Patient Safety and Practice Assessment
A MIPS eligible clinician providing unscheduled care (such as an emergency room, urgent care, or other unplanned encounter) attests that, for greater than 75 percent of case visits that result from a clinically significant adverse drug event, the MIPS eligible clinician provides information, including through the use of health IT to the patient’s primary care clinician regarding both the unscheduled visit and the nature of the adverse drug event within 48 hours. A clinically significant adverse event is defined as a medication-related harm or injury such as side-effects, supratherapeutic effects, allergic reactions, laboratory abnormalities, or medication errors requiring urgent/emergent evaluation, treatment, or hospitalization.
Allow primary care doctors to immediately tailor plans of care for patients to prevent further medication errors and achieve better outcomes in the future.
Documentation of communication regarding clinically significant adverse drug events from the eligible clinician providing unscheduled care to the primary care clinician within 48 hours. Unscheduled care includes emergency room visit, urgent care, or other unplanned encounter. A clinically significant adverse event is defined as a medication-related harm or injury such as side-effects, supra-therapeutic effects, allergic reactions, laboratory abnormalities, or medication errors requiring urgent/emergent evaluation, treatment or hospitalization. Include all of the following elements:
1) Documentation of the process for capturing adverse drug events; AND
2) Details of clinically significant adverse drug event – Documentation (e.g., medical record, chart note) of clinically significant adverse event; AND
3) Communication of event within 48 hours – Documentation of communication of the event to the patient's primary care clinician within 48 hours of the unscheduled event (e.g., Health Information Exchange, other Health Information Technology, secure email). Communication to include both details about the unscheduled event and the nature of the adverse drug event.
• A small internal medicine practice has numerous patients on warfarin. Those patients are managed by the local “Coumadin Clinic” at the hospital. Occasionally, those patients are seen in the local emergency department for bleeding, or are referred to the emergency department from the Coumadin Clinic that is testing the patients’ International Normalized Ratio (INR). The hematology group partners with the emergency department clinician group to develop a process for communicating adverse warfarin reactions. They identify all appropriate diagnosis codes that could be linked to an adverse warfarin level or reaction. They work with IT to create an automatically generated email (fax, etc.) of the clinical record, triggered by the diagnosis code, and have it sent to the primary care clinician.
• An emergency department clinician group creates an internal policy that all clinically significant adverse drug reactions are communicated with the eligible primary care clinician. As a result, they create a manual process that requires the emergency physician to contact the eligible primary care clinician and communicate the situation. The eligible clinicians create a specific field in the electronic health record for documenting the brief details of the communication.