Testing a Heart Failure Bundle

1. Testing a Heart Failure Bundle Professor Allan Struthers

3. TESTING THE HEART FAILURE BUNDLE IN NINEWELLS HOSPITAL • Implement a Heart Failure Bundle within ward 4 (1) by end of Nov 2010 • Test and implement a Heart Failure Bundle • The appropriate patients have all elements of the bundle completed with 95% compliance

4. P P P P A A A A D D D D S S S S S S S S D D D D A A A A P P P P A A A A P P P P S S S S D D D D P P P P A A A A D D D D S S S S IMPROVEMENT METHODOLOGY TO TEST AND DEVELOP HEART FAILURE BUNDLE The Bundle Training The Group Spread

5. DRAFT 1 • HEART FAILURE BUNDLE DATA • To Be Filled in by Nurse • 1. Date of Hospital Admission _______________________ • 2. Date of Ward 4 Admission _______________________ • 3. Date of Ward 4 Discharge _______________________ • DVT Prophylaxis YES / NO • To Be Filled in by Doctor • Expert Review by Consultant • / Registrar in Heart Failure YES / NO • Further investigations CONSIDERED / NOT CONSIDERED • Review of current meds DONE / NOT DONE • Use of diuretics CONSIDERED / NOT CONSIDERED • Devices (CRT, ICD) CONSIDERED / NOT CONSIDERED • Advanced therapies • (LVADs, transplant) CONSIDERED / NOT CONSIDERED • Palliative care CONSIDERED / NOT CONSIDERED • 2. Evidence Based Drugs • ACE inhibitors CONSIDERED / NOT CONSIDERED • Beta Blocker CONSIDERED / NOT CONSIDERED • Spironolactone CONSIDERED / NOT CONSIDERED • ARB CONSIDERED / NOT CONSIDERED

7. DRAFT 5 HEART FAILURE BUNDLE Complete this document for all patients admitted with a primary diagnosis of heart failure secondary to LVSD confirmed by echocardiogram To Be Completed by Ward Nurse Date of Hospital Admission : ………….…… Date of Ward Admission: …..…..….…… Date of Ward Discharge : …………..….... DVT Prophylaxis YES / NOElement 1 & 2 To Be Completed by Doctor Element 3 to be completed by a Nurse Element 4 to be completed by Specialist Heart Failure Nurse Affixe Patient Label Patient Name………………… DOB/CHI………………………

8. ELEMENT 1

9. ELEMENT 2

10. ELEMENT 3

11. ELEMENT 4 All elements of bundle have been completedYESNOPlease tick as appropriate

12. Case Notes ECG Echo UE Patient History/exam Drugs Current ones Diuretics BB/ACEI/Spir CRT Palliative Care HF Nurses CCF Ward Round

13. CCF Ward RoundHF Bundle ECG CRT/ICD Echo LVSD UE ACEI/Spir History/exam Diuretics Drugs/current Review of meds BB/ACEI/Spir BB/ACEI/Spir CRT CRT/ICD Palliative care Palliative Care HF Nurses HF Nurse

14. MODEL FOR IMPROVEMENT What are we trying to accomplish? How will we know that a change is an improvement? What changes can we make that will result in an improvement? Act Plan Study Do

16. CHALLENGES • Winter • Roll out to other hospitals

18. Any Questions?