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HEART FAILURE

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heart failure team membership cardiology, cardiovascular surgery, medicine, nursing, qrm, cce, medical records project coordinators carmen barc, rn, bsn – PowerPoint PPT presentation

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Title: HEART FAILURE


1
HEART FAILURE
  • TEAM MEMBERSHIP
  • CARDIOLOGY, CARDIOVASCULAR SURGERY, MEDICINE,
    NURSING, QRM, CCE, MEDICAL RECORDS
  • PROJECT COORDINATORS
  • CARMEN BARC, RN, BSN
  • CAROL KEELER, RN, MS

2
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 lt40 or
description of moderate/severe dysfunction)
Smoking cessation counseling Writte
n 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
3
OPPORTUNITY STATEMENT
Concurrent patient care and retrospective chart
review indicated an opportunity for improvement
in process and outcome for each of the measures.
4
Cycle 1
PLAN Implement a Heart Failure Core Measures
program in accordance with JCAHO/CMS guidelines
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
ACT Physician and nursing staff
education Develop HF-specific documentation
forms Decrease data variability
5
Cycle 2
PLAN Capture HF patient population using ICD-9
codes rather than DRG coding Dedicated FTEs for
the Core Measures initiative Revise HF Discharge
Progress Note(DPN) addendum Physician and
nursing staff education
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 Multidisciplina
ry education by in-services and point of service
posters/ information
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
STUDY Improved documentation of D/C
instructions LV assessment documentation peaked
to a level of excellence Decreased data
variability Continuity of required documentation
house-wide needs improvement
6
Cycle 3
PLAN Focus on unit and nurse specific
performance
DO 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
ACT Surgical and non-cardiac unit-specific
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
7
Heart Failure Patients Receiving Left Ventricular
Systolic Function Assessment
106
104
UCL 103.54
102
100
Mean 98
98
Percent
96
94
LCL 92.98
92
90
Apr-04 (n58)
Jul-04 (n58)
Apr-05 (n57)
Jul-05 (n52)
Jan-04 (n55)
Feb-04 (n56)
Mar-04 (n35)
Jun-04 (n47)
Aug-04 (n55)
Sep-04 (n35)
Oct-04 (n57)
Nov-04 (n49)
Dec-04 (n50)
Jan-05 (n69)
Feb-05 (n53)
Mar-05 (n69)
Jun-05 (n52)
Aug-05 (n58)
Sep-05 (n62)
May-04 (n60)
May-05 (n73)
Oct-05 (n56)
Nov-05 (n71)
Jan-06 (n48)
Dec-05 (n76)
Feb-06 (n26)
Month
Preliminary data for quality improvement
purposes only
8
National Hospital Quality Measures
Heart Failure Patients Receiving Complete
Discharge Instructions Prior to Discharge
90
90
UCL 83.62
UCL 83.62
80
80
70
70
Mean 63
Mean 62.97
60
60
Distributed HF Packets to ED
Percent
Percent
and units that treat HF population
50
50
LCL 42.32
LCL 42.32
40
40
Apr-04 (n52)
Jul-04 (n50)
Apr-05 (n52)
Jul-05 (n47)
Apr-04 (n52)
Jul-04 (n50)
Apr-05 (n52)
Jul-05 (n47)
Jan-04 (n43)
Feb-04 (n46)
Mar-04 (n28)
Jun-04 (n41)
Aug-04 (n51)
Sep-04 (n33)
Oct-04 (n51)
Nov-04 (n43)
Dec-04 (n44)
Jan-05 (n61)
Feb-05 (n50)
Mar-05 (n59)
Jun-05 (n46)
Aug-05 (n52)
Sep-05 (n54)
Jan-04 (n43)
Feb-04 (n46)
Mar-04 (n28)
Jun-04 (n41)
Aug-04 (n51)
Sep-04 (n33)
Oct-04 (n51)
Nov-04 (n43)
Dec-04 (n44)
Jan-05 (n61)
Feb-05 (n50)
Mar-05 (n59)
Jun-05 (n46)
Aug-05 (n52)
Sep-05 (n54)
May-04 (n57)
May-05 (n66)
Oct-05 (n49)
Nov-05 (n65)
Jan-06 (n44)
May-04 (n57)
May-05 (n66)
Oct-05 (n49)
Nov-05 (n65)
Jan-06 (n44)
Dec-05 (n70)
Feb-06 (n26)
Dec-05 (n70)
Feb-06 (n26)
Month
Month
Preliminary data for quality improvement
purposes only
Preliminary data for quality improvement
purposes only
9
Heart Failure Patients With Left Ventricular
Systolic Dysfunction Receiving
ACE Inhibitor or ARB Prescription at Discharge
110
UCL 104.88
100
Mean 84
90
80
Percent
70
LCL 63.57
60
Apr-04 (n25)
Jul-04 (n24)
Apr-05 (n30)
Jul-05 (n27)
Jan-04 (n25)
Feb-04 (n24)
Mar-04 (n14)
Jun-04 (n20)
Aug-04 (n22)
Sep-04 (n15)
Oct-04 (n26)
Nov-04 (n24)
Dec-04 (n21)
Jan-05 (n40)
Feb-05 (n35)
Mar-05 (n34)
Jun-05 (n31)
Aug-05 (n32)
Sep-05 (n31)
May-04 (n25)
May-05 (n43)
Oct-05 (n30)
Nov-05 (n47)
Jan-06 (n26)
Dec-05 (n45)
Feb-06 (n13)
Month
Preliminary data for quality improvement
purposes only
10
Smokers Receiving Smoking Cessation Counseling
for Heart Failure Patients
140
120
UCL 117.84
100
Mean 77
80
Percent
60
40
LCL 36.38
20
0
Apr-04 (n9)
Apr-05 (n8)
Jul-05 (n9)
Jan-04 (n7)
Jun-04 (n4)
Aug-04 (n3)
Oct-04 (n4)
Jun-05 (n8)
Aug-05 (n9)
Feb-04 (n7)
Mar-04 (n6)
Jul-04 (n10)
Sep-04 (n4)
Nov-04 (n7)
Jan-06 (n8)
Dec-04 (n10)
Jan-05 (n14)
Feb-05 (n11)
Mar-05 (n10)
Sep-05 (n15)
Feb-06 (n6)
May-04 (n11)
May-05 (n18)
Oct-05 (n15)
Nov-05 (n15)
Dec-05 (n21)
Month
Preliminary data for quality improvement
purposes only
11
Heart Failure Patients With Left Ventricular
Systolic Dysfunction Receiving
ACE Inhibitor or ARB Prescription at Discharge
120
110
100
90
Percent
80
70
Jul-04
Jul-05
Apr-04
Jun-04
Aug-04
Oct-04
Apr-05
Jun-05
Aug-05
Jan-04
Feb-04
Mar-04
May-04
Sep-04
Nov-04
Dec-04
Jan-05
Feb-05
Mar-05
May-05
Sep-05
Oct-05
Nov-05
Dec-05
Jan-06
Feb-06
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
12
Heart Failure Patients Receiving Complete
Discharge Instructions Prior to Discharge
120
110
100
90
80
70
Percent
60
50
40
Jul-04
Jul-05
Apr-04
Jun-04
Aug-04
Oct-04
Apr-05
Jun-05
Aug-05
Jan-04
Feb-04
Mar-04
May-04
Sep-04
Nov-04
Dec-04
Jan-05
Feb-05
Mar-05
May-05
Sep-05
Oct-05
Nov-05
Dec-05
Jan-06
Feb-06
Month
LUHS Discharge Instruction Rate
UHC Academic Hospitals Discharge Instruction Rate
National Discharge Instruction Rate
Preliminary data for quality improvement
purposes only
13
Heart Failure Patients Receiving Left Ventricular
Systolic Function Assessment
120
115
110
105
100
Percent
95
90
85
Jul-04
Jul-05
Apr-04
Jun-04
Aug-04
Oct-04
Apr-05
Jun-05
Aug-05
Jan-04
Feb-04
Mar-04
May-04
Sep-04
Nov-04
Dec-04
Jan-05
Feb-05
Mar-05
May-05
Sep-05
Oct-05
Nov-05
Dec-05
Jan-06
Feb-06
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
14
Smokers Receiving Smoking Cessation Counseling
for Heart Failure Patients
120
110
100
90
80
Percent
70
60
50
Jul-04
Jul-05
Apr-04
Jun-04
Aug-04
Oct-04
Apr-05
Jun-05
Aug-05
Jan-04
Feb-04
Mar-04
May-04
Sep-04
Nov-04
Dec-04
Jan-05
Feb-05
Mar-05
May-05
Sep-05
Oct-05
Nov-05
Dec-05
Jan-06
Feb-06
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
15
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
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