CHF paths should be adjusted for severity
CHF paths should be adjusted for severity
Jefferson path includes NYHA classification
Case managers at Thomas Jefferson University Hospital in Philadelphia incorporate severity adjustment into their congestive heart failure (CHF) pathway by adding the New York Heart Association's (NYHA) four-tiered severity classification system. (See Jefferson's CHF critical pathway, inserted in this issue.)
Case manager Kimberly Jungkind, RN, MPH, and her colleagues have made their pathway specific to the point of including pharmaceuticals, target doses, and telephone numbers of specific clinicians, either on the pathway itself or as an attachment.
"We think it's important to allow everyone to know, for example, which ACE inhibitor is on the formulary and what the target dose and starting dose should be," Jungkind says.
She thinks that clinicians are going to see more integrated pathways, so when a patient enters the emergency department, that part of the pathway will be started. "Then the paperwork ideally should follow through with those patients if they get admitted or if they don't." Phone numbers are there so staff know who to call for subacute care or for transfers to home health.
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