Transcript HEART FAILURE - Loyola Medicine

HEART FAILURE
TEAM MEMBERSHIP
CARDIOLOGY, CARDIOVASCULAR SURGERY, MEDICINE,
NURSING, QRM, CCE, MEDICAL RECORDS
PROJECT COORDINATORS
CARMEN BARC, RN, BSN
CAROL KEELER, RN, MS
Heart failure accounts for more hospital admissions than any other
Medicare diagnosis. Research shows that the following care processes
decrease morbidity and mortality rates for heart failure patients:
Left ventricular systolic function assessment
ACEI or ARB prescribed for LVSD
(EF <40% or description of moderate/severe dysfunction)
Smoking cessation counseling
Written discharge instructions regarding activity, diet,
follow-up, medications, symptoms worsening, and weight management
Our goal is to achieve 100% compliance to these measures.
Source: www.jcaho.org
OPPORTUNITY STATEMENT
Concurrent patient care and
retrospective chart review indicated
an opportunity for improvement in
process and outcome for each of the
measures.
PLAN
Implement a Heart
Failure Core
Measures program
in accordance with
JCAHO/CMS
guidelines
Cycle 1
L
A
N
P
PLAN
A
DO
C
STUDY
T
ACT
•Physician and nursing staff
education
•Develop HF-specific
documentation forms
•Decrease data variability
D
O
ACT
S T
Y
U
D
DO
•HF Task Force formed
•Nursing clinical ladder
opportunity offered for
data collection and entry
•Pilot study of core
measure performance for
DRG 127
STUDY
•Current processes not
adequately fulfilling
project requirements
•Lack of house-wide
awareness/understanding
of HF Core Measures
•Data variability identified
PLAN
•Capture HF patient
population using ICD-9 codes
rather than DRG coding
P
•Dedicated FTEs for the Core
Measures initiative
•Revise HF Discharge
A
Progress Note(DPN)
C
addendum
T
•Physician and nursing staff
education
Cycle 2
L
A
N
PLAN
D
DO
O
STUDY
ACT
S T
Y
U
D
ACT
•Attend nurse managers meeting
to discuss National Hospital
Quality Measures
•Place HF packets – including
standard order sets, discharge
instructions, and discharge
progress note addendum – in the
ED, EP lab, and all patient care
areas that treat the HF population
DO
•100% chart review based on
ICD-9 diagnosis codes
•Nursing Quality Specialist given
responsibility for data collection
and entry as well as education
•DPN addendum revision to
include documentation of ARB as
potential contraindication to ACE
inhibitor
•Multidisciplinary education by
in-services and point of service
posters/ information
STUDY
•Improved documentation of D/C instructions
•LV assessment documentation peaked to a
level of excellence
•Decreased data variability
•Continuity of required documentation housewide needs improvement
Cycle 3
PLAN
•Focus on unit and
nurse specific
performance
L
A
DO
N
P
PLAN
A
DO
C
STUDY
T
O
ACT
ACT
•Surgical and non-cardiac unitspecific education
•Agency and registry nurse
education
•Involve cardiac rehabilitation
nurses, heart transplant case
managers and nurse
practitioners, as well as
cardiovascular case managers
and nurse practitioners
D
S T
Y
U
D
•Analyze and provide
unit and nurse specific
performance data to
managers
•Provide overall
performance data to the
HF task force
STUDY
•High volume cardiac units tend
to perform well; however, there
is still an opportunity for
improvement
•Surgical and non-cardiac units
need further education
regarding the HF measures
•Staff nurses perform better
than agency nurses
Heart Failure Patients Receiving Left Ventricular Systolic Function Assessment
106
104
UCL = 103.54
102
100
Percent
Mean = 98%
98
96
94
LCL = 92.98
92
90
Month
* Preliminary data for quality improvement purposes only
National Hospital Quality Measures
Heart Failure Patients Receiving Complete Discharge Instructions Prior to Discharge
90
UCL = 83.62
80
70
Mean = 63%
Percent
Percent
Mean = 62.97
60
Distributed HF Packets to ED
and units that treat HF population
50
LCL = 42.32
40
Month
Month
* Preliminary data for quality improvement purposes only
Heart Failure Patients With Left Ventricular Systolic Dysfunction Receiving
ACE Inhibitor or ARB Prescription at Discharge
110
UCL = 104.88
100
Percent
90
Mean = 84%
80
70
LCL = 63.57
60
Month
* Preliminary data for quality improvement purposes only
Smokers Receiving Smoking Cessation Counseling for Heart Failure Patients
140
120
UCL = 117.84
100
Mean = 77%
Percent
80
60
40
LCL = 36.38
20
0
Month
* Preliminary data for quality improvement purposes only
120
Heart Failure Patients With Left Ventricular Systolic Dysfunction Receiving
ACE Inhibitor or ARB Prescription at Discharge
110
Percent
100
90
80
70
Month
LUHS ACE Inhibitor or ARB for LVSD Rate
UHC Academic Hospitals ACE Inhibitor or ARB for LVSD Rate
National ACE Inhibitor or ARB for LVSD Rate
* Preliminary data for quality improvement purposes only
Heart Failure Patients Receiving Complete Discharge Instructions Prior to Discharge
120
110
100
90
Percent
80
70
60
50
40
Month
LUHS Discharge Instruction Rate
UHC Academic Hospitals Discharge Instruction Rate
National Discharge Instruction Rate
* Preliminary data for quality improvement purposes only
Heart Failure Patients Receiving Left Ventricular Systolic Function Assessment
120
115
110
105
Percent
100
95
90
85
Month
LUHS Left Ventricular Function Rate
UHC Academic Hospitals Left Ventricular Function Rate
National Left Ventricular Function Rate
* Preliminary data for quality improvement purposes only
Smokers Receiving Smoking Cessation Counseling for Heart Failure Patients
120
110
100
Percent
90
80
70
60
50
Month
LUHS Smoking Cessation Advice Rate
UHC Academic Hospitals Smoking Cessation Advice Rate
National Smoking Cessation Advice Rate
* Preliminary data for quality improvement purposes only
NEXT STEPS
Involve cardiac rehabilitation nurses as
well as cardiovascular NPs in the NHQM
initiatives
Analysis of physician specific performance
Computerize discharge processes
Evaluate process/outcome improvement
resulting from interventions
Continue public reporting of performance
measures