How important is it to give AM dose of beta blocker on day of surgery?
beta blockers
- Thread starter bentrider
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It depends?
It's one of the SCIP criteria that we're held accountable for, but from their perspective that just means documentation of what you do is more important than what you actually do.
You are correct. SCIP cares whether or not they got it within 24 hours of surgery. If they haven't, you can either document a reason why it was held (bradycardia, hypotension, expected high blood loss, etc) or you can administer it any time from preop through the OR and into PACU. Just has to be either 1) given prior to leaving PACU or 2) documented why not prior to leaving PACU.
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It's pure BS!
The reason we have "doctors" seeing patients pre-op is because these so called "doctors" should be able to decide what medication to give or not to give pre-op.
So, an anesthesiologist who is a "DOCTOR" should be able to make that determination the morning of surgery.
This applies to every medication the patient takes or doesn't take!
So, be a doctor, look at the whole picture, don't follow any nursing protocol, and try to come up with a meaningful anesthesia plan.
If you deviate from SCIP criteria, the hospital can be denied payment for any part of the hospitalization of the patient.
I'm assuming that whatever department or group you work for has some agreement/contract with the hospital stating you will abide by all stupid regulations including SCIP.
Feel free to not give the med, but you better document why.
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I'm so sick of SCIP. My hospital admin are such sticklers with scip. Dont't forget about abx within 1 hr preincision (unless vanco 2 hr) and normothermia upon arrival to PACU (unless you use forced air).All my pt get bair huggers. I'll even throw the hose under the blanket sometimes so I can check the stupid box.
I love playing SCIP for the stupidity that it is.... when I do not know pt's BB status or last dose for whatever reason... I will give 2.5 mg esmolol IVP preop. This fully complies with SCIP BB criteria.
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Our Medicare payments will be tied to SCIP as well. 0.25 mg of Metop at induction seems to be well tolerated by all patients who are receiving beta blockers at home.
-pod
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I only give the medications that the patient needs based on my judgement and knowledge.
that's fine, but you still have to document why you aren't giving a beta blocker if they are on one. If not, you will eventually be out a job. Because when the hospital is making 10s of thousands of dollars on a case, they like to get paid that rather than get paid nothing.
And as mentioned, in the near future your direct reimbursement is going to depend on it.
So unless you like working for free...
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So what do you do to change it?
The patchwork of bull$h1t already exists. SCIP, meaningful use, JCAHO and Press Ganey crap, and whatever else comes out of PPACA... I am sure that this is only the beginning.
The midlevels are less independently minded than physicians and are thus better at playing this game than we are. Since the game is how the "quality" of our care is graded, the midlevels will ultimately be deemed to provide higher quality care if we stick to Plankton's stance.
It is the mid-level management modernization of American Medicine. Pick a generally meaningless, but easily quantified, metric to demonstrate "quality" or lack thereof. Set up systems by which to track these metrics. Link payment to the ability to provide "quality" care as defined by this metric. This demonstrates to upper management that you are making quantifiable "improvements" in your division.
The provider than plays the game by doing things like placing a BAIR hugger and running the patient on room temp air, giving meaningless doses of beta blockers etc, to maintain good quality of care grades. Voila, you have exponentially increased the cost of healthcare, while making no actual improvement in the quality of care provided.
But what can you do. You can't win if you don't play the game.
- pod
The patchwork of bull$h1t already exists. SCIP, meaningful use, JCAHO and Press Ganey crap, and whatever else comes out of PPACA... I am sure that this is only the beginning.
The midlevels are less independently minded than physicians and are thus better at playing this game than we are. Since the game is how the "quality" of our care is graded, the midlevels will ultimately be deemed to provide higher quality care if we stick to Plankton's stance.
It is the mid-level management modernization of American Medicine. Pick a generally meaningless, but easily quantified, metric to demonstrate "quality" or lack thereof. Set up systems by which to track these metrics. Link payment to the ability to provide "quality" care as defined by this metric. This demonstrates to upper management that you are making quantifiable "improvements" in your division.
The provider than plays the game by doing things like placing a BAIR hugger and running the patient on room temp air, giving meaningless doses of beta blockers etc, to maintain good quality of care grades. Voila, you have exponentially increased the cost of healthcare, while making no actual improvement in the quality of care provided.
But what can you do. You can't win if you don't play the game.
- pod
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I agree, but I can't fix that ...
Anyway, a good EMR (even a lousy one) covers this pretty easily. I click a box doing my preop with whether or not the patient is on a BB and it trees out other boxes to click. The anesthesia EMR autopopulates an abx entry tied to cut time (which has to be adjusted but it's there) and temp / air warming is there too. It's minimally inconvenient.
Micromeasuring minutia to avoid payment is the future. 🙁
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Who said you don't document?
You see the patient in the morning and you look at the whole picture, and determine if the patient appears betablocked or not.
Then you decide if you should give a beta blocker or not.
And you put your reasoning in your pre-op note.
This applies to every medication the patient takes in the morning, not only beta blockers.
And this is simply proper patient care, it should be done regardless of what credentialing entities, groups of retired nurses, insurance companies, government dysfunctional organizations... might say or do.
You sir must write one hell of a pre-op note if you are commenting on the need (or not) to give every med in their list the day of surgery.
