Developed Congestive Heart Failure Core Measure Form (see below for content): DOCTORS USE THIS FORM TO BE COMPLIANT WITH JCAHO CORE MEASURES CHF

Doctor please use this section as part of your progress note and/or as a reminder to order the following:

• Left Ventricular Ejection Fraction (LVEF) is less than 40% or the patient has moderate or severe dysfunction (LVSD)
  • Yes
  • No
• If LVEF is unknown:
  • Will assess as an out patient
  • Order Echo this admission
  • Other______________________
• If no aggressive treatment is this patient( circle and order)
  • Palliative Care,
  • Hospice or
  • Comfort Care?
• Doctor please use the below as a reminder to order at Discharge:
  • Write ACE Inhibitor or ARB Rx at Discharge (if EF <40%% or the patient has moderate or severe dysfunction (LVSD)
  • Contraindicated? Why:___________________________
  • Physician Sig ______________________ Date: ______________________
• Discharge instructions: Ordering the following computerized instructions will meet Core Measure Indicators
  • Order Diet
  • Order Weight monitoring and ask nurse to give patient current wt.
  • Order Follow up instructions
  • Order nurse to give a complete list of all medications
  • Order CHF Computerized d/c instructions and it will include:
    • What to do if the patients symptoms worsen.
    • Smoking Cessation Information

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Educated medical staff, nursing and case management on use of the physician forms. Case Mgt places form in the physician progress note section. Purchased a computer software product for discharge instructions. All patients are automatically given instructions according to dx and core measures. Do not need to rely on nursing or physicians to write the instructions. Medical staff approved that these instructions can be given without order. Case Mgt monitors completion of physician forms.

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Physicians are more compliant with documentation because all indicators are listed on form and is easy to use. Case Mgt audit of charts daily.

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Lower 10 percentile to top 25 percentile.

Cost of purchasing computer, printer and software product approximately $5,000. Has helped us improve with discharge instructions for all patients to 90-100%.

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