Transcript Heart failure accounts for more hospital admissions than any other

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
SARAH BORN, RN, BSN
CONFIDENTIAL-FOR QUALITY IMPROVEMENT PURPOSES ONLY
OPPORTUNITY STATEMENT
Improve the quality of care for heart
failure patients by providing evidencebased treatment as outlined in the Heart
Failure Core Measures
CONFIDENTIAL-FOR QUALITY IMPROVEMENT PURPOSES ONLY
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.
Written discharge instructions regarding activity, diet, follow-up,
medications, symptoms worsening, and weight management
Smoking cessation counseling for patients who have smoked within
last twelve months
Our goal is to achieve 100% compliance to these measures.
*Heart Failure Society of America. HFSA 2006 Comprehensive Heart Failure Practice Guidelines
CONFIDENTIAL-FOR QUALITY IMPROVEMENT PURPOSES ONLY
the
FORCES OF MAGNETISM
Force 6: Quality of Care
Force 7: Quality Improvement
Force 9: Autonomy
Force 11: Nurses as Teachers
Force 13: Interdisciplinary Relationships
CONFIDENTIAL-FOR QUALITY IMPROVEMENT PURPOSES ONLY
2008 INTERVENTIONS
Cardiac rehab documentation tool incorporated into
EPIC
Involved cardiac research nurses in the heart failure
initiative
Developed and provided physicians with core
pocket cards
measure
Inserviced 5T nursing staff (new unit/new staff) on the
Heart Failure core measures
Redistributed Heart Failure core measure pocket cards to
nursing staff
CONFIDENTIAL-FOR QUALITY IMPROVEMENT PURPOSES ONLY
•
Definition: Number of heart failure patients receiving 100% of indicated care / all heart failure patients
•
Data Source: Original data extracted from LUMC charts by RNs.
•
Analysis: The number of LUMC patients with Heart Failure who receive all indicated care significantly decreased in November and
December 2006 due an EPIC issue that negatively affected documentation of discharge instructions. This issue has been resolved and
performance now is significantly improved over baseline.
CONFIDENTIAL-FOR QUALITY IMPROVEMENT PURPOSES ONLY
•
Definition: HF patients with documentation in the hospital record that left ventricular function (LVF) was assessed before
arrival, during hospitalization, or is planned for after discharge / All HF Patients.
•
Datasource: Original data extracted from LUMC charts by RNs.
•
Analysis: LUMC performance has been above 97% since January 2006.
CONFIDENTIAL-FOR QUALITY IMPROVEMENT PURPOSES ONLY
•
Definition: Heart Failure patients who are prescribed an angiotensin converting enzyme inhibitor (ACEI) or angiotensin receptor blocker
(ARB) at hospital discharge / HF patients with LVSD and without contraindications. LVSD is defined as chart documentation of a left
ventricular ejection fraction less than 40% or a narrative description of left ventricular function consistent with moderate or severe systolic
dysfunction. Prior to 2005, ARBs were not recognized in compliance with this measure.
•
Datasource: Original data extracted from LUMC charts by RNs.
•
Analysis: LUMC performance has been at 100% since May 2007.
CONFIDENTIAL-FOR QUALITY IMPROVEMENT PURPOSES ONLY
•
Definition: HF patients with documentation that they or a caregiver received discharge instructions (weight monitoring, what to do if
symptoms worsen, diet, medications, activity level, follow-up appointment) prior to hospital discharge / HF patients discharged to home.
•
Data Source: Original data extracted from LUMC charts by RNs.
•
Analysis: A technical issue with the electronic medical record lead to a decline in this measure. This was resolved starting with January
2007 discharges, and performance has improved significantly.
CONFIDENTIAL-FOR QUALITY IMPROVEMENT PURPOSES ONLY
Definition: Smokers receiving smoking cessation counseling / HF Patients who have smoked cigarettes at any time in the 12
months prior to hospital arrival.
Data Source: Original data extracted from LUMC charts by RNs.
Analysis: LUMC performance has been nearly perfect since March 2006.
CONFIDENTIAL-FOR QUALITY IMPROVEMENT PURPOSES ONLY
NEXT STEPS
Require a complete discharge medication list in the
medical record for all inpatient heart failure
discharges
Incorporate revised discharge instructions into EPIC
discharge navigator
Ongoing multidisciplinary education and feedback
CONFIDENTIAL-FOR QUALITY IMPROVEMENT PURPOSES ONLY