Nursing Care

Biography

Biography: Dr. Cameo Green

Abstract

Among heart failure patients in rural communities, nurse practitioners play an essential role in consulting and working along with other healthcare professionals, such as nurses, nutritionists, therapists, pharmacists, and physicians.  A quality improvement project was developed to ensure that selected core measure sets from the Centers of Medicare and Medicaid Services (CMS) for heart failure management were met in the outpatient setting of a rural family practice in the Southeastern US.  Patients 18 years of age or older with the diagnosis of heart failure were included which is International Classification of Diseases (ICD) version 9 code of 428.0.  A sample of 56 patients was used.  The clinical staff included one physician, two nurse practitioners, and one physician assistant.  The project director analyzed the charts for 1) use of angiotensin converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) medication or document for contraindication and 2) report of left ventricular function (echocardiogram or cardiac catheterization).  The intervention included providing chart prompts to the providers and nursing staff to increase compliance with CMS core measure standards for heart failure management.  The pre-QI audit identified 49 patients or 87.5% of the study population who met the ACEI or ARB medication criteria prior to the intervention.  After the intervention, 54 patients or 96.4% were brought up to compliances.  The pre-QI left ventricular assessments identified 49 patients or 87.5% that already had an echocardiogram or heart catheterization in their chart.  After the post QI audit, 53 patients or 94.6% were brought up to compliance.