Complete and detailed information is available in the Specifi cations Manual located on QualityNet (www.QualityNet.org) under the Hospitals-Inpatient tab.

AQAF 2 Perimeter Park South, Suite 200 West Birmingham, AL 35243 205-970-1600 or 800-760-4550 AMI, HF, PN & SCIP www.aqaf.com Core Measures Help Booklet

This material was originally created by IQH, the Medicare Quality Improvement Organization for Mississippi, and distributed by AQAF, the Medicare Quality Improvement Organization for Ala- bama, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. Contents do not necessarily refl ect CMS policy. 10SOW-AL-C8-12-15 Page 1 Page 26 AMI Immunization - New (Beginning with January, 1 , 2012 discharges) Aspirin at Discharge: Pneumococcal Immunization (*PPV23) Prescribe at discharge or document reason for No aspirin at discharge. (Includes ALL patients discharged from acute care age 65 years and older AND ages 6 through 64 who are Documentation must clearly indicate aspirin is being prescribed at discharge. considered †high risk and who have a LOS less than or equal to 120 days) Excludes: Patients less than 6 years of age, who are pregnant or who received an organ transplant this Reasons: • Allergy hospitalization • Coumadin/warfarin or Pradaxa/dabigatran at discharge • Other explicitly documented reason by Phys/APN/PA/Pharmacist 1. Screen pts 65 and older and 6 – 64 years of age with a †high risk condition for vaccination status 2. *Vaccinate pt prior to discharge if: ‡Fibrinolytic Therapy: (Fibrinolysis/Reperfusion) a. Not previously vaccinated (Vaccines noted as “up-to-date” count. Do not use “UTD.” [If provided w/in 6hrs of hospital arrival & is primary reperfusion therapy] b. No documented allergy (document exact complication) Clear documentation is important: Applies to pts with ST-segment elevation/LBBB noted on ECG performed c. Not likely to be uneffective due to bone marrow transplant w/in the past 12 months closest to arrival. d. No radiation/chemotherapy currently being received as a scheduled dose, received Give w/in 30 min of hospital arrival or *document reason for the delay. during this stay or within 2 weeks prior to this stay Reasons: • Balloon pump; Cardiopulmonary arrest; Intubation e. No shingles (Zostavax) vaccination received w/in the past 4 weeks [Automatic - If occurred w/in 30 min after hosp arrival] f. Patient/caregiver does not refuse • Pt/Caregiver refusal [No further documentation needed] g. For patients 6 years of age or older: Did not receive a conjugate vaccine w/in the past the • Other reasons that include BOTH the notation of delay + underlying (non-system) reason previous 8 weeks ‡Table 4 †6-64 – High risk conditions include: diabetes, nephritic syndrome, ESRD, CHF, COPD, HIV or asplenia Primary PCI: (PCI/Reperfusion/Cath/Transfer to Cath Lab) [If performed w/in 24hrs of hospital arrival] - Clear documentation is important: Applies to pts with ST- †19-64 – Include the high risk condition of asthma in addition to the above segment elevation/LBBB noted on ECG performed closest to arrival. * For high-risk children 6-18 years of age may include either PCV13 or PPV23 as this population Perform w/in 90 min of hospital arrival or *document reason for delay. should receive PCV13 prior to PPV23 Reasons: • Balloon pump; Cardiopulmonary arrest; Intubation [Automatic - If occurred w/in 90 min after hosp arrival] Infl uenza Immunization • Pt/Caregiver refusal [No further documentation needed] (Includes ALL patients discharged from acute care age 6 months and older AND who have a LOS less than or • Other reasons that include BOTH the notation of delay + underlying (non-system) reason equal to 120 days.) *Only Phys/PA/APN documentation. Excludes: Patients less than 6 months of age or who received an organ transplant this hospitalization. ‡Statin (or HMG CoA reductase inhibitors) Prescribed at Discharge: Prescribe at discharge or document reason for No statin at discharge. *1. Screen pts 6 months and older during current fl u season (when vaccine is available - March) for vaccina- tion status. *Hospital is only responsible for collection during discharges Oct - March. Documentation must clearly indicate the medication (listed by name) is being prescribed at discharge. Reasons: • Allergy to or complication related to statins 2. Vaccinate pt prior to discharge if: • Other explicitly documented reason by Phys/APN/PA/Pharmacist, i.e., statins contrain- a. Not previously vaccinated this fl u season dicated due to: b. No documented allergy to infl uenza vaccine; anaphylactic latex allergy or • **Hepatic failure anaphylatic allergy to eggs (document exact complication) • **Myalgias c. Not likely to be uneffective due to bone marrow transplant w/in the past 6 months • **Rhabdomyolysis d. No documented Guillian-Barre’ syndrome w/in 6 weeks after previous infl uenza (**More common reasons. Must be linked to no statins prescribed.) vaccination ‡Table 5 e. Patient/caregiver does not refuse

Excludes: Patients with an LDL < 100 mg/dL [either direct or calculated] w/in 24hrs after hospital arrival or 30 days prior to hospital arrival and not discharged on a statin.

Special Note: Comfort Measures Only excludes cases from all measures except lytic and PCI. Page 25 Page 2 ED Throughput - New (Beginning with January, 1 , 2012 discharges) AMI Beginning with January 2012, the following measures were retired or suspended. Median Time from ED Arrival to ED Departure for Admitted ED Patients: (Includes ALL patients discharged from acute care AND with a LOS less than or equal to 120 days) There are several reasons measures are retired: 1. Measure performance among hospitals is so high and unvarying that meaningful distinctions and Excludes: Patients who are not *ED patients improvements in performance can no longer be made; 2. Performance or improvement on a measure does not result in better patient outcomes; Document in the ED Record the date and time when the patient physically left the ED. (Don’t use disposittion 3. A measure does not align with current clinical guidelines or practice; date/time, the time the discharge order was written, or the report called time.) Emphasis is placed on captur- 4. There is the availability of a more broadly applicable measure for the topic; ing the latest time the patient was receiving care in the ED, under ED services or awaiting transport. 5. There is the availability of a measure that is more proximal in time to desired patient outcomes for the particular topic; 6. There is the availability of a measure that is more strongly associated with desired patient outcomes for the Admit Decision Time to ED Departure Time for Admitted Patients: particular topic; and (Includes ALL patients discharged from acute care AND with a LOS less than or equal to 120 days) 7. Collection or public reporting of a measure leads to negative unintended consequences other than patient harm. Excludes: Patients who are not *ED patients The one retired measure, Adult Smoking Cessation Advice/Counseling, is considered “topped out,” indicating that Document in the ED Record the date and time the decision was made to admit the patient to the hospital as nationally, it has met and maintained a very high performance level, with little or no room for improvement. Also, an inpatient. (The admit or disposition order date/time may be used). Emphasis is placed on when the screening should apply to ALL patients, not just those with AMI. No data will be collected or reported on this AMI measure. (earliest) decision was communicated.

The suspended measures are those which CMS is considering retiring; however, due to public concern over Document in the ED Record the date and time when the patient physically left the ED. (Don’t use disposittion possible declination of adherence, data collection and submission may be continued and any data submitted will be date/time, the time the discharge order was written, or the report called time.) Emphasis is placed on captur- publically reported on Hospital Compare. ing the latest time the patient was receiving care in the ED, under ED services or awaiting transport. Because these measures are still considered “best practices” and indicators of high quality, they will * ED Patient is defi ned as any patient receiving care or services in the Emergency Department. continue to be a part of this Core Measures Help Booklet.

Special Notes for **Observation Patients Aspirin at Arrival: [Suspended] Under ED Services: Use the time patients depart from observation services. Give w/in 24hrs before or after arrival or document reason for No aspirin on arrival. • If admitted to an observation unit of the ED, use the time they departed the observation unit. • If placed into observation services but remains in the ED or ED unit, use the time they departed the ED or Note regarding 24 hrs prior to arrival: For patients received as transfers, documentation must be clear that ASA ED unit for the fl oor/surgery, etc.; not the time they are placed into observation. was received within 24 hours of arrival or was a current medication at the transferring facility. Reasons: • Allergy Outside the services of the ED: Use the time of departure from the ED. • Pre-arrival Coumadin/warfarin or Pradaxa/dabigatran • If patient is placed into observation but remains in the ED or ED unit, use the time they departed the ED • Other explicitly documented reason by Phys/PA/APN/Pharmacist or ED unit for the fl oor/surgery, etc.; not the time they are placed into observation.

** Observation Services: Services furnished by a hospital on the hospital’s premises, including use of a bed and periodic monitoring by a hospital’s nursing or other staff, which are reasonable and necessary to evaluate an outpatient’s condition or determine the need for possible admission to the hospital as an inpatient.

Improvement noted as: A decrease in the median value. Page 3 Page 24 AMI VTE - Recommended Prophylaxis (Table 12) ‡ACEI/ARB at Discharge for LVSD: [Suspended] (Includes RAS/RAAS blockers/inhibitors) Surgery Recommend Prophylaxis Prescribe EITHER at discharge for pts with < 40% EF or moderate/severe LVSD; or document reason for No ACEI AND No ARB at discharge. Elective Total Knee Replacement Any of the following: • Low molecular weight heparin (LMWH) ‡Tables 1 & 2 • Factor Xa Inhibitor (fondaparinux) • Warfarin Documentation must clearly indicate the medication (listed by name) is being prescribed at discharge. • Oral Factor Xa Inhibitor (Rivaroxaban) * • Intermittent pneumatic compression devices (IPC) Reasons: • Allergy • Venous foot pump (VFP) • Moderate or severe aortic stenosis [Counts for BOTH] • Other explicitly documented reason by Phys/APN/PA/Pharmacist Hip Fracture Surgery Any of the following: • Phys/APN/PA/Pharmacist documentation that either an ACEI or an ARB was not given • Low-dose unfractionated heparin (LDUH) due to one of the following 5 conditions [Counts for BOTH]: • Low molecular weight heparin (LMWH) 1. Angioedema • Factor Xa Inhibitor (fondaparinux) 2. Hyperkalemia • Warfarin 3. Hypotension Elective Total Hip Replacement Any of the following: 4. Renal artery stenosis with a reason for not administer- • Intermittent pneumatic compression devices (IPC) 5. Worsening renal function/renal disease/dysfunction ing pharmacological prophylaxis • Venous foot pump (VFP) • A Conditional Hold with parameters (re: BP) counts as a reason IF there is documenta- tion that the ACEI/ARB was held due to the specifi ed parameters. Hip Fracture Surgery with a Any of the following: reason for not administering phar- • Graduated compression stockings (GCS) macological prophylaxis • Intermittent pneumatic compression devices (IPC) Adult Smoking Cessation Advice/Counseling: [Retired] • Venous foot pump (VFP) Give to pts with clear history of cigarette smoking anytime during the past year prior to arrival. Always inquire. *The U.S. Food and Drug Administration has approved Xarelto (Rivaroxaban) to reduce the risk of blood clots, deep vein thrombosis (DVT) and pulmonary embolism (PE) following knee or hip replacement surgery ONLY.

‡Beta-Blocker at Discharge: [Suspended] Note: Patients who receive neuraxial anesthesia or have a documented reason for not administering pharma- Prescribe at discharge or document reason for No beta-blocker at discharge. cological prophylaxis may pass the performance measure if either appropriate pharmacological is ordered or mechanical prophylaxis is ordered or placed on pt. Documentation must clearly indicate the medication (listed by name) is being prescribed at discharge. Reasons: • Allergy • 2nd or 3rd degree heart block on ECG on arrival or during stay w/o pacemaker • Other explicitly documented reason [including Bradycardia] by Phys/APN/PN/Phar- macist • A Conditional Hold with parameters (re: HR or BP) counts as a reason IF there is documentation that the beta-blocker was held due to the specifi ed parameters. ‡Table 3 Page 23 Page 4 VTE - Recommended Prophylaxis (Table 12) AMI/HF - ACEIs (Table 1)

Surgery Recommend Prophylaxis Accupril Enalapril/felodipine Prinivil Accuretic Enalapril/hydrochlorothiazide Prinzide Intracranial Neurosurgery Any of the following: Aceon Enalaprilat Quinapril • Intermittent pneumatic compression devices (IPC) with or without graduated compression stockings (GCS) Altace Fosinopril Quinapril HCL • Low-dose unfractionated heparin (LDUH) Benazepril Fosinopril Sodium/ Quinapril HCL/HCT hydrochlorothiazide • Low molecular weight heparin (LMWH)† Benazepril Hydrochloride Quinapril Hydrochloride/ Lexxel hydrochlorothiazide • LDUH or LMWH† combined with IPC or GCS Benazepril/amlodipine Benazepril/hydrochlorothiazide Lisinopril Quinapril/hydrochlorothiazide † Current guidelines recommend postoperative low molecular Capoten Lisinopril/hydrochlorothiazide Quinaretic weight heparin for Intracranial Neurosurgery. Capozide Lotensin Ramipril Capozide 25/15 Lotensin HCT Tarka General Surgery Any of the following: Capozide 25/25 Lotrel Teczem • Low-dose unfractionated heparin (LDUH) Capozide 50/15 Mavik Trandolapril • Low molecular weight heparin (LMWH) Capozide 50/25 Moexipril Trandolapril/verapamil • Factor Xa Inhibitor (fondaparinux) Captopril Moexipril Hydrochloride Trandolapril/ • LDUH or LMWH or Factor Xa Inhibitor (fondaparinux) com- Moexipril Hydrochloride/ verapamil hydrochloride bined with IPC or GCS Captopril HCT hydrochlorothiazide Uniretic Captopril/hydrochlorothiazide General Surgery with a reason for Any of the following: Moexipril/hydrochlorothiazide Univasc Enalapril not administering pharmacologi- • Graduated compresstion stockings (GCS) Monopril Vaseretic Enalapril Maleate/diltiazem cal prophylaxis • Intermittent pneumatic compression devices (IPC) Monopril HCT Vasotec Enalapril Maleate/ Gynecologic Surgery Any of the following: hydrochlorothiazide Monopril HCT 10/12.5 Zestoretic • Low-dose unfractionated heparin (LDUH) Enalapril/diltiazem Perindopril Zestril • Low molecular weight heparin (LMWH) Perindopril Erbumine • Factor Xa Inhibitor (fondaparinux) • Intermittent pneumatic compression devices (IPC) • LDUH or LMWH or Factor Xa Inhibitor (fondaparinux) com- bined with IPC or GCS

Urologic Surgery Any of the following: AMI/HF - ARBs (Table 2) • Low-dose unfractionated heparin (LDUH) Atacand Eprosartan/hydrochlorothiazide Tasosartan • Low molecular weight heparin (LMWH) Atacand HCT Exforge Telmisartan Factor Xa Inhibitor (fondaparinux) Avalide Hyzaar Telmisartan/amlodipine • Intermittent pneumatic compression devices (IPC) Avapro Irbesartan Telmisartan/hydrochlorothiazide • Graduated compression stockings (GCS) Azilsartan Irbesartan/hydrochlorothiazide Teveten • LDUH or LMWH or Factor Xa Inhibitor (fondaparinux) com- bined with IPC or GCS Azor Losartan Teveten HCT Benicar Losartan/hydrochlorothiazide Twynsta Elective Total Hip Replacement Any of the following: Benicar HCT Micardis Valsartan • Low molecular weight heparin (LMWH) • Factor Xa Inhibitor (fondaparinux) Candesartan Micardis HCT Valsartan/aliskiren • Warfarin Candesartan/ Olmesartan Valsartan/amlodipine hydrochlorothiazide • Oral Factor Xa Inhibitor (Rivaroxaban) * Olmesartan/amlodipine Valsartan/hydrochlorothiazide Cozaar Olmesartan/amlodipine/ Valturna Diovan hydrochlorothiazide Verdia Diovan HCT Olmesartan Medoxomil Edarbi Olmesartan Medoxomil/amlodipine Eprosartan Olmesartan/hydrochlorothiazide Page 5 Page 22 AMI/HF - Beta Blockers (Table 3) SCIP - Diuretics (Table 10) Acebutolol Inderide LA Propranolol Hydrochloride Atenolol InnoPran XL Propranolol/hydrochlorothiazide Aldactazide Dyrenium Indapamide Osmitrol Atenolol/chlorthalidone Kerledex Sectral Aldactone Edecrin Lasix Polythiazide Betapace Kerlone Sorine Amiloride HCL Enduron Lozol Quinethazone Betapace AF Labetalol Sotalol Amiloride HCL/hydro- Esidrix Mannitol Renese Betaxolol Levatol Sotalol HCL chlorothiazide Ethacrynic acid Maxzide Resectisol Bisoprolol Lopressor Tenoretic Aquatensen Bisoprolol/fumarate Lopressor HCT Tenormin Exna Metahydrin Saluron Bendrofl umethiazide Bisoprolol/hydrochlorothiazide Lopressor/hydrochlorothiazide Tenormin I.V. Furosemide Methyclothiazide Spironolactone Benzthiazide Blocadren Metoprolol Timolide Hydrochlorothiazide Metolazone Spironolactone/hydrochlo- Bumetanide rothiazide Brevibloc Metoprolol/hydrochlorothiazide Timolol Hydrochlorothiazide/triam- Microzide Bystolic Metoprolol Tartrate/ Timolol Maleate/ Bumex terene Thalitone hydrochlorothiazide hydrochlorothiazide Midamor Carteolol Chlorthalidone HydroDIURIL Torsemide Nadolol Timolol/hydrochlorothiazide Moduretic Cartrol Démodé Hydrofl umethiazide Triamterene Carvedilol Nadolol/bendrofl umethiazide Toprol Mykrox Diucardin Hydromox Trichlormethiazide Coreg Nebivolol Toprol-XL Naqua Nebivolol HCL Trandate Diurese Hydro-Par Zaroxolyn Corgard Naturetin Nebivolol Hydrochloride Trandate HCL Dyazide Hygroton Corzide 40/5 Oretic Corzide 80/5 Normodyne Visken Esmolol Penbutolol Zebeta Inderal Pindolol Ziac SCIP - Urinary Antiseptics (Table 11) Inderal LA Propranolol Inderide Propranolol HCL Apo-Nitrofurantoin Hiprex Methenamine AMI - Fibrinolytics (Table 4) Cystex Novo-Furantoin Nitrofurantoin Abbokinase Eminase Tenecteplase Furadantin Mandelamine Urex Activase Kabikinase Tissue plasminogen activator Furalan Macrobid Utira C Alteplase Retavase TNKase Furatoin Macrodantin Anistreplase Reteplase tPA (TPA) Anisoylated Plasminogen-Strepto- rPA (RPA) UK kinase Activator Complex Streptase Urokinase APSAC Streptokinase

AMI - Statins (Table 5) Advicor Lescol XL Rosuvastatin Altoprev Lipitor Simcor Atorvastatin Livalo Simvastatin Atorvastatin/amlodipine Lovastatin Simvastatin/ezetimibe Caduet Lovastatin/niacin Simvastatin/niacin Crestor Mevacor Vytorin Fluvastatin Pitavastatin Zocor Fluvastatin XL Pravachol Lescol Pravastatin Page 21 Page 6 Prophylactic ABX Regimen Selection for (Table 9) HF Discharge Instructions: CABG, Other Cardiac or Vascular Hysterectomy (For pts discharged to home/home care/court or law enforcement) Cefazolin, Cefuroxime, or Vancomycin** Cefotetan, Cefazolin, Cefoxitin, Cefuroxime, or 1. Address all: Ampicillin/Sulbactam 1. Activity If ß-lactam allergy: Vancomycin* or Clindamycin* If ß-lactam allergy: 2. Diet Clindamycin + Amikacin, Gentamicin, or 3. F/U Appt (no PRN) Tobramycin 4. Wt Monitoring Colon Or 5. HF Symptoms Worsening Cefotetan, Cefoxitin, Ampicillin/Sulbactam, Clindamycin + Moxifl oxacin, Ciprofl oxacin, or 6. Discharge Medications or Ertapenem† Levofl oxacin Important: All discharge medications should be noted clearly and accurately in the chart and listed in Or the Discharge Instructions. [Specifi c instructions apply. See data element.] OR Clindamycin + Aztreonam OR 2. Give discharge instructions to patient/caregiver. (Documentation must verify) Cefazolin or Cefuroxime + Metronidazole Metronidazole + Amikacin, Gentamicin, or Tobramycin If ß-lactam allergy: Or Evaluation of LVS Function: Clindamycin + Amikacin, Gentamicin, or Metronidazole + Moxifl oxacin, Ciprofl oxacin, or *Evaluate LVS function prior to arrival (no time limit), during stay, or defi nitively plan evaluation for after dis- Tobramycin Levofl oxacin charge. Otherwise, **document a reason for Not evaluating. Or * Includes documentation of LVSF. Note: Document clearly. Clindamycin + Moxifl oxacin, Ciprofl oxacin, or Hysterectomy (Principal) + Colon (Other) **Phys/APN/PA documentation only. Levofl oxacin Cefotetan, Cefazolin, Cefoxitin, Cefuroxime, or Or Ampicillin/Sulbactam Clindamycin + Aztreonam OR ‡ACEI/ARB at Discharge for LVSD: (Includes RAS/RAAS blockers/inhibitors) Ertapenem† Prescribe EITHER at discharge for pts with < 40% EF or moderate/severe LVSD; or document reason for No OR ACEI AND No ARB at discharge. If ß-lactam allergy: ‡Tables 1 & 2 Metronidazole + Amikacin, Gentamicin, or Clindamycin + Amikacin, Gentamicin, or Tobramycin Tobramycin Documentation must clearly indicate the medication (listed by name) is being prescribed at discharge. Or Or Reasons: • Allergy Metronidazole + Moxifl oxacin, Ciprofl oxacin, or Clindamycin + Moxifl oxacin, Ciprofl oxacin, or • Moderate or severe aortic stenosis [Counts for BOTH] Levofl oxacin Levofl oxacin • Other explicitly documented reason by Phys/APN/PA/Pharmacist Or • Phys/APN/PA/Pharmacist documentation that either an ACEI or an ARB was not given Clindamycin + Aztreonam due to one of the following 5 conditions [Counts for BOTH]: Hip/Knee Arthroplasty OR 1. Angioedema Cefazolin, Cefuroxime, or Vancomycin** Metronidazole + Amikacin, Gentamicin, or 2. Hyperkalemia Tobramycin 3. Hypotension If ß-lactam allergy: Or 4. Renal artery stenosis Vancomycin* or Clindamycin* Metronidazole + Moxifl oxacin, Ciprofl oxacin, or 5. Worsening renal function/renal disease/dysfunction Levofl oxacin • A Conditional Hold with parameters (re: BP) counts as a reason IF there is documenta- tion that the ACEI/ARB was held due to the specifi ed parameters. Special Considerations *For cardiac, orthopedic, and vascular surgery, if the patient is allergic to ß-lactam antibiotics, Vancomycin or Special Note: Comfort Measures Only excludes cases from all measures. Clindamycin are acceptable substitutes.

**Vancomycin is acceptable with a Physician/APN/PA/Pharmacist documented justifi cation for its use. (See data element Vancomycin)

† A single dose of Ertapenem is recommended for colon procedures. Page 7 Page 20 HF SCIP Beginning with January 2012, the following measure was retired. Beginning with January 2012, the following measure was suspended.

There are several reasons measures are retired: The suspended measures are those which CMS is considering retirement; however, due to public concern 1. Measure performance among hospitals is so high and unvarying that meaningful distinctions and im- over possible declination of adherence, data collection and submission may be continued and any data submit- provements in performance can no longer be made; ted will be publically reported on Hospital Compare. 2. Performance or improvement on a measure does not result in better patient outcomes; 3. A measure does not align with current clinical guidelines or practice; Because the measure is still considered “best practice” and an indicator of high quality, it will continue 4. There is the availability of a more broadly applicable measure for the topic; to be a part of this Core Measure Booklet. 5. There is the availability of a measure that is more proximal in time to desired patient outcomes for the particular topic; 6. There is the availability of a measure that is more strongly associated with desired patient outcomes for Surgery Pts With Appropriate Hair Removal: [Suspended] the particular topic; and Either remove surgical site hair by clippers or depilatory OR do not perform hair removal. Clearly docu- 7. Collection or public reporting of a measure leads to negative unintended consequences other than ment actual hair removal or that hair removal was not done. patient harm.

The one retired measure, Adult Smoking Cessation Advice/Counseling, is considered “topped out,” indicating that nationally, it has met and maintained a very high performance level, with little or no room for improvement. Also, screening should apply to ALL patients, not just those with HF. No data will be collected or reported on this HF measure.

Because this measure is still considered “best practice” and an indicator of high quality, it will con- tinue to be a part of this Core Measures Help Booklet.

Adult Smoking Cessation Advice/Counseling: [Retired] Give to pts with clear history of cigarette smoking anytime during the past year prior to arrival. Always inquire. Page 19 Page 8 SCIP PNEUMONIA (CAP) Urinary Catheter Removed: (Awareness of and monitoring need to continue urinary cath is crucial.) Blood Cultures Performed: Remove indwelling urethral catheter on *POD0 through POD2; or document reason on POD1 or POD2 for 1. Pts Transferred or Admitted w/in 24hrs of Hospital Arrival to ICU (due to PN or complications due to continuing cath. *POD 0 = Anesthesia End Date. POD 2 ends at midnight. PN) Collect blood culture anytime from the day prior to arrival up to 24hrs after hospital arrival. Urinary Catheter only applies to: 2. ED [Determined by clearly documented admit order] 1. Indwelling urethral caths If blood culture is done, collect blood culture prior to initial antibiotic. 2. Inserted after arrival but prior to discharge from *recovery/PACU (Insertion must be noted) And Initial Antibiotic Selection: (See ‡Table 6, ‡‡Table 7 and ‡‡‡Table 8 for applicable medications) 3. Still in place upon discharge from **recovery/PACU (documented w/in 24hrs after anesthesia end time) (**Or Administer, in accordance to ‡current antibiotic consensus recommendations, the initial antibiotic regi- max of 6hrs after arrival to a recovery area other than PACU, i.e., ICU) men w/in 24hrs of arrival. Must clearly document to refl ect actual administration and 1. ABX Name; 2. Date of Admin; 3. Time of Admin; 4. Route of ABX. Reasons: ‡ Allowance is given when documentation refl ects pt has *another source of infection (w/in the 1st 24hrs of ar- • Pt in ICU and receiving diuretics (one dose counts) rival), is ‡‡compromised, or has healthcare associated PN. • Phys/APN/PA reason documented for continuing cath postoperatively Do Not Count: Physician orders alone (i.e., keep catheter); high risk of falls/any risk of falls [* Francisella tularensis (tularemia) or Yersinia pestis (pneumonic plague) have been added. Please refer to • A medical staff-approved facility urinary catheter protocol. There must be physician documentation on the data element as specifi c inclusions/exclusions apply.] Note: The only B-lactam allergy regime is for Non-ICU, ‡‡‡pseudomonal risk patients. POD0, POD1 or POD2 ordering/instructing the nursing staff to follow the formal protocol AND docu- mentation on POD1 or POD2 of a reason to continue catheterization in the protocol. The reason may be Special Note: Comfort Measures Only excludes cases from all measures. documented by a nurse. • Patient refusal. The reason may be documented by a nurse. Beginning with January 2012, the following measures were retired. There are several reasons measures are retired: Excludes: Patients who had urological/gynecological/perineal procedures performed or patients who had a 1. Measure performance among hospitals is so high and unvarying that meaningful distinctions and im- urinary diversion or a urethral catheter or were being intermittently catheterized prior to hospital arrival provements in performance can no longer be made; ‡ Table 10 2. Performance or improvement on a measure does not result in better patient outcomes; 3. A measure does not align with current clinical guidelines or practice; 4. There is the availability of a more broadly applicable measure for the topic; Perioperative Temperature Management: (Consistency in temp documentation will be helpful.) 5. There is the availability of a measure that is more proximal in time to desired patient outcomes for the • Includes ALL patients – pediatric included—regardless of age. particular topic; • Excludes pts who did not have neuraxial/general anesthesia. 6. There is the availability of a measure that is more strongly associated with desired patient outcomes for the particular topic; and Document *Active Warming intraoperatively to maintain normothermia AND/OR at least 1 body temp ≥ 7. Collection or public reporting of a measure leads to negative unintended consequences other than 96.8F/36C 30 min prior to or 15 min after anesthesia end time; or Document **Intentional/Maintained Hypo- patient harm. thermia perioperatively. Documentation must refl ect use during the periop period. The one retired measure, Adult Smoking Cessation Advice/Counseling, is considered “topped out,” indicating [Intraop: From †Anesthesia Start to Anesthesia End Time] that nationally, it has met and maintained a very high performance level, with little or no room for improvement. Also, screening should apply to ALL patients, not just those with PN. No data will be collected or reported on [Periop: Within 24hrs of incision through discharge from the PACU/recovery area Or max of 6hrs after arrival this PN measure. to a recovery area other than PACU, i.e., ICU)] Because this measure is still considered “best practice” and an indicator of high quality, it will con- * Only modalities accepted: Forced air warming; Conductive warming, Resistive warming; Warm water tinue to be a part of this Core Measures Help Booklet. garments ** Any reference to cardiopulmonary bypass is considered automatic intentional hypothermia. Adult Smoking Cessation Advice/Counseling: [Retired] Give to pts with clear history of cigarette smoking anytime during the past year prior to arrival. Always inquire. † Anesthesia Start and Anesthesia End Times: Represent the beginning and ending of Anesthesia for the principal procedure (or surgical episode if multiple procedures). It is recommended to view the Anesthesia Re- Also retired were Antibiotic Received [Timing Measure] (due to possible unintended consequent of antibiotic cord as the priority source; but other sources may be used. If no inclusion terms/phrases are noted, alternative overuse) and Infl uenza Vaccination and Pneumococcal Vaccination (due to the addition of a more broadly terms/phrases that best represent the time (e.g., “procedure start” or “to PACU”) may be used, starting with the applicable measure topic—Global Immunization. These measures will no longer be a part of the Core Anesthesia Record. Measures Help Booklet. Page 9 Page 18 PNEUMONIA Antibiotic Concensus Recommendations (Table 6) SCIP Non-ICU Patients For Non-ICU, Pseudomonal Risk Patients Only Beta-Blocker Therapy Pts Receiving Beta-Blocker During Periop Period: Give to pts (on daily BB therapy prior to arrival) during the periop period (the day prior to surgery through POD B-lactam (IV or IM) Antipneumococcal/Antipseudomonal B-lactam (IV) 2); or **document reason for Not giving beta-blocker periop. [Ampicillin/Sulbactam, Cefotaxime, Ceftaroline, [Cefepime, Doripenem, Imipenem/Cilastatin, Meropenem, Ceftriaxone, Ertapenem] Piperacillin/Tazobactam] 2 categories: + + 1. Patients with a LOS postoperatively < 2 days: Looking for documentation of administration the day prior Macrolide (IV or PO) Antipseudomonal Quinolone (IV or PO) or the day of surgery [Azithromycin, Clarithromycin, Erythromycin, [Ciprofl oxacin, Levofl oxacin **] 2. Patients with a LOS postoperative 2 or more days: Looking for documentation of administration the day Erythromycin Gluceptate] prior to or day of surgery AND POD 1 or POD2 OR OR Reasons (Documented during periop period): Antipneumococcal/Antipseudomonal B-lactam (IV) Bradycardia [HR < 50]; Antipneumococcal Quinolone Monotherapy [Cefepime, Doripenem, Imipenem/Cilastatin, Meropenem, Hypotension [Systolic ≤ 100 mm/Hg] (IV or PO) Piperacillin/Tazobactam] Concurrent use of intravenous inotropic medications during periop period [Gemifl oxacin, Levofl oxacin **, Moxifl oxacin] + Other reason by Phys/PA/APN/Pharmacist. Excludes NPO documentation. Aminoglycoside (IV) OR [Amikacin, Gentamycin, Tobramycin] -A Conditional Hold with parameters (re: HR or BP) counts as a reason IF there is documentation that the beta- + either blocker was held due to the specifi ed parameters. B-lactam (IV or IM) Antipneumococcal Quinolone (IV or PO) [Ampicillin/Sulbactam, Cefotaxime, Ceftaroline, [Gemifl oxacin, Levofl oxacin **, Moxifl oxacin] **A reason must be noted each day the BB is held or not administered. Ceftriaxone, Ertapenem] or + Macrolide (IV or PO) Note: If pt took BB prior to arrival, the time of the last dose must be documented, unless taken the day of Doxycycline (IV or PO) [Azithromycin, Clarithromycin, Erythromycin, surgery, to determine if w/in 24hrs prior to incision. [Doxycycline] Erythromycin Gluceptate] Excludes: Pregnant patients or patients with heart transplantation or ventricular assistant devices OR For Documented B-lactam Allergy Pts: Aztreonam (IV or IM) VTE Prophylaxis Ordered and Received: Tigecycline (IV) Monotherapy [Aztreonam] 1. Order ‡VTE Recommended Prophylaxis (pharmacological and/or **mechanical) anytime from hospital [Tigecycline] + arrival to 24hrs after anesthesia end time AND Antipneumococcal Quinolone (IV or PO) 2. Administer recommended prophylaxis w/in 24hrs prior to anesthesia start to 24hrs after anesthesia end [Gemifl oxacin, Levofl oxacin **, Moxifl oxacin] time; or document reason for Not administering both mechanical and pharmacological prophylaxis. + Aminoglycoside (IV) ‡Table 12 [Amikacin, Gentamycin, Tobramycin] ** Any application of Mechanical VTE prophylaxis counts as ordered; no order or protocol required. OR Excludes: Patients on continuous oral anticoagulation therapy prior to hospitalization Aztreonam (IV or IM) [Aztreonam ***] + Levofl oxacin (IV or PO) [Levofl oxacin **]

Pseudomonas Risk (One of the following): 1)Bronchiectasis, 2)“Pseudomonal Risk,” 3)Structural Lung Disease AND documented hx of repeated antibiot- ics or long term/chronic use of systemic corticosteroids w/in the past 3 months Page 17 Page 10

SCIP Principal Procedures applied: CABG, Other Cardiac, Hip/Knee Arthroplasty, PNEUMONIA Antibiotic Concensus Recommendations (Table 6) continued Colon, Hysterectomy, Vascular and *Other Major Surgery ICU Patients Antiipneumococcal/Antipseudomonal B-lactam (IV) Prophylactic Antibiotic Received: [Cefepime, Doripenem, Imipenem/Cilastatin, Merope- Initiate w/in 1hr [or 2hrs if rec’ving Vancomycin or a fl uoroquinolone] prior to surgical incision. Macrolide (IV) nem, Piperacillin/Tazobactam] Must clearly document to refl ect actual administration and 1. ABX Name; 2. Date of Admin; 3. Time of [Azithromycin, Erythromycin, Erythromycin + Admin; 4. Route of ABX. Document suspected/diagnosed infections clearly. Gluceptate] Aminoglycoside (IV) + either [Amikacin, Gentamycin, Tobramycin] B-lactam (IV) + either *Prophylactic Antibiotic Selection: [Ampicillin/Sulbactam, Cefotaxime, Ceftriaxone] Antipneumococcal Quinolone (IV) Administer the ‡recommended prophylactic antibiotics for specifi c surgical procedures. or [Levofl oxacin **, Moxifl oxacin] Must clearly document to refl ect actual administration and 1. ABX Name; 2. Date of Admin; 3. Time of Antiipneumococcal/Antipseudomonal B-lactam (IV) or Admin; 4. Route of ABX. Document suspected/diagnosed infections clearly. [Cefepime, Doripenem, Imipenem/Cilastatin, Merope- Macrolide (IV) ‡Table 9 nem, Piperacillin/Tazobactam] [Azithromycin, Erythromycin, Erythromycin Gluceptate] OR *Prophylactic Antibiotic Discontinued: If the patient has Francisella tularensis or Yersinia Discontinue prophylactic antibiotics [excluding ‡Urinary Antiseptics] w/in 24hrs (or 48hrs for CABG or Other Antipneumococcal Quinolone (IV) pestis risk as determined by Another Source of Cardiac Surgery) of anesthesia end time or document **Reasons to Extend Antibiotics. [Levofl oxacin **, Moxifl oxacin] Infection (see data element) the following is another + either acceptable regimen: **Includes: B-lactam (IV) • Treatment of Infection [currently diagnosed/suspected] [Ampicillin/Sulbactam, Cefotaxime, Ceftriaxone] Doxycycline (IV) • Documentation of a benign or malignant bone tumor of the same lower extremity on which the or [Doxycycliine] principal procedure of an original or revised arthroplasty was performed Antiipneumococcal/Antipseudomonal B-lactam (IV) + either • Use of Erythromycin for increasing gastric motility [Cefepime, Doripenem, Imipenem/Cilastatin, Merope- B-lactam IV • Treatment of hepatic encephalopathy nem, Piperacillin/Tazobactam] [Ampicillin/Sulbactam, Cefotaxime, Ceftriaxone] • Prophylaxis against PCP for AIDS pt or • Treatment of syndrome of inappropriate antidiuretic hormone hypersecretion (SIADH) of OR Antiipneumococcal/Antipseudomonal B-lactam (IV) hyponatremia with Demeclocycline [Cefepime, Doripenem, Imipenem/Cilastatin, (**Must be Phys/APN/PA documentation. Please refer to data element for specifi c Antipseudomonal Quinolone (IV) Meropenem, Piperacillin/Tazobactam] documentation time frames, etc.) [Ciprofl oxacin, Levofl oxacin **] ‡Table 11 + either B-lactam (IV) *Antibiotic (SCIP-Inf) Measures exclude Other Major Surgery [Ampicillin/Sulbactam, Cefotaxime, Ceftriaxone] or Antipneumococcal/Antipseudomonal B-lactam Cardiac Surgery Pts with Controlled 6AM Postop Blood Glucose: (IV) Control pt’s 6AM blood glucose to ≤200 mg/dL on Postop Day 1 (POD1) AND Postop Day 2 (POD2). [Cefepime, Doripenem, Imipenem/Cilastatin, Merope- nem, Piperacillin/Tazobactam] Suggestion: Maintain and document blood glucose levels throughout the entire postop period. OR Excludes: Burn patients, transplant patients and patients with preop infections

** Levofl oxacin should be used in 750mg dosage when used in the management of patients with pneumonia.

*** For patients with renal insuffi ciency. Page 11 Page 16 PN - Immunosuppresives (Table 7) PN - Systemic Corticosteroids (Table 8)

141W94 Alkeran BCVPP CAV ACTH-80 Delta-Cortef Hydrocortone Acetate Prelone 1592U89 Alkeran I.V. BEP CAVE A-Hydrocort Deltasone Hydrocortone Phosphate Repository Corticotropin Injection 3TC Altretamine Betaferon CBV Amcort Depmedalone Kenacort Solu-Cortef 5 + 2 Amcort Betamethasone CC A-Methapred Depoject Kenacort Solu-Medrol 5-FU Amdoxovir Betamethasone Acetate CCNU Aristocort Depo-Medrol Kenaject Solurex 6MP A-Methapred Betamethasone Dipro- CDDP/VP Aristocort Forte Depopred Kenalog pionate Solurex LA 7 + 3 Amethopterin CeeNu Aristocort Intralesional Dexamethasone Key-Pred Betamethasone Dipropio- Sterapred DS Abacavir Amifostine nate Powder Celestone Aristospan Intra-articular Dexamethasone Acetate Liquid Pred Systemic Corticosteroid ABC Amprenavir Betamethasone Sodium Celestone Phosphate Aristospan Intralesional Dexamethasone Intensol Meticorten Not Otherwise Specifi ed (NOS) Abraxane Anastrozole AP Phosphate Celestone Soluspan Atolone Dexamethasone Sodium Medralone Phosphate Tac-3 ABT-378 Antithymocyte Globulin Beta-Phos/AC Cellcept Betamethasone Medrol Dexamethasone Sodium Triam-A ABV APV Betaseron Cerubidine Betamethasone Sodium Phosphate with Lidocaine M-Prednisol Phosphate Triamcinolone AC Arabinasyl Cytosine Bexarotene CEV Dexamethasone Sodium Methylprednisolone Betamethasone Sodium Phosphate with Lidocaine Triamcinolone Acetonide Ace Ara-C Bexxar CF Phosphate and Betameth- HCL Methylprednisolone asone Acetate Acetate Triamcinolone Diacetate Acetocot Arava Bicalutamide CFM Dexasone Budesonide Methylprednisolone Triamcinolone Hexace- Acthrel Arimidex BiCNU CHAP Dexasone LA Sodium Succinate tonide Celestone Actummune Aristocort BIP ChIVPP Dexone Nor-Pred TBA Triam Forte Celestone Phosphate Actinomycin D Aristocort for Injection Bis-Pom PMEA ChIVPP/EVA Dexone LA Orasone Triamonide Celestone Soluspan Abacavir/Lamivudine Aristocort Forte Blenoxane Chlorambucil Duralone Panasol-S Tri-Kort Clinacort Adalimumab Aristopak Bleomycin CHOP Entocort EC Paramethasone Trilog Cortastat Adbeon Aristopan Injection Bleomycin Sulfate CHOP-BLEO Florinef Prednicen-M Trilone Cortef Adefovir Aromasin BOMP Chromic phosphate P32 Fludrocortisone Pedlapred Tristoject Cortef ADF Arsenic Trioxide Bortezomib CISCA Haldrone Predalone Cortenema Adlone-40 Asparaginase Budesonide CISCA/VB Hexadrol Predate TBA Corticotropin Adlone-80 Atazanavir Busulfan Cisplatin Hexadrol Phosphate Predcor Cortisone Adrenocot ATG CAE Cisplatinum HP Acthar Gel Predcor TBA Cortisone Acetate Adrenocot L.A. Atrgam CAF Citrororum Factor Hydeltrasol Predisolone Sodium Cortone Acetate Adriamycin PFS ATV CAL-G Cladribine Hydrocortisone Phosphate Dalalone Adriamycin RDF Avonex CAM CMF Hydrocortisone Acetate Prednisol TBA Dalalone DP Adriamycin RDF/PFS Azacitidine Camptosar CMFP Hydrocortisone (Cortisol) Prednisolone Dalalone LA Adrucil Azasan CAP CMFVP Hydrocortisone Cypionate Prednisolone Acetate Decaject AF1549 Azathioprine Capecitabine Combivir Hydrocortisone Retention Prednisolone Sodium Decaject LA Enema Phosphate Agenerase Azathioprine sodium Capravirine COMLA Decadron Hydrocortisone Sodium Prednisolone Terbutate A-Hydrocort AZT Carboplatin COMP Decadron LA Phosphate Prednisone Aldesleukin Basiliximab Carimune COP Decadron Phosphate Hydrocortisone Sodium Prednisone Intensol Alferon N BCG Carmustine COPE Succinate Concentrate Decadron w/Xylocaine Alimta BCNU Casodex COPP Hydrocortone Page 15 Page 12 PN - Immunosuppresives (Table 7) cont. PN - Immunosuppresives (Table 7) cont.

TheraCys TZV Xeloda Cortef Daclizumab Depo-Medrol Duralone FAC Theracys 3 Uracil Mustard Zalcitabine Corticorelin Dactinomycin Depopred Duratest FAM TheraCys Intravesical U-Tri-Lone Zanosar Corticorelin Ovine DAL Depo-Predate Durathate 200 FAMe (as trifl uoracetate) Thioguanine VAC ZDV Dalalone De-Sone LA DVP FAMTX Cortisone Thioplex VACAdr-lfoVP Zenapex Dalalone D.P. Dexacen-4 EAP FAP Cortisone Acetate Thiotepa VAD Zerit Dalalone L.A. Dexacorten EC Fareston Cort-K Thymoglobulin VadrC Zevalin DAPD Dexamethasone Efalizumab F-CL Cortone Acetate TICE BCG Valrubicin Ziagen Darcarbazine Dexamethasone Efavirenz FED Cortrosyn Acetate Tice BCG Vaccine VATH Zidovudine DAT EFP Femara Cosmegan Dexamethasone Tipranavir VBAP Zoladex Daunomycin Intensol EFV Filgrastim Cosmegen Toposar VC Daunorubicin Dexamethasone ELF FK-506 Cosyntropin Topotecan VCAP Daunorubicin Citrate Lidocaine Eligard FL Cotolone Liposome Topotecan Hydrochoride VCR Dexamethasone Elspar Fle Coviracil Daunorubicin Hydro- Sodium Phosphate Toremifene VDA chloride EMA 86 Florinef CP Dexasone Toremifene Citrate VDP Daunorubicin Lipo- Dexasone LA Emcyt Floxuridine Crixivan somal Torisel Velban Dexone Emtricitabine/Teno- Fludara CT DaunoXome fovir Tositumomab Velcade Dexone LA Fludarabine Curcumin DAV Enbrel TPV VePesid Dexrazoxane Fludarabine Phos- Curretab DCT Endoxan phate Tramacort-D Vercyte DHAP CVD DDC EP Fludrocortisone Trastuzumab Vesanoid DI CVI DDI Epirubicin Fluorouracil Tretinoin Vidaza Didanosine CVP Decadron Epivir Fluorouracil, Sys- Triam-A Videx DLV temic CVPP Decadron Phos- Ergamisol Triamcinolone Vinblastine Flutamide Cyclophosphamide phate, Injectable DMP-266 Erlotinib Triamcinolone Diacetate Vinblastine Sulfate Decadron with Docetaxel FOAM Cyclophosphamide Xylocaine ESHAP Triamcinolone Hexacetonide Vincristine Lyophilized Dororubicin Folex Decadron-LA Estramustine Triamcort Vincristine Sulfate Cyclosporine Doxil Folex PFS Deca-Durabolin Estramustine Phos- Triam-Forte Vinorelbine Cyclosporine A Doxorubicin phate Sodium Folinic Acid Decaject Triamcinolone Acetonide Vinorelbine Tartrate Cycrin Doxorubicin HCL Etanercept Fortase Decaject L.A. Triamonide 40 VIP Cystosine Arabino- Doxorubicin Hydro- Ethoyl FTC side Tri-Kort VIP-1/2 Delatest chloride Etopophos FTV Cytarabine Trilog Viracept Delatestryl Doxorubicin Hydro- Etoposide FUDR Cytosar-U chlorideliposome Trilone Viramune Delavirdine Etoposide (as Phos- FZ Cytoxan Doxorubicin Lipo- phate) Tri-Med VM Deltasone somal Gefi tinib Cytoxan Lyophilized Eulexin Tristoject VP16 Dep Medalone 80 Droxia Gemcitabine D4T EVA Trizivir V-TAD Depandro 100 DTIC-Dome Gemcitabine HCL DA Everone Turmeric Vumon Depmedalone Durabolin Gemtuzumab Tysaybri VX-478 Dacarbazine Depoject-80 Durabolin-50 Exemestane Page 13 Page 14 PN - Immunosuppresives (Table 7) cont. PN - Immunosuppresives (Table 7) cont. Gemzar Idarubicin Letrozole Melphalan Mutamycin PAC Prelone Simulect Gleevec Idarubicin HCL Leukeran Mercaptopurine MV Paclitaxel Preveon Sirolimus Gliadel Idarubicin Hydrochloride Leukine Mesnex M-VAC Paclitaxel Protein-bound Pri-Cortin 50 Sodium Iodide I 131 Glivec IDV Leukovoren Metastron MVP Paraplatin Primethasone Sodium Phosphate P32 Goserelin IE Leuprolide Methotrexate MVPP PC Procarbazine Solu-Cortef Goserelin Acetate Ifex Leuprolide Acetate Methotrexate LPF Mycophenolate Mofetil PCV Procarbazine HCL Solu-Medrol Halotestin Infl iximab Leustatin Methotrexate LPF Sodium Mycophenolate Mofetil Pediapred Procarbazine Hydrochlo- Solurex Hydrochloride ride HDMTX Ifosfamide Levamisole Methotrexate Sodium Pegaspargase Solurex LA Myleran Prograf Herceptin IfoVP Levamisole HCL Methylcotol Pegasys Sorafenib Navelbine Proleukin Hexadrol Imatinib Mesylate Levamisole Hydrochloride Methylone 40 Pegfi lgrastim SQV Nelfi navir ProMACE Hexadrol Phosphate Imuran Liquid Pred Methylone 80 Peginterferon Stanford V Neoral ProMACE/cytaBOM Hexalen Indinavir Lomustine Methylprednisolone PEG-Intron Stanozolol Neosar Purinethol Hexamethylmelamine Interferon Alfa-2a Lopinavir/Ritonavir Methylprednisolone Pemetrexed Stavudine Acetate Neulasta PVB HIVID Interferon Alfa-2b LPV/RTV Pentostatin Sterapred Methylprednisol/One Neumega PVDA HN2 Interferon Alfa-n3 Lysodren Sodium Succinate PFL Sterapred DS Neupogen PVP-16 Humira Interferon Beta-1a M-2 Meticorten Phenylalanine Mustard Stilphostrol Nevirapine Rapamune Hybolin Decanoate Interferon Beta-1b MAID MF Phosphocol P32 Streptozocin Nexavar Rapamycin Hybolin-Improved Interferon Gamma-1b Matulane MINE-ESHAP Photofrin Strontiun-89 Chloride NFL Raptiva Hycamtin Intron A m-BACOD Mini-BEAM Pipobroman SU11248 NFV Remicade Hydeltrasol Intron A HAS Free MBC Mithracin Plaquenil Sunitinib Nipent Rescriptor Hydeltra-T.B.A. Invirase MC Mithramycin Platinol Sustiva Nitrogen Mustard Retrovir Hydrea Iodine I 131 Mechlorethamine Mitomycin Platinol-AQ Sutent Nolvadex Revlimid Hydrocort SS Iodine I 131 Tositumomab Mechlorethamine HCL Mitotane Platinol-Q TAC 3 Norvir Rheumatrex Hydrocortisone Iodotope Mechlorethamine Hydro- Mitoxantrone Plicamycin Tacrolimus chloride Novantrone Rheumatrex Dose Pack Hydrocortisone Acetate Iressa Mitoxantrone HCL PNU-14069 Tamoxifen Medicort NOVP Ritonavir Hydrocortisone Cypionate Irinotecan Mitoxantrone Hydrochlo- POC Tamoxifen Citrate Medidex NVP Rituxan Hydrocortisone Sodium Kaletra ride Porfi mer Tarabine PFS Phosphate Medidex LA Oncaspar Rituximab Kenaject-40 MIV Porfi mer sodium Tarceva Hydrocortisone Sodium Medipred MK-639 Oncovin Roferon-A Succinate Kenalog-10 Predacort 50 Taxol Meditest MOPP OPA Rubex Hydrocortone Kenalog-40 Predacorten Taxotere Medralone MOPP/ABV OPPA RTV Hydrocortone Acetate Key-Pred Predaject-50 Taz Medralone 40 MP Oprelvekin Samarium SM 153 Hydrocortone Phosphate Key-Pred SP Predalone 50 Temozolomide Medralone 80 M-Prednisolone Orasone Sandimmune Hydroxychloroquine KLT Predate-50 Temsirolimus Medrol Orthoclone Okt 3 Saquinavir Sulfate Lamivudine MTXCP-PDAdr Predcor Teniposide Megace Oxandrin Sargostim Hydroxyurea Lefl unomide Muromonab-CD3 Prednisolone Teslac Megestrol Oxandrolone Selestoject Ibritumomab Lefl unomine Mustargen Prednisolone Sodium Thalidomid Megestrol Acetate Oxymetholone Semustine Idamycin Lenalidomide Mustargen HC Prednisone Thalidomide