ANGELA ROSS, RN, BSN –PRESTIGE CARE, INC. - …

1 CONGESTIVE HEART FAILURERED-YELLOW-GREENPROTOCOLANGELA ross , RN, bsn prestige care , : Obrien, R, Paima, A & Abaga, N. Congestive Heart Failure Hospital Readmissions: Preventable or Inevitable? A Literary Review, Consultant: Volume 55, Issue 4, April 2015 Approximately 2 million Americans aged 65 and over reside in a long term care facility and suffer from some form of cardiovascular disease (Number will increase with Baby Boomers) Congestive Heart Failure (CHF), accounts for approximately 17% of hospitalizations and more than 250,000 deaths per year According to the CDC, 75% of hospital admissions for CHF are patients that are 65 years and older2 StatisticsRef: Obrien, R, Paima, A & Abaga, N. Congestive Heart Failure Hospital Readmissions: Preventable or Inevitable?

2 A Literary Review, Consultant: Volume 55, Issue 4, April 2015 Between 2000-2006, the rate of SNF facility readmission to the hospital grew by 29% - All Cause By 2006, of all hospital discharges to a SNF returned directly to the hospital in less than 30 days, costing Medicare approximately billion in 1 year All Cause Staggering Numbers, and has gotten a lot of attention!!3 Changes in Health care Payment Centers for Medicare & Medicaid Services (CMS) has imposed financial penalties on hospital systems for readmission rates around CHF (Other diagnoses as well) Financial penalties will also occur for SNF s, along with hits to 5 Star Rating around readmission rates4 How to Manage the Changes imposed by CMSRef: Obrien, R, Paima, A & Abaga, N. Congestive Heart Failure Hospital Readmissions: Preventable or Inevitable?

3 A Literary Review, Consultant: Volume 55, Issue 4, April 2015 Develop evidenced based strategies to reduce hospital readmissions in patients with CHF from the SNF Randomized outcome trials of SNF s with a designated program focused on, and, applied interventions for CHF readmission prevention and reduction have proven to reduce 30 day readmission rates by 20% to 40%5 CHF Zone Management Tool Utilized by Nurse in SNF1. Tool developed to be used while Patient is in the SNF2. Built into our EHR System3. Tool put in place for all Patients with a Diagnosis of CHF4. Everyday:1. Weigh Patient2. Medication Management3. NAS Diet4. Monitor for Swelling, SOB, Chest Discomfort, Difficult Breathing, Dizziness, Coughing, Confusion, General Complaints5.

4 Balance Activities vs. Rest6. Monitor Fluid Intake5. Based on Tool Document and follow the interventions listed, example if weight gain is 3 lbs in 1 week, the nurse would need to contact the Weight Tracking Calendar1. Tool utilized to monitor patient s daily weight 2. Tool also utilized to document what zone patient is in each and every day3. Built into our EHR system7 CHF Zone Management Tool Utilized by Patient at Home1. Tool utilized by patient at home2. Nurse or Therapy provides education of patient/caregiver prior to discharge3. Tool is utilized in the same fashion as prior slide 8 CHF Weight Tracking Calendar Used by Patient at Home1. Patient tracks daily weight and what zone he or she is in based on prior slide2. Education provided at SNF prior to discharge3.

5 Patient to take this to all physician appointments9 prestige Successes Readmission Rates for All Payers/All Diagnoses/All prestige Buildings has gone from: 23% down to 12% CHF was our number 1 reason for return to the hospital when we started tracking this data in 201010