Heart Failure Core Measures

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GHA Power Hour Athens Regional Medical Center

• Heart Failure Core Measures
• Tips from the Trenches

June 11, 2008
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Heart Failure Core Measures

• Tips from the Trenches
• Mary Beth Bell, MS, RN, NP-C
• Heart Failure Support Program Coordinator
• Mbell_at_armc.org 706-475-5688
• Patricia Thomas, RN
• Quality Analyst
• Pthomas_at_armc.org 706-475-5744
• A summary of ideas and actions from the front
  line perspective

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Heart Failure Core Measures

• Ultimate Goal
• We will work together to ensure
• HF patients admitted to ARMC will receive the
  best patient care
• Our Core Measures performance will be in the top
  10 of the nation

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Presentation Outline

• For each Heart Failure (HF) Core Measure
• Barriers
• Actions
• Results

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Heart Failure The Big Picture

• Barrier
• Biggest barrier identifying Heart Failure
  patients while in the hospital
• Only identifying 74 of potential patients
• Why?
• Hidden CHF diagnosis
• Co-morbidities
• History of CHF
• Coding / condition changes

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Heart Failure The Big Picture

• Actions
• Computerized medical record
• Offensive mindset
• Results
• Patient population more accurately identified (
  98)

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Heart Failure The Big Picture

• Barrier
• Second biggest barrier no real time data lag
  time between discharge and coding
• Action
• Concurrent chart review

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Concurrent review tool
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HF 2 Assessment of LVEF

• Barriers
• Lack of Documentation
• Additional diagnostic test for LVEF ordered on
  patient after initial review of Core Measure

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HF 2 Assessment of LVEF

• Actions
• Process developed to pull previous LV function
  tests forward
• Notes left for Physicians on charts when LVEF not
  addressed
• Process developed to look at Core Measures on day
  of discharge

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HF-3 ACEI / ARB Prescribed at Discharge

• Barriers
• Physician documentation
• No contraindications listed
• MDs not used to charting what is NOT done
• Buy-in by physicians was not 100

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HF-3 ACEI / ARB Prescribed at Discharge

• Actions
• Physician Champion
• Process developed to look at Core Measures day of
  discharge
• Developed contraindication reminder stickers that
  are placed in chart
• Collaboration with Health Information Management,
  Care Coordinators, and Heart Failure Support
  Program to have Physician sign sticker

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Reason(s) for No ACEI /ARB usage with LVSDF?
Allergy ? Angioedema ? Cough
? Hypotension ? Hyperkalemia ?
Intolerance ? Moderate Severe AS ?
Renal insufficiency ? Other
_________________________________________________
__________________________________________________
Signature______________________________________
_______(Must be signed by a physician, NP, or
PA)
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HF-3 ACEI / ARB Prescribed at Discharge

• Actions
• Education
• Medical Staff Meetings
• Poster placed in Physician Staff Lounge
• Laminated Pocket Card
• Core Measure graphs put up in Dictation Areas
• Physician Champion educated Physicians
• Information put in Physician Staff Newsletter

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HF 4 Smoking Cessation

• Barriers
• No process for Smoking Cessation Documentation

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HF 4 Smoking Cessation

• Action
• Developed a process
• Started during admission by giving EVERY patient
  smoking cessation information
• Gave nurses a place to document by placing it on
  the Admission Assessment sheet
• Educated on smoking within last year
• Working on putting smoking cessation on discharge
  instruction sheet

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HF 1 Discharge Instructions

• Barriers
• Identifying the patient population
• Inadequate documentation of education by staff
• Currently discharge instructions are not computer
  generated

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HF 1 Discharge Instructions

• Actions
• Redesign of Heart Failure Education Form for more
  complete and accurate discharge instruction
  information
• Built education documentation in computerized
  Medical Record

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HF 1 Discharge Instructions

• Actions
• Incorporated nursing orders to obtain patient
  education, documentation, and consult for Heart
  Failure Support Program
• All identified patients seen by HFSP nurses

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HF 1 Discharge Instructions

• Biggest Barrier to meeting measure
• MEDICATIONS
• Discharge meds not written out by MD
• Transcription errors
• Non-standard tools and formats
• Process is highly variable

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HF 1 Discharge Instructions

• Action
• Built hard stop to discharge process
• Nurses at discharge copy any scripts on chart
• Nurses reconcile meds and call MD if unclear or
  not documented
• When possible TWO nurses reconcile meds together
• Concurrent review allows Directors to be notified
  for staff education purposes
• Physician Champion sent letter to Physicians
  addressing importance of Med Reconciliation

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HF 1 Discharge Instructions

• Action
• Future Working towards an electronic medication
  reconciliation / discharge medication instructions

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Whats worked...

• Start with the basics
• Identify target population
• Build in process for real-time data (concurrent
  review)
• 24 / 7
• Key people
• Set a compelling goal

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Whats worked...

• Standardize good processes
• Clearly specify what you want
• Provide timely feedback
• Data to the right audience
• Dont wait to make it perfect
• Do something!

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Whats worked...

• Maximize efforts through ownership and
  collaboration
• CV Operations Team
• Administration, Service Leaders, Care
  Coordinators, Heart Failure Staff, Quality
  Support Staff, Physician
• Have a Physician Champion
• Educate and inform staff and physicians

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GHA Power Hour Athens Regional Medical Center

• Heart Failure Core Measures
• Tips from the Trenches

June 11, 2008