of  |
|     |       |            |            |       | **ONLY**          |
|     |       |            |            |       | graduated         |
|     |       |            |            |       | compression       |
|     |       |            |            |       | stockings knee or |
|     |       |            |            |       | thigh high such   |
|     |       |            |            |       | as: Anti-embolism |
|     |       |            |            |       | stockings, TED    |
|     |       |            |            |       | hose (TEDS),      |
|     |       |            |            |       | Jobst stockings,  |
|     |       |            |            |       | **DOES NOT**      |
|     |       |            |            |       | qualify for       |
|     |       |            |            |       | mechanical        |
|     |       |            |            |       | prophylaxis.      |
+-----+-------+------------+------------+-------+-------------------+
|     | *     | By the end | 1: Yes     |       | **In order to     |
|     | *NORX | of         |            |       | select "1," there |
|     | PRO** | hospital   | 2: No      |       | must be           |
|     |       | day two,   |            |       | physician, APN,   |
|     |       | was there  |            |       | or PA             |
|     |       | physic     |            |       | documentation of  |
|     |       | ian/APN/PA |            |       | a specific        |
|     |       | doc        |            |       | contraindication  |
|     |       | umentation |            |       | to                |
|     |       | in the     |            |       | pharmacological   |
|     |       | medical    |            |       | VTE               |
|     |       | record of  |            |       | prophylaxis**.    |
|     |       | a          |            |       |                   |
|     |       | contra     |            |       |                   |
|     |       | indication |            |       |                   |
|     |       | to         |            |       |                   |
|     |       | pharm      |            |       |                   |
|     |       | acological |            |       |                   |
|     |       | venous     |            |       |                   |
|     |       | throm      |            |       |                   |
|     |       | boembolism |            |       |                   |
|     |       | (VTE)      |            |       |                   |
|     |       | pr         |            |       |                   |
|     |       | ophylaxis? |            |       |                   |
|     |       | (Warfarin, |            |       |                   |
|     |       | heparin,   |            |       |                   |
|     |       | low        |            |       |                   |
|     |       | molecular  |            |       |                   |
|     |       | weight     |            |       |                   |
|     |       | heparin,   |            |       |                   |
|     |       | a          |            |       |                   |
|     |       | lternative |            |       |                   |
|     |       | antico     |            |       |                   |
|     |       | agulants). |            |       |                   |
+-----+-------+------------+------------+-------+-------------------+