Transcript Slide 1

HEART FAILURE
TEAM MEMBERSHIP
DEPARTMENTS OF CARDIOLOGY, CARDIOVASCULAR
SURGERY, MEDICINE, NURSING, QUALITY AND RESOURCE
MANAGEMENT, THE CENTER FOR CLINICAL
EFFECTIVENESS, MEDICAL RECORDS, INFORMATION
TECHNOLOGIES, EPIC
PROJECT COORDINATORS
CARMEN BARC, RN, BSN
CAROL KEELER, RN, MS
OPPORTUNITY STATEMENT
Improve the quality of care for heart
failure patients by providing
evidence-based treatment as
outlined in the Heart Failure Core
Measures
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 (LVSF) assessment
Angiotensin converting enzyme inhibitor (ACEI) or angiotensin receptor
blocker (ARB) prescribed for left ventricular systolic dysfunction
(LVSD). Ejection fraction (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.
PLAN
Implement a Heart
Failure (HF) 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 discharge
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
Cycle 4
PLAN
Incorporate HF
measures into the
electronic medical
record
L
A
DO
N
P
PLAN
A
DO
C
STUDY
T
ACT
●Develop a CV Surgery
discharge order set to include a
HF assessment, HF specific
discharge instructions, and
smoking cessation counseling
●Analyze physician compliance
with electronic medical record
documentation
D
O
ACT
S T
●Develop a HF admission order
set
●Develop a medicine discharge
order set to include a HF
assessment, HF specific
discharge instructions, and
smoking cessation counseling
●Include respiratory therapy in
smoking cessation counseling
Y
U
D
STUDY
●Improved documentation of LVSF
assessment and contraindications to
prescribing ACEI and ARB for patients with
LVSD
●Improved documentation of smoking
cessation counseling
●Identified that surgical heart failure patients
were not being included in the current
electronic workflow pathways
NEXT STEPS
Analyze physician compliance with
electronic medical record documentation
Computerize nursing documentation
Ongoing staff education