CHF Team at St. Joseph Hospital, Orange, California

Posted by Julie Smith for Judy Rousch
Pictured above are some of the CHF team

The CMS (which stands for Centers for Medicare and Medicaid Services) Demonstration Project, encourages evidence- based care to patients with these diagnoses:
· Community Acquired Pneumonia (CAP)
· Congestive Heart Failure (CHF)
· Acute Myocardial Infarction (AMI)
· Coronary Artery Bypass Grafts (CABG), and
· Total Joint Replacement (TJR).
Our hospital is required to collect data from patient charts, collated by an outside company, reviewed, and compared to hospitals nationwide. This data is publicly available The current data retrieval required for three of the above diagnosis is:
· One of the current goals of the TJR part of data collection is to ensure that the last dose of antibiotics is administered within 24 hours of the incision “close time”.
· For CAP, the goal is an antibiotic started within 4 hours of arrival, O2 sat or ABG within the first 24 hours of admission, Pneumococcal and Influenza vaccines as appropriate and smoking cessation counseling as appropriate.
· With CHF, the hospital must show that LVF is assessment is documented, detailed discharge instructions are given to the patient and charted. ACE/ARB medication is prescribed for an ejection fraction of <40%, and smoking cessation counseling is begun and charted.
As you can see, this requires a lot of time and effort to ensure these steps are taken both with patient care as well as the actual data retrieval. The team has developed tools for the patient care nurse to use to insure that her patient is receiving these evidence-based recommendations and that the hospital is compliant in providing these services to our patients. For further information or to access help for your patient, contact any member of the 4E/W team, Megan Whalen, the Heart Failure Clinic Nurse Practioner, at extension 8858, Trish Cruz, the Quality Management RN- ext. 8208, or access the Clinical Practice Guidelines for the CHF patient posted in third and fourth floor nursing units, or the CHF Resource Binder. Some of the questions that might come up are:
· What happens when they are confused and disoriented?
· Include family or caregivers
· What if the patient is a DNAR?
· Much of the teaching can be considered palliative care. For example fluid and sodium diet restrictions enable the patient to breathe easier.
· What if they are discharged to a SNF?
· Include the written DC instructions in the envelope to go to the SNF. Sometimes the SNF staff doesn’t know how to care for CHF patients.
· What if the doctor hasn’t ordered an ACEI or ARB for EF<40%
· Call the physician and ask for the medication or the contraindication
· What happens when my patient refuses?
· Document that the patient refuses
· What happens if the doctor doesn’t list the discharge medications and doses?
· Call the physician and ask. If you can’t determine what meds the patient is on, how is the patient supposed to be able to?