Core Measures in Nursing: Handling Acute Myocardial Infarction

By Colleen Moore on Fri, Oct 05, 2012

core measures, nursing documentationCore measures in nursing. What are they and why do we need them? Core measures are Joint Commission required measures that were established using evidence based practice. Over time, it demonstrated better patient health care outcomes.

 

The Joint Commission focuses on five core measures, but just like the national patient safety goals, this list will more than likely grow.

 

The five measures that we are focused on right now are Acute Myocardial Infarction (AMI), Congestive Heart Failure (CHF), Community Acquired Pneumonia (CAP), Surgical Infection Prevention (SCIP), Childhood Asthma, Outpatient measures and Pregnancy Related Conditions.

 

Many nursing professionals do not understand the importance these measures have on patient outcomes. Nurses are feeling overwhelmed and this is just another thing they need to think about in their busy day.

 

The requirements of these measurements can be time consuming - an extra phone call to the physician to order the beta block or to stop an antibiotic, documenting patient education on smoking cessation, CHF patient education and documentation and the dreaded accurate Medication Reconciliation at time of discharge, which means it needed to be correct on admission. Yes, it can be overwhelming. Yes, it is extra work for the nurse. Yes, it will save your patient’s life! As nurses, we take an oath to do the right thing, so why do we try and take short cuts?

 

Core nursing is not possible if we will not all work together. Nurses, we need you to be on board with this initiative. These evidenced based practices combine medical care and nursing care to form a plan of care that is best for the patient.

 

Nurses have been demanding for years to be taken seriously as a credible profession. This is where we can have a significant impact on the future of the nursing profession.

 

In this article, let us focus on the Acute MI.  

 

If a patient comes into your hospital, presenting with chest pain symptoms and ruled in as an AMI, he/she must receive the following interventions:

 

  • Administration of aspirin to everyone who does not have a contraindication within the first 24 hours of admission.

    Aspirin must be administered. Documentation of the time given has to be on the chart for the measure to be complete. If aspirin is contraindicated, it must be clearly documented in the patient’s chart.
     
  • Aspirin must be prescribed at discharge if not contraindicated.

    The order must be written and transcribed onto the medication list that is sent home with the patient. If aspirin is contraindicated, it must be clearly documented in the patient’s chart. Patient education on this new medication should be discussed and given to the patient - remember to document all education.
     
  • Beta Blocker administered on admission unless otherwise contraindicated.

    Beta blocker must be given in the first 24 hours of the onset of AMI, or contraindications must be clearly documented in the chart.
     
  • Ejection Fracture less then 40%, the patient should be given an ACE Inhibitor at discharge unless contraindicated.

    If the patient is intolerant, the reason must be clearly documented in the chart. Otherwise, it must be clearly documented in the patient’s chart that an ACE Inhibitor was prescribed. The medication must be listed on the patient’s medication discharge list. Education on this new medication should be discussed and given to the patient - remember to document all education.
     
  • Smoking Cessation Education to all patient’s with AMI.

    All patients that smoke or have smoked should be given specific education on smoking cessation and it must be documented in the chart.

     
  • Beta Blocker must be prescribed for the patient at discharge, unless otherwise contraindicated.
    patient medication, nursing care
    Contraindications must be clearly documented in the chart. Otherwise, a Beta Blocker has to be ordered at discharge and documented on the patient’s discharge medication list. Education on this new medication should be discussed and given to the patient, remember to document all education.
     
  • Time specific documentation of administration of a thrombolytic.

    If appropriate the patient must receive a thrombolytic within 30 minutes of arrival.
     
  • Cardiac Catheterization (PCI) within 90 minutes of arrival.

    Patients with an acute MI have to have a PCI to meet the AMI core measure.
     
  • Statin ordered at discharge to achieve an LDL of less than 100.

    Again, this must be on the patient’s discharge medication list.  Education on this new medication should be discussed and given to the patient - remember to document all education.

There may be some duplication in this article, but it is important that, as part of the core measures we are targeting, patient medications are documented accurately, including home medications, and that any patient education is documented thoroughly. As nurses, you need to take credit for what you do. The only way that happens is through nursing documentation.

With the help of core measures in nursing, errors on patient will be prevented and it can ensure exceptional nursing management.



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