Measure Abbreviation
MED-01
Data Collection Method

This measure is calculated based on data extracted from the electronic medical record combined with administrative data sources such as professional fee and discharge diagnoses data. This measure is explicitly not based on provider self-attestation.

Measure Type
Outcome
Description

Percentage of cases that required the use of nalaxone or flumazenil for medication overdose.

Measure Time Period

Anesthesia Start to Anesthesia End

Inclusions

All cases in which opioids or benzodiazepines were administered during the intraoperative period.

Exclusions
  • ASA 5 and 6 cases
  • Patients not given opioids or benzodiazepines during the intraoperative period
  • Cases where naloxone or flumazenil is administered before the first dose of opioid/benzodiazepine
  • Patients that are still intubated at anesthesia end
  • ECT cases
Success

Administration of naloxone or flumazenil was not required for the case.

Special Considerations: If naloxone was given as an infusion AND as a bolus, the case is flagged due to the bolus. If naloxone is only given as an infusion, then the case is still evaluated for flumazenil. Patients receiving naloxone as in infusion indicate naloxone is being infused for pruritus for neuraxial technique.

Other Measure Build Details

MED 01 is an outcome measure that identifies intraoperative medication overdose by monitoring the administration of opioids and/or benzodiazepines and the administration of their reversals: flumanzenil and naloxone. Flumazenil is given for benzodiazepine overdose. Nalaxone is given for opioid overdose. The time period for this measure is Anesthesia Start to Anesthesia End. PACU time is not included currently.

Algorithm for determining Case Duration:

Case Start:

  1. Anesthesia Induction End. If not available, then
  2. Anesthesia Induction Begin. If not available, then
  3. Procedure Start. If not available, then
  4. Patient in Room. If not available, then
  5. Anesthesia Start

Case End:

  1. Patient Extubated. If not available, then
  2. Procedure End. If not available, then
  3. Patient Out of Room. If not available, then
  4. Anesthesia End.
Responsible Provider

The provider who is signed in for the longest portion of the case between Case Start and Case End. See ‘Other Measure Build Details’ section of this specification to view the algorithm used for determining case duration.

Threshold
=5%
MPOG Concept IDs Required

Opioid MPOG Concept IDs

Benzodiazepine MPOG

Concept IDs

Reversal Medication MPOG Concept IDs

10306

Morphine

10301

Midazolam

10191

Flumazenil

10186

Fentanyl

10154

Diazepam

10312

Naloxone

10219

Hydromorphone

 

10414

Sufentanil

 

Data Diagnostics Affected
  • Percentage of Cases with Bolus Medications
  • Percentage of Cases with an Intubation Note
  • Percentage of Cases with an Extubation Note
  • Percentage of Medications with a Meaningful Medication Mapping
  • Percentage of Cases with any Staff Tracking
  • Percentage of Anesthesia Provider Sign-Ins that are Timed
Rationale

Opioid and/or benzodiazepine administration can lead to respiratory depression, brain damage, and even death.   Judicious use of opioids for patients that have planned extubation at end of case can avoid use of reversal agents and their side effects.  For patients not meeting extubation requirements due to opioids or benzodiazepines, waiting until the effects wear off is preferable to reversal administration.

Risk Adjustment

Not applicable

References
  1. Lee LA, Caplan RA, Stephens LS, Posner  KL, Terman GW, Voepel-Lewis T, Domino KB. Postoperative opioid- induced respiratory depression: A closed claims analysis. Anesthesiology. 2015;122(3):659-665.
  2. Ramachandran SK, Haider N, Saran KA, Mathis M, Kim J, Morris M, O’Reilly M. Life-threatening critical respiratory events: A retrospective study of postoperative patients found unresponsive during analgesic therapy. J Clin Anesth. 2011;23:207–13.