Heart Failure Core Measures

1. Heart Failure Core Measures GMEC QI Presentation

2. Congestive Heart Failure • Heart failure accounts for more than 700,000hospitalizations every year. • Heart Failure is associated with high rates of mortality and morbidity.

3. Core Measures • standardized sets of valid, reliable and evidence based measures of care • describe the level of performance with regard to patient outcomes • provide a “comparative” measurement that is standardized and risk adjusted. • Core Measures drive the CMS Quality Initiatives (i.e., pay for performance)

4. CHF Core Measures Team • Multidisciplinary: • Internal Medicine/ Hospital Medicine • Cardiology • Nursing • Pharmacy • Information Technology Services • Medical Records • Performance Improvement • Case Management

5. CHF Core Measures Team • Medicine Program/House Staff Leadership: • Developed a set of “discharge instructions” specific to Congestive Heart Failure (CHF) • Added “smoking cessation” to all d/c instructions • Developed MIS “physician” prompt/reminder for ACEI/ARB inclusion in CHF d/c instruction pathway • Ensure MIS d/c instructions are comprehensive & include CHF “reminders” for patients with CHF as a secondary diagnosis • Consolidated d/c instructions and d/c summaries for patients with 2-5 day length of stay (LOS)

6. Heart Failure Core Measure Set • Discharge Instructions • LVF Assessment • ACEI/ARB for LVSD • Adult Smoking Cessation Advice/Counseling

7. Discharge Instructions • Activity • Diet • Follow-up • Medications • Symptoms Worsening • Weight Monitoring

8. Discharge Instructions

9. Left Ventricular Systolic Function • LVF Assessment (Before arrival, during hospitalization, planned for after discharge)

10. Left Ventricular Systolic Function

11. ACE-I or ARB for LVSD • ACE-I or ARB Prescribed at Discharge • Contraindication to ACE-I or ARB @ Discharge

12. ACE-I or ARB for LVSD

13. Smoking Cessation • Adult Smoking Counseling • Adult Smoking History

14. Smoking Cessation

15. THANK YOU!!!

16. Medication Reconciliation GMEC QI Presentation

17. Medication Reconciliation • Reconciliation is a process of comparing an accurate list of a patient’s “current” medications — including name, dosage, frequency, and route — with those ordered for the patient while under the care of the hospital • Reconciliation involves comparing the patient’s current list of medications against the admission, transfer, and/or discharge medication orders. • Joint Commission National Patient Safety Goal #8

18. Admission Medication Reconciliation • History & Physical is present • History & Physical is “current” version • History & Physical is “Dated” and “Timed” • Medication Inventory is complete • Medication Instructions are provided • Medication was “taken today”

19. History & Physical is present

20. History & Physical is “current” version

21. History & Physical -“Dated” and “Timed”

22. Medication Inventory is complete

23. Medication Instructions are provided

24. Medication was “taken today”

25. Please DO: • DO assure retention within the medical record of patient-provided medication lists by writing “Retain in Permanent Medical Record” across the top of the list. • DOanswer the MIS prompt regarding a patient’s contraindication to ACEI and/or ARB therapy for patients with LV dysfunction for whom you are not prescribing an ACEI or ARB at discharge • DO list the names & doses of all medications the patient will be taking after discharge within the MISdischarge instructions or within any other discharge instructions given to the patient (e.g., Heart Failure Service discharge instruction form).

26. Please DON’T: • DO NOT write “resume home medications” or “resume current medications” or “follow home regimen” on the discharge note, on the discharge instructions, or on the dictated discharge summary. • DO NOT list or mention any discharge medications in a problem list within the dictated discharge summary or discharge progress note. • DO NOT list or mention any discharge medications. Doing so forces a (100%) reconciliation process with the medications on the MIS discharge instructions. A single non-match causes non-compliance (0%).

27. Heart Failure Core Measures & Medication Reconciliation • Keep Up the Good Work! • Pick Up & Follow the Trend! • Let’s Take It to the Next Level!

28. THANK YOU