13 Keeping up the beat: a quality improvement project on heart failure monitoring & management

Abstract

Introduction There have been many cases observed in our cardiology wards and non-cardiology wards where heart failure patients are not having optimum fluid management and uptitrating therapy. One case led a patient to have prolonged hospital stay and outcome was death. Therefore, this project is important to raise awareness. Currently, we only have a basic daily weight chart, which the nurses record the patients weight every morning. The heart failure medications are separately found on the drug chart, and bloods are found on Cyberlab. Plus the heart failure guidelines are found on the European Society of Cardiology website. This shows that it takes a lot of effort and can cause time-consuming problems when accumulating this information together for heart failure monitoring; especially during busy ward round. For effective heart failure monitoring, a new proforma was devised, which consists of daily weight, medications, U and Es with electrolytes, patient heart failure details and admission weight. The guidelines (flow chart) are found at the back. This will be filled in by both nurses and doctors. This effectively improves titrating heart failure medications for better weight loss secondary to fluid overload. Aims and Outcomes To improve inpatient management of Congestive Cardiac Failure. By July 2016 at Queen's Hospital and King George Hospital, we should obtain 50% in: 1. Optimising fluid management (weight loss) 2. Up-titrating therapy to maximum prognostic benefit Methods 2 PDSA (Plan-Do-Study-Act) cycles were completed trust-wide project at BHR Hospitals "Queens" and KGH Coronary Care Units (Figure 1): In PDSA Cycle 1, a two-week based proforma was trialled and compatibility was checked with daily ward round and CCF management. In PDSA Cycle 2, it was changed to a 7 days based proforma with an additional aspect on renal function (figure 2 see below). The new proforma was used, analysed and edited for each PDSA cycle. Patient parameters were derived and confirmed from Solus and Cyberlab. Results There was a significant improvement from the new proforma in heart failure monitoring and management. The results are shown in table 1: There were limitations with unwell patients, especially those who developed AKI secondary to heart failure treatment. With reducing hospital stay, helps reduce costs to the NHS. Conclusions Heart Failure monitoring and management is important to help reduce morbidity and mortality. There was success from QI project by using the new proforma by improving patient care and co-ordinated care. It will be implemented in the trust on other medical wards like Acute Medicine.