2.50
Hdl Handle:
http://hdl.handle.net/10755/164191
Category:
Abstract
Type:
Presentation
Title:
CNS Led Multi-disciplinary Heart Failure Unit Improves Outcomes
Author(s):
Fischer, Mary
Author Details:
Mary Fischer, MSN, RN, CCRN, St. Vincent Hospital, Indianapolis, Indiana, USA, email: nacnsorg@nacns.org
Abstract:
Purpose: December of 2005, St. Vincent Hospital created a 20-bed Heart Failure Unit dedicated to providing evidence-based care to all patients-a clinical nurse specialist was hired to drive this initiative. Significance: To date, no published studies have evaluated these measures as part of a multi-disciplinary inpatient heart failure unit. Background/Design: Heart failure (HF) affects over five million people in the United States. Its incidence has doubled in the last ten years resulting in 6,500,000 hospital admissions annually. Patients are prone to frequent exacerbations often resulting in readmission. Recent advances in pharmacological and non-pharmacological treatment have improved HF outcomes. In 2005, JCAHO identified core measures essential to treatment (left ventricular dysfunction (LVSD) assessment, ACEI or ARB for LVSD, smoking cessation counseling, discharge instructions for activity level, diet, discharge medications, follow-up appointment, weight monitoring and steps to take for worsening symptoms). Methods: Upon admission to the unit with a pre-printed order set, the patient automatically receives a cardiac rehabilitation consult and is begun on an evidence-based clinical pathway. Daily (M-F) multi-disciplinary patient rounds are conducted under the direction of a Cardiology Clinical Nurse Specialist along with a Case Manager-RN, Cardiac Rehabilitation RN, Pharmacist, Primary Care RN, and Cardiology Clinical Nurse Specialist; the team is joined weekly by a palliative care physician. The focus of rounds includes daily physical assessment of the patient, weight trend, lab results, and current concerns. Core measures are confirmed or addressed; education and activity progress is provided; medications are reviewed; the patient's home situation and need for home health care are evaluated; telehealth in-home monitoring is arranged to monitor selected patients. Patients unable to return home are assisted with placement in a long term assisted care (LTAC), short-term nursing facility (SNF), or hospice (if end-stage). An outpatient HF clinic is available for patient referral. At discharge, the physician's nurse reinforces patient education and arranges outpatient follow-up, and the patient is provided pre-printed discharge instructions. Data on the impact of these interventions was abstracted from hospital medical records. Findings: Results at 3 months into the intervention indicate significant improvement in discharge instructions (72% up to 92%), LVSD assessment (92% to 96%), ACE/ARB use (82% to 92%) and smoking cessation counseling (84% to 100%) compared to the 3 months prior to the intervention. Unit tracking of home health care referrals, outpatient heart failure clinic referrals, physician compliance with admission and discharge summary instructions show a trend toward improvement. Conclusions: Patient specific measures tied to direct patient quality of life and mortality measures improved. Implications for Practice: In summary, a multi-disciplinary disease-specific unit improves patient-specific outcomes as indicated by JCAHO core measures. Further research is needed to evaluate the impact on cost of care and length of stay.
Repository Posting Date:
27-Oct-2011
Date of Publication:
27-Oct-2011
Conference Date:
2007
Conference Name:
CNS Outcomes: Ensuring Safety and Quality
Conference Host:
NACNS - National Association of Clinical Nurse Specialists
Conference Location:
Phoenix, Arizona, USA
Description:
Conference theme: CNS Outcomes: Ensuring Safety and Quality, held February 28-March 1 in Phoenix, Arizona, USA
Note:
This is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.

Full metadata record

DC FieldValue Language
dc.type.categoryAbstracten_US
dc.typePresentationen_GB
dc.titleCNS Led Multi-disciplinary Heart Failure Unit Improves Outcomesen_GB
dc.contributor.authorFischer, Maryen_US
dc.author.detailsMary Fischer, MSN, RN, CCRN, St. Vincent Hospital, Indianapolis, Indiana, USA, email: nacnsorg@nacns.orgen_US
dc.identifier.urihttp://hdl.handle.net/10755/164191-
dc.description.abstractPurpose: December of 2005, St. Vincent Hospital created a 20-bed Heart Failure Unit dedicated to providing evidence-based care to all patients-a clinical nurse specialist was hired to drive this initiative. Significance: To date, no published studies have evaluated these measures as part of a multi-disciplinary inpatient heart failure unit. Background/Design: Heart failure (HF) affects over five million people in the United States. Its incidence has doubled in the last ten years resulting in 6,500,000 hospital admissions annually. Patients are prone to frequent exacerbations often resulting in readmission. Recent advances in pharmacological and non-pharmacological treatment have improved HF outcomes. In 2005, JCAHO identified core measures essential to treatment (left ventricular dysfunction (LVSD) assessment, ACEI or ARB for LVSD, smoking cessation counseling, discharge instructions for activity level, diet, discharge medications, follow-up appointment, weight monitoring and steps to take for worsening symptoms). Methods: Upon admission to the unit with a pre-printed order set, the patient automatically receives a cardiac rehabilitation consult and is begun on an evidence-based clinical pathway. Daily (M-F) multi-disciplinary patient rounds are conducted under the direction of a Cardiology Clinical Nurse Specialist along with a Case Manager-RN, Cardiac Rehabilitation RN, Pharmacist, Primary Care RN, and Cardiology Clinical Nurse Specialist; the team is joined weekly by a palliative care physician. The focus of rounds includes daily physical assessment of the patient, weight trend, lab results, and current concerns. Core measures are confirmed or addressed; education and activity progress is provided; medications are reviewed; the patient's home situation and need for home health care are evaluated; telehealth in-home monitoring is arranged to monitor selected patients. Patients unable to return home are assisted with placement in a long term assisted care (LTAC), short-term nursing facility (SNF), or hospice (if end-stage). An outpatient HF clinic is available for patient referral. At discharge, the physician's nurse reinforces patient education and arranges outpatient follow-up, and the patient is provided pre-printed discharge instructions. Data on the impact of these interventions was abstracted from hospital medical records. Findings: Results at 3 months into the intervention indicate significant improvement in discharge instructions (72% up to 92%), LVSD assessment (92% to 96%), ACE/ARB use (82% to 92%) and smoking cessation counseling (84% to 100%) compared to the 3 months prior to the intervention. Unit tracking of home health care referrals, outpatient heart failure clinic referrals, physician compliance with admission and discharge summary instructions show a trend toward improvement. Conclusions: Patient specific measures tied to direct patient quality of life and mortality measures improved. Implications for Practice: In summary, a multi-disciplinary disease-specific unit improves patient-specific outcomes as indicated by JCAHO core measures. Further research is needed to evaluate the impact on cost of care and length of stay.en_GB
dc.date.available2011-10-27T11:43:44Z-
dc.date.issued2011-10-27en_GB
dc.date.accessioned2011-10-27T11:43:44Z-
dc.conference.date2007en_US
dc.conference.nameCNS Outcomes: Ensuring Safety and Qualityen_US
dc.conference.hostNACNS - National Association of Clinical Nurse Specialistsen_US
dc.conference.locationPhoenix, Arizona, USAen_US
dc.descriptionConference theme: CNS Outcomes: Ensuring Safety and Quality, held February 28-March 1 in Phoenix, Arizona, USAen_US
dc.description.noteThis is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.en_US
All Items in this repository are protected by copyright, with all rights reserved, unless otherwise indicated.