Transcript Heart-Failure-Core-Measure-Set-competency-Jan

A Guide for Nursing Staff
Developed by Kathy Wonderly RN, BSPA, CPHQ
Performance Improvement Coordinator
Developed:September 2009
Most recent revision: October 2013
HEART FAILURE CORE MEASURE SET
LEARNING OBJECTIVES
To recognize the 2 measures included in the
Heart Failure Core measure set.
 To identify the need for documentation of
measure compliance or reasons for noncompliance.
 To identify the measures that are nursing staff
driven.

MEASURE SET CHANGE
For the first time, there differences in the
requirements for Centers for Medicare and
Medicaid Services (CMS) and The Joint
Commission (TJC) heart failure measure set
requirements.
 CMS only has one indicator in their measure
set while TJC requires two measures.

INTRODUCTION
There are two measures included in the CHF
measure set.


1. Documentation of the evaluation of left ventricular
systolic (LVS) function.
2. ACEI or ARB ordered for left ventricular systolic
dysfunction (LVSD)
Changes in the measure set starting January 1,
2014 will be in italics.
LET’S EXPLORE EACH OF THESE FURTHER
EVALUATION OF LVS FUNCTION
(REQUIRED BY BOTH CMS AND TJC)

National guidelines advocate the evaluation of
left ventricular systolic function as the single
most important diagnostic test in the
management of all patients with heart failure.
Jessup. 2009 and HFSA, 2006
EVALUATION OF LVS FUNCTION

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This measure is a practitioner driven indicator. There must
be documentation in the medical record that the LVSF has
been evaluated. This evaluation can be done prior to
admission, during the hospital stay or planned for after
discharge.
This evaluation can be documented in the H&P, progress
note, consult note, discharge summary or if the actual
diagnostic test results are on the chart.
If the evaluation is not done, the practitioner must clearly
state why not.
Examples include: life expectancy < 1 month, patient refuses
test or technically poor test due to patient inability to
cooperate.
HOW CAN NURSES HELP?
1. After reviewing the chart, remind the physician
that the documentation is missing.
2. Place a copy of the most recent diagnostic test
on the chart if it is not already there.
ACEI OR ARB MEDICATION FOR LVSD
This indicator is required by TJC only. Hospitals
can choose to submit their data voluntarily to
CMS if they wish.
 Please follow your hospital plan of care for
heart failure patients.

ACEI OR ARB MEDICATION FOR LVSD

This is also a practitioner driven measure.
If the ejection fraction is documented as less
than 40% or the physician describes moderate
to severe systolic dysfunction (LVSD), the
patient should be ordered an ACEI or ARB
medication.
YOUR ROLE
To help meet this measure you should review the
medical record. If you noticed the patient has
LVSD check to see if he/she is on any of the
medications included on the approved lists that
follow.
 If not, remind the practitioner to either order a
medication or document why the patient cannot
take one.
 Pharmacy can help with this measure by reviewing
the diagnostic test results and the medication list.

APPROVED ACEI MEDICATION LIST
Accupril
Accuretic
Aceon
Altace
Benazepril
Benazepril Hydrochloride
Benazepril/amlodipine
Benazepril/hydrochlorothiazide
Capoten
Capozide
Captopril
Captopril HCT
Captopril/hydrochlorothiazide
Enalapril
Enalapril Maleate/hydrochlorothiazide
Enalapril/hydrochlorothiazide
Enalaprilat
Fosinopril
Fosinopril Sodium/hydrochlorothiazode
Lisinopril
Lisinopril/hydrochlorothiazide
Lotensin
Lotensin HCT
Lotrel
Mavik
Moexipril
Moexipril Hydrochloride
Moexipril Hydrochloride/hydrochlorothiazide
Moexipril/hydrochlorothiazide
Monopril
Perindopril
Perindopril Erbumine
APPROVED ACEI MEDICATION LIST
Prinivil
Prinzide
Quinapril
Quinapril HCL
Quinapril HCL/HCT
Quinapril Hydrochloride/hydrochlorothiazide
Quinapril/hydrochlorothiazide
Quinaretic
Ramipril
Tarka
Trandolapril
Trandolapril/verapamil
Trandolapril/verapamil hydrochloride
Uniretic
Univasc
Vaseretic
Vasotec
Zestoretic
Zestril
Specifications Manual for National Hospital Inpatient
Quality Measures Discharges 01-01-13(1Q13) through
12-31-13(4Q13) Appendix C
SMOKING CESSATION ADVICE/COUNSELING
The Smoking Cessation indicator has been
retired from the CHF measure set starting
January 1, 2012. CMS feels this should occur
for all patients and are considering this as a
global measure for future use.
 That said, each hospital will need to determine
how they will address this change.
 If your facility chooses to continue to offer
smoking cessation the requirements are on the
next slides.

SMOKING CESSATION ADVICE/COUNSELING
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This is a nursing driven measure.
CMS defines a smoker as anyone who has smoked
cigarettes anytime during the year prior to admission.
With this definition in mind it is important to get the
most accurate smoking history possible. Ask very
specific questions such as:
Have you smoked cigarettes within the past year?
Do you still smoke? If not when did you quit
(month/year if possible)?
Would you like information or help to quit smoking?
SMOKING CESSATION CONT.

Our role as healthcare providers is to offer
help to all smokers. The patient has the right
to refuse, just be sure that the refusal is
clearly documented.
IN CLOSING

Heart failure is one of the leading causes for
admission and readmission to hospitals in the
USA. By providing care as established through
evidence based medicine research and great
patient teaching the experts feel these patients
will be able to handle their health issues better
and improve their quality of life therefore
reducing the number of hospital stays.
TEST YOUR KNOWLEDGE
1. It isn’t important to evaluate the Left
Ventricular Systolic function of patients with
heart failure.
A. True
B. False
TEST YOUR KNOWLEDGE
2. Left systolic ventricular dysfunction is defined
as having an ejection fraction of less than 40%.
A. True
B. False