Tools, tactics of the MI heart failure QI project
Tools, tactics of the MI heart failure QI project
Here is a closer look at the major tools and tactics used in the successful heart failure initiative conducted in and around Flint, MI, and reported on by University of Michigan Health System Researchers:
- Standard orders: Standard orders were written for beta blockers, diuretics, ACE inhibitors and aldosterone antagonists — all of which have been shown to help reduce problems in heart failure patients. Physicians were automatically prompted to prescribe certain drugs to all heart failure patients, except to those with underlying reasons not to take the drugs. "In most cases, for community hospitals that included a pre-printed order, so the PA or physician identifying heart failure pulled the paper out, and it prompted the physician to go line by line to do those things that would enhance patient care," explains Todd Koelling, MD, University of Michigan (Ann Arbor) Cardiovascular Center heart failure expert.
- In-hospital counseling: This included smoking cessation, exercising, limiting salt intake to prevent fluid retention, and other lifestyle steps that have been shown to keep heart failure from worsening or slow its progression. The counseling can be done by one of two groups, says Koelling either by the nurses or doctors on the floor, through written information, or by "smoking teams." "At The University of Michigan, for example, there is a smoking cessation team (These can include nurses or allied health professionals) that is activated when someone is admitted [for heart failure]," he explains. "The team is alerted, they do the intervention and try to continue counseling after discharge." This action can be included in your documentation for the Joint Commission, he adds.
- Discharge contracts: This was a document that patients, doctors, and nurses all had to read, understand, and sign before the patient could go home from the hospital. Heart failure patients can do a lot at home to help their health and prevent another crisis that will send them back to the hospital — but it can be difficult to keep up with all the medications and lifestyle actions.
The discharge contract, which explains the individual at-home plan for each patient, makes doctors and nurses stop to make sure that all prescriptions have been written and educational sessions have been conducted before the patient goes home. It also helps patients get a sense of responsibility for what they must do at home to stay out of the hospital for as long as possible.
Here is a closer look at the major tools and tactics used in the successful heart failure initiative conducted in and around Flint, MI, and reported on by University of Michigan Health System Researchers:Subscribe Now for Access
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