CHF clinics can impact care in your ED
CHF clinics can impact care in your ED
Over the past few years, growth of congestive heart failure (CHF) clinics has been exponential.
"Only two years ago, there were literally no heart failure centers in Arizona. Now there are eight," says Victoria L. Mugica, RN, BSN, clinical program coordinator for the center for heart failure management at the University of Chicago Hospital. This trend is also occurring throughout the United States, she reports.
If CHF clinic patients who have a relapse and need to be seen in the ED, nurses can access the patient’s complete history. "Flexible diuretic dosing is key to outpatient management and may be all that is needed to manage an exacerbation," says Mugica. "However, there are times patients must be seen in the ED for IV diuretics."
If the patient goes directly to the ED, the entire medical record is on file, including the number of times the patient has been admitted. "The CHF clinic nurses are an important resource for the ED nurses, because they manage a patient through the whole course of treatment," notes Mugica.
Clinics conduct risk profile
When a patient comes to the CHF clinic, a risk profile is completed. "I look at what medications they’re on, the dosages and what they’re using them for, what family supports are available, how much education they’ve had about their condition, and how many times they’ve been admitted," says Mugica. Those factors impact the patients’ ability to follow a program, she explains.
The following are high-risk criteria requiring more frequent follow-up:
• NYHA (New York Heart Association) functional class III or IV;
• history of frequent hospitalizations;
• documented history of medication non-compliance;
• barriers to compliance: poor level of understanding of written or verbal instructions, insufficient home or community support system, inadequate income to obtain medication or transportation, inability to easily access telephone service, and diagnosed psychiatric disorder/depression.
If the patient falls into a high risk category, he or she is called twice a week. "As they become more independent, I gradually wean them off," says Mugica.
If patients don’t fall into the high-risk category, they still receive calls. "Some patients are independent and know to weigh themselves every day, and can call me when there is an issue. Those patients usually get one follow-up call from me," Mugica explains.
The following criteria are assessed over the telephone:
• weight;
• blood pressure;
• heart rate;
• signs and symptoms of left heart failure:
— shortness of breath. At rest? With activity? How much activity?
— dizziness on exertion. After ambulating how far? After ascending how many stairs?
— orthopnea. Can patient lie flat? How many pillows are used?
— cough. Worse when supine? Productive?
• signs and symptoms of right heart failure:
— edema;
— abdominal distention/bloating;
— nausea/vomiting;
— anorexia.
• other cardiac signs and symptoms:
— angina;
— fatigue/weakness;
— lightheadedness/dizziness;
— syncope;
— changes in mental status;
— nocturia (urinating at night).
Every time a patient starts a new medication or changes dosages, he or she is contacted within 72 hours. "The last thing I’d want is for a patient to stop a medication because they feel it’s making them sick," says Mugica. Doses can be readjusted or other medications can be tried if the provider is aware of problems a patient is having with a particular medication, she says.
Patients are given a log sheet to record any changes that are made in their medications. Because medication dosages change so often, this is valuable information for the ED to have, stresses Mugica. "Otherwise, the hospital discharge would be the only list of medications they have, other than the ones they carry in their wallet," she says.
Subscribe Now for Access
You have reached your article limit for the month. We hope you found our articles both enjoyable and insightful. For information on new subscriptions, product trials, alternative billing arrangements or group and site discounts please call 800-688-2421. We look forward to having you as a long-term member of the Relias Media community.