St. Mary’s Health Care System, Inc.

Joint Commission

Disease Specific Certifications– Advanced Primary Stroke (2004)– Heart Failure (2007)– Total Knee Replacement (2008)

St. Mary’s Health Care System, Inc.

• Achieving Excellence in Patient Care

• Presenters:– Darlene Morocco, RN, BSN, NE-BC

• Director, IMCU• Chair, Heart Failure Program

– Dina Hewett, Ph.D., RN, CCRN, NEA-BC• Director, ICU

A Team Approach!

• Senior Leadership

• Staff

• Physicians

• Medical Records

• Quality Department

• Heart Failure Team

Performance Improvement

• Identifying the HF patient with primary and/or secondary diagnosis

• Standardized Order Sets and Pathways

• Core Measure Checklist

• Concurrent Chart Audits

• Daily Reports of Hospital Census

• Discharge Medication Reconciliation

Education

• Staff – Monthly Heart Failure Inservices– Monthly Educational Bulletin Board (HF)– PharmD students (UGA) provide inservices

• Physicians– Attend office staff meetings

• Hospitalists and Cardiologists

Heart FailureACEI or ARB for LVSD at Discharge

HF: ACEI or ARB for LVSD

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100

Sep-09

Oct-09

Nov-09

Dec-09

Jan-10

Feb-10

Mar-10

Apr-10

May-10

Jun-10

Jul-10 Aug-10

Sep-10

Acute Myocardial InfarctionACEI or ARB for LVSD at Discharge

AMI: ACEI or ARB for LVSD

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10

20

30

40

50

60

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80

90

100

Sep-09

Oct-09

Nov-09

Dec-09

Jan-10

Feb-10

Mar-10

Apr-10

May-10

Jun-10

Jul-10

Aug-10

Sep-10

Core Measure ChecklistHeart Failure

Discharge instructions to include (activity level, diet, discharge medications, follow up appointment, daily weight monitoring, what to do if symptoms worsen).

Sign: Date: Time:

ACEI or ARB at discharge for patients with documented EF of < 40%. If ACEI or ARB not prescribed at discharge MD/NP/Pharmacist/PA must document a reason, such as, allergy angioedema, hyperkalemia, hypotension, renal artery stenosis, worsening renal function. Documentation must be tied to reason, for example, No ACEI due to renal artery stenosis.

Discharge

Sign: Date: Time:

Heart Failure Order Set in Use.Sign: Date: Time:

Evaluation of EF (documentation in the chart that ejection fraction was evaluated before arrival, during hospitalization, or is planned for after discharge).

Sign: Date: Time:

Smoking advice or counseling to patients with a history of smokinganytime during the last year.

AdmissionSign: Date: Time:

Measure Measure Met

Discharge instructions to include (activity level, diet, discharge medications, follow up appointment, daily weight monitoring, what to do if symptoms worsen).

Sign: Date: Time:

ACEI or ARB at discharge for patients with documented EF of < 40%. If ACEI or ARB not prescribed at discharge MD/NP/Pharmacist/PA must document a reason, such as, allergy angioedema, hyperkalemia, hypotension, renal artery stenosis, worsening renal function. Documentation must be tied to reason, for example, No ACEI due to renal artery stenosis.

Discharge

Sign: Date: Time:

Heart Failure Order Set in Use.Sign: Date: Time:

Evaluation of EF (documentation in the chart that ejection fraction was evaluated before arrival, during hospitalization, or is planned for after discharge).

Sign: Date: Time:

Smoking advice or counseling to patients with a history of smokinganytime during the last year.

AdmissionSign: Date: Time:

Measure Measure Met

Core Measure Checklist Acute MI

Beta blocker prescribed at discharge. If not prescribed at discharge MD/NP/Pharmacist/PA must document reason, such as, allergy or sensitivity, 2nd or 3rd degree heart block with no pacemaker,

Sign: Date: Time:

ACEI or ARB at discharge for patients with documented LVSD of < 40%. If ACEI or ARB not prescribed at discharge MD/NP/Pharmacist/PA must document a reason, such as, allergy angioedema, hyperkalemia, hypotension, renal artery stenosis, worsening renal function. Documentation must be tied to reason, for example, No ACEI due to renal artery stenosis.

Sign: Date: Time:

ASA prescribed at discharge. If ASA not given a MD/NP/Pharmacist/PA must document reason why, such as, ASA allergy or sensitivity, currently on anticoagulation medication, history of GI bleeding when taking ASA, chronic hepatitis.

DischargeSign: Date: Time:

Smoking advice or counseling to patients with a history of smokinganytime during the last year.

Sign: Date: Time:

90 min PCI door-to-balloon time for patients with ST-segment elevation or LBBB on the ECG.

Sign: Date: Time:

Fibrinolytic therapy received within 30 minutes of hospital arrival for AMI patients with ST-segment elevation or LBBB on ECG.

Sign: Date: Time:

ASA within 24 hours before or after hospital arrival. If ASA not given a MD/NP/Pharmacist/PA must document reason, such as, ASA allergy or sensitivity, currently on anticoagulation medication, history of GI bleeding when taking ASA, chronic hepatitis.

AdmissionSign: Date: Time:

Measure Measure Met

Beta blocker prescribed at discharge. If not prescribed at discharge MD/NP/Pharmacist/PA must document reason, such as, allergy or sensitivity, 2nd or 3rd degree heart block with no pacemaker,

Sign: Date: Time:

ACEI or ARB at discharge for patients with documented LVSD of < 40%. If ACEI or ARB not prescribed at discharge MD/NP/Pharmacist/PA must document a reason, such as, allergy angioedema, hyperkalemia, hypotension, renal artery stenosis, worsening renal function. Documentation must be tied to reason, for example, No ACEI due to renal artery stenosis.

Sign: Date: Time:

ASA prescribed at discharge. If ASA not given a MD/NP/Pharmacist/PA must document reason why, such as, ASA allergy or sensitivity, currently on anticoagulation medication, history of GI bleeding when taking ASA, chronic hepatitis.

DischargeSign: Date: Time:

Smoking advice or counseling to patients with a history of smokinganytime during the last year.

Sign: Date: Time:

90 min PCI door-to-balloon time for patients with ST-segment elevation or LBBB on the ECG.

Sign: Date: Time:

Fibrinolytic therapy received within 30 minutes of hospital arrival for AMI patients with ST-segment elevation or LBBB on ECG.

Sign: Date: Time:

ASA within 24 hours before or after hospital arrival. If ASA not given a MD/NP/Pharmacist/PA must document reason, such as, ASA allergy or sensitivity, currently on anticoagulation medication, history of GI bleeding when taking ASA, chronic hepatitis.

AdmissionSign: Date: Time:

Measure Measure Met

Keys to Success

• Daily monitoring!!

• On-going Education

• Collaboration and Networking