DEFINITION ( Numerator and Denominator )
Physician Compliance with Opioid Prescribing Requirements (AB 474)
- (Numerator) all patients who are prescribed Schedule II, III, or IV drugs for pain in the ED
- whose chart reflects
- bona fide relationship with the patient; and
- evaluation and risk assessment, including
- review of PDMP and patient’s medical history
- physical exam
- obtain and review medical records, document the conclusions, and assess patient’s mental health and risk of abuse, dependency and addiction; and
- preliminary diagnosis of the patient; tailored treatment plan, and
- documented reasons for prescribing the controlled substance instead of alternative; and
- obtain informed written consent from the patient, parent, or legal guardian
- (Denominator) all patients who are prescribed Schedule II, III, or IV drugs for pain in the ED
Age Appropriate Vital Signs w/in 20 minutes of Discharge from ED
- (Numerator) all patients who come to the ED for treatment
- will have age-appropriate vital signs (e.g., TPR)
- taken and charted
- within 20 minutes of discharge from the ED
- regardless of where patient goes (e.g., home, inpatient unit, transfer to another facility, etc.
- (Denominator) all patients who come to the ED for treatment
Complete Credentialing Files and Appropriate Privileging
- (Numerator) all provider files have evidence of
- Education and training primary source verification
- Current licensure primary source verification
- Specialty board status, if required by bylaws or DOP
- Current certificates, if required by bylaws, DOP, or LiCON
- Current malpractice insurance
- Current NPDB/OIG list (within past two years)
- Appropriate and complete delineation of privileges form
- (Denominator) all healthcare providers actively seeing patients in the facility
*Note: Nonrandom sample of 25% of healthcare providers per quarter, with the goal of auditing 100% of providers in a year
