Clearly implied reasons for not prescribing a statin medication at discharge
Calling all Get With The Guidelines Stroke abstractors – below are some helpful examples of clearly implied reasons for not prescribing a statin medication at discharge.
Example 1:
Case Scenario: Patient had LDL value of 137 mg/dL and received pravastatin during their entire stay. However, Pravastatin was not prescribed at discharge. The only documentation appeared in the Medication Administration Record (MAR) reconciliation audit for Pravastatin where the physician documented “Do not order at discharge”.
When asking The Joint Commission (TJC) if this would meet the criteria as a reason for no statin at discharge they confirmed this would be a clearly implied reason.
So, in addition to the source documents that you routinely review for documented reasons:
Consultation notes, Progress notes, Physician orders, Discharge summary, After Visit Summary (AVS); remember to also review the MAR and Medication reconciliation for Physician documentation.
Example 2:
Other helpful reminders when looking for reasons for not prescribing statins at discharge:
Reasons do NOT need to be documented at discharge or otherwise linked to the discharge timeframe: Documentation of reasons anytime during the hospital stay are acceptable (e.g., mid-hospitalization note stating “no statin medications due to abnormal liver enzymes” – select “Yes,” even if documentation indicates that the liver enzyme levels normalized by the time of discharge and the lipid-lowering medication was restarted.”
Documentation of a LDL-C less than 70 mg/dL anytime during the hospital stay is an acceptable stand alone reason for not prescribing statin medication at discharge – Linkage with statin is not needed. If more than one LDL value is documented, the highest value must be less than 70 mg/dL. LDL values obtained within 30 days prior to hospital arrival are acceptable to select “Yes.”
Example 3:
Physician/APN/PA or pharmacist documentation of a hold on a statin medication or discontinuation of a statin medication that occurs during the hospital stay constitutes a “clearly implied” reason for not prescribing a statin medication at discharge. A hold/discontinuation of all P.O. medications counts if statin medication P.O. was on order at the time of the notation. (This does not include conditional holds/discontinuation – e.g. Stop atorvastatin if myalgias persist).