Congestive Heart Failure is one of the Joint Commission Core Measures. Core Measures are a systematic approach through evidence based practice to treating specific disease processes. Although there are seven core measures at the present time, in years to come we will see more quality indicators for specific disease processes. As nurses, the most important thing to remember is that these measures improve the outcomes for our patients, and documentation is the only way to measure our success.
Congestive Heart Failure measures were developed by the Joint Commission in conjunction with the Center of Medicare and Medicaid Services (CMS) and the American Heart Association (AHA). Four measures must be met to be in compliance.
- Left Ventricular Function (LVF): During hospitalization, patients should be assessed for LVF, either by having an Echocardiogram or cardiac catheterization. If this is not done during admission, it needs to be scheduled outpatient.
- Angiotensin-converting enzyme inhibitors (ACEI) for Left Ventricular Systolic Dysfunction (LVSD): Patients with Congestive Heart Failure and LVSD should be placed on an ACEI or Beta Blocker unless contraindicated. If contraindicated, it must be clearly documented in the patient’s medical record.
- Smoking Cessation: Smoking cessation education and counseling must be given to all CHF patients and clearly documented, regardless if the patient has ever smoked. Remember to clearly document in the patient’s medical record all education.
- Discharge Instructions and Medication Reconciliation: Written discharge instructions must be given to all patients with CHF. These instructions must include dietary instructions, exercise level, weight monitoring and discharge medications. All discharge medications must be clearly listed out with dose and schedule and given to the patient. If just one medication is missed on the discharge list the whole core measure is thrown out.
- Pneumonia and Flu Vaccine: Patients that meet the criteria for vaccinations should receive them during their hospital stay. Criteria includes but not limited to 65 years or older; resident of chronic care facility regardless of age; a history of CHF. Although this is not a mandatory measure it has been accepted by most facilities as standard practice.
It does not seem like these standards would be hard to achieve, but many healthcare facilities are struggling with CHF core measures. The number one reason is the medication reconciliation process at discharge. It is important that the nurse look at all areas a physician may write home medications, including the orders, the discharge summary, and the patient’s list of home medications listed on admission. If there is any question, the nurse should call the physician and clarify before the patient is discharged home.
Many facilities have adopted standard orders and clinical pathways to help facilitate in all of the core measures. The future of health care is moving toward pay for performance and the accuracy of the core measures will be at the front of the line.
Tune in next week for article 3 on Community Acquired Pneumonia.
By Colleen Moore
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