What are Core Measures in Nursing?

The Centers for Medicare and Medicaid (CMS) and The Joint Commission (TJC) have worked collaboratively since 2003 to define a set of criteria used by both organizations to measure the quality of patient care. These evidence-based criteria, the Core Measures, are indicators of the timeliness and effectiveness of care for certain specific conditions. They state key actions which have contributed to successful outcomes for these conditions.

The most recent "Specifications Manual for National Hospital Inpatient Quality Measures" contains categories of Core Measures including Acute Myocardial Infarction (AMI), Heart Failure, Pneumonia, Surgical Care Improvement, Immunization, Prevention and other categories.

Adherence to the Core Measure standards, along with patient satisfaction data reported on the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, impact an organization’s reimbursement for care and accreditation status. Therefore, knowledge about the Core Measures, what each one entails, and how the standards are satisfied, is critical to the organizations in which you work.

Acute Myocardial Infarction (AMI) will be used to illustrate Core Measures related to this condition. AMI Measures include nine actions that must be documented. These nine Core Measures include the administration of aspirin at arrival, the prescription of aspirin, beta-blockers and statins (as appropriate) upon discharge, the use of Angiotensin Converting Enzyme Inhibitor (ACEI) or Angiotensin Receptor Blocker (ARB) for all patients with left ventricular systolic dysfunction (LVSD), the timely administration of fibrinolytic therapy within 30 minutes of hospital arrival, and the timely initiation of Percutaneous Coronary Intervention (PCI) within 90 minutes of hospital arrival. These specific AMI measures must be documented in a timely and accurate manner to ensure compliance with the standards.

The nurse plays a pivotal role in implementing Core Measures and is responsible for ensuring orders include ACEI or ARB, aspirin, beta blocker and statin medication. During hospitalization, the nurse is to administer medications as ordered, document, and provide patient instruction concerning the medications.

The nurse is also responsible for providing and documenting patient teaching concerning patient compliance with ACEI or ARB, aspirin, beta blocker, and statin medication prescriptions, as well as other aspects of care. Use the Teach-Back Method to ensure that the patient or caregiver has learned the information and can state it back to you. Finally, the nurse plays a critical role in supporting the healthcare organization’s achievement of high ratings on Core Measures.

The public may compare specific healthcare organizations’ results on Core Measures at The Joint Commission website and at the U.S. Department of Health and Human Services (USDHHS) Hospital Compare website.

Biography:

Bette Case Di Leonardi, Ph.D., RN-BC has worked in nursing, education, and healthcare administration for more than 40 years and was among the first group of nurses certified in Nursing Professional Development. Today, Di Leonardi is an independent consultant who publishes and presents on a variety of professional and educational topics.