Transcript Slide 1
Acute Myocardial Infarction (Heart Attack) Committee Membership: B. Majcher, APRN, C. Mulhall, APRN, K. McLean, MD, M. Jarotkiewicz RRT, MS, Administrative Director Cardiovascular Service Line, Nursing Staff of 3NEWS, CCU, 3 ITV, and Emergency Room, Cardiac Cath Lab, Medical Records Department, Center for Clinical Effectiveness. Confidential: For Quality Improvement Purposes Only Evidence • Angiotensin converting enzyme inhibitor (ACEI) therapy reduces mortality and morbidity in patients with left ventricular systolic dysfunction (LVSD) after AMI . • Recent clinical trials have also established angiotensin-II receptor blocker (ARB) therapy as an acceptable alternative to ACEI, especially in patients with heart failure and/or LVSD who are ACEI intolerant. Confidential: For Quality Improvement Purposes Only CMS/TJC Core Measure Specification Guidelines Evidence • National guidelines strongly recommend ACEI for patients hospitalized with AMI who have either clinical heart failure or LVSD. • Guideline committees have also supported the inclusion of ARBs in performance measures for AMI. • Despite these recommendations, ACEIs remain under-utilized in eligible older patients hospitalized with AMI. Confidential: For Quality Improvement Purposes Only ACC/AHA Guidelines for the management of patients with STEMI 2004, ACC/AHA Guidelines for the management of patients with UA and NSTEMI 2002. Opportunity for Improvement • Loyola was achieving 100% compliance in most Acute Myocardial Infarction (AMI) Core Measures. • Loyola provided ACEI / ARB prescriptions on discharge less consistent than other hospitals (National and UHC). Confidential: For Quality Improvement Purposes Only Solutions Implemented • The Core Measures Committee meets monthly to review and reviews the percentage of patients receiving ACEI and/or ARB prescriptions at discharge. • On daily basis, each patient’s Medication Administration Record (MAR) is reviewed by cardiac case manager for any changes in patients’ severity, medications and planned discharged date. Confidential: For Quality Improvement Purposes Only Solutions Implemented • Patient’s are checked for inpatient ACEI or ARB administration and/or possible contraindications to ACEI or ARB. If a discrepancy is noted, communicative action among the health care providers is taken to improve documentation within the medical record. • On discharge each AMI patient’s chart and discharge summary is reviewed and assessed by a cardiac case manager to ensure that appropriate inclusion of an ACEI and/or ARB prescription, or that a contraindication to this medication therapy is documented. Confidential: For Quality Improvement Purposes Only Solutions Implemented during discharge process Confidential: For Quality Improvement Purposes Only Solutions Implemented during discharge process Confidential: For Quality Improvement Purposes Only Acute Myocardial Infarction Patients With Left Ventricular Systolic Dysfunction Receiving ACE Inhibitor or ARB Prescription at Discharge 180 160 140 UCL = 140.1 120 Percent 100 Mean = 91.3 80 60 LCL = 42.5 40 20 Confidential: For Quality Improvement Purposes Only 0 Month Outcomes • Significant Improvement! • Since December 2006, the observed percentage of ACEI / ARB prescription at discharge at Loyola has been at 100% which is above the national average rate – This improvement appears to be due to improved communication, team work among health care providers and detail processes to ensure that cases are appropriately re-reviewed for medication administration on daily basis and included in this measure. Confidential: For Quality Improvement Purposes Only Next Steps • Continue performing case level review of AMI cases at monthly Core Measures Committee meeting. • Assess need for other interventions with other AMI Core Measures Confidential: For Quality Improvement Purposes Only