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  • 11/29/2011


    IHI Expedition:

    Effective Implementation of Heart Failure Core


    Peg Bradke, RN, MA, Faculty

    Christine McMullan, MPA, Director

    December 1, 2011

    These presenters have nothing to disclose


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  • 11/29/2011


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    Today’s Agenda • Homework Discussion

    ─ Peg Bradke

    • Improved Care for Patients

    With Heart Failure at

    Stonybrook University

    Medical Center ─ Lisa Sokoloff

    • Questions and Answers

    • Increasing Reliability ─ Chris McMullan

    • Homework for next session


  • 11/29/2011


    Christine McMullan

    Chris McMullan, MPA, is the Director of Continuous Quality Improvement at Stony Brook

    University Medical Center. She served as an

    adjunct faculty member at the Harriman Business

    School and School of Professional Development

    at Stony Brook University. She was Lead Faculty

    on the IHI Early Warning Systems: The Next Level

    of Rapid Response Expedition and a Faculty

    member on the IHI Sepsis Detection and Initial

    Management Expedition. She was a co-faculty

    member of the Hospital Association of New York

    State's 2007 learning collaborative to prevent

    ventilator associated pneumonia. Ms. McMullan

    has held a variety of managerial positions in

    quality improvement and human resources.

    Peg Bradke, RN, MA

    Peg M. Bradke, RN, MA, Director of Heart Care

    Services, St. Luke's Hospital, coordinates services for

    two intensive care units, two step-down telemetry

    units, the Cardiac Catheter Lab, Electrophysiology

    Lab, Diagnostic Cardiology, Interventional/Vascular

    Lab, and Cardiopulmonary Rehabilitation. In her 25-

    year career, she has had various administrative roles

    in critical care areas. Ms. Bradke works with the

    Institute for Healthcare Improvement on the

    Transforming Care at the Bedside initiative and

    Transitions Home work. She is President-Elect of the

    Iowa Organization of Nurse Leaders.

  • 11/29/2011


    Follow up discussion from Nov. 17 Call

    • Concurrent vs Retrospective Chart Audits

    • What has been the most efficient and effective process for your facility?

    • How are you making the process work for you?

    • If you could change how you are presently doing your audit”

    What would it be?

    What would it take to do?

    Improved Care for Patients With Heart


    “…to infinity and beyond”, Buzz Lightyear

    But it feels like forever already!


  • 11/29/2011




    • HF-1 Discharge Instructions

    • HF-2 Evaluation of LVS Function

    • HF-3 ACEI or ARB for LVSD

    • HF-4 Adult Smoking Cessation Advice/Counseling

    HEART FAILURE- Other Considerations


    •Length of Stay


  • 11/29/2011


    HIDE and SEEK! Question: Where are the Heart Failure Patients?

    Answer: Everywhere!


    • we have dedicated Heart

    Failure RNs who screen

    new admits to assist us in

    identification (we still have


    Plan to…

    • Utilize electronic record

    more effectively (problem

    lists; PowerPlans etc.)

    • Link diagnosis and

    PowerPlan to specific lists

    (to notify HF team for

    example) and required


    Discharge Instructions DESCRIPTION:

    • HF patients discharged home with written

    instructions or educational material given

    to patient or caregiver at d/c or during the

    hospital stay. The information must

    address all of the following: activity level,

    diet, discharge medications, follow-up

    appointment, weight monitoring, and what

    to do if symptoms worsen.

    • Non-compliance with diet and medications

    is an important reason for changes in

    clinical status. Health care professionals

    should ensure that patients and their

    families understand their dietary

    restrictions, activity recommendations,

    prescribed medication regimen, and the

    signs and symptoms of worsening heart












    Q3 2010 Q4 2010 Q1 2011 Q2 2011

    Compliance Target

  • 11/29/2011


    Currently… • All adults patients are given a generic

    discharge instruction sheet on admit

    (covers all required elements)

    • Concurrent Review- Heart Failure

    Service Nurse screens new admits to

    identify heart failure patients and follow

    up on completion of the

    education/additional, documentation

    • Zone Guide given at discharge to assist

    with self management and early

    recognition of impending exacerbation

    They are missed when the diagnosis seems

    secondary ; the standard work

    strategies are not employed; hand

    written D/C plan – error prone process

    Plan to… • Electronic Depart Process to facilitate

    medication reconciliation and discharge

    instructions (roll- out imminent)

    • Consider trialing Discharge Contract for

    Cardiac patients

    • Expand Clinical Integration role

    – Enhance communication and early

    f/u with community LIP or HF Clinic

    – Smooth transitions for the patient

    related to various needs including

    medication management

    – Early alternative intervention for

    symptom management and


    Discharge Instructions-

    Discharge Planning

    Starts on Admit:

    This generic tool is given to

    all adult patients on

    Medicine units upon

    admission, to start the

    process of discharge

    planning and satisfy the core


  • 11/29/2011


    Heart Failure

    Specific Discharge


    DISTRIBUTION: White-Medical Record; Yellow-Patient

    What is Congestive Heart Failure (CHF)? CHF means that your heart muscle is weak and can no longer pump blood with enough force to all parts of your body. When this happens, fluid backs up in the lungs and other parts of the body. CHF can make it more difficult for you to do normal daily activities that may have been easy for you in the past. Good control of your disease can improve the quality of your life Please follow the following guidelines: MEDICATIONS

    ♥ Take your medicine as prescribed by your physician(s). It may take many months to feel the effect of these medications.

    ♥ Do not take more than the prescribed dose. ♥ If you miss a dose, take it as soon as you remember, but do not take two doses at the same

    time. ♥ Take your medications at the same time every day. ♥ If you have several physicians, make sure they all know what medications you are taking.

    DIET ♥ Eat a well balanced diet of three meals per day; restricted to 2 grams of sodium per day. ♥ Eat at regular times every day. ♥ Follow fat, salt and other possible restrictions if your physician has told you to do so.

    WEIGHT ♥ Check you weight every day on the same scale with minimal clothing and write it

    down on a calendar. This is because one the symptoms of worsening CHF is fluid

    accumulation, which would cause a gain in weight.


    ♥ Some regular activity is very helpful for your heart. ♥ Do not undertake an exercise program without first speaking to your physician. ♥ Walking is an excellent routine form of exercise, but recognize your limitations. ♥ Take frequent rest periods and pace yourself to conserve energy. ♥ Plan your activities, so you avoid temperature extremes. ♥ If you are too short of breath talk, you need to slow your pace or stop. If you remain short of

    breath after slowing down, you need to call your physician.


    ♥ Get a Pneumonia vaccine shot at least once in your life. ♥ Get a FLU vaccine shot every year in the Fall unless directed otherwise by your physician. ♥ Smoking Cessation advice and counseling have been provided if you smoked cigarettes

    within the last twelve months. Discontinue smoking to maintain or improve heart function.

    CALL YOUR PHYSICIAN IF: ♥ You experience: weight gain of more than 3 pounds in a day (or


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