Needs/Resource Assessment
Performing an Institutional Assessment of Current Care
One of the first steps in improving care is a thorough survey of your current care environment, order sets, critical pathways and guidelines, care processes central to heart failure care, and a variety of other factors. This section provides a framework for such an assessment. Again, you may wish to focus on selected portions of the assessment at first, but eventually, essentially all these items need to be assessed and improved on in order to achieve optimal care. Note: You might find it helpful to use process mapping when you do your assessment of selected areas of interest. Process Flow Mapping in the Analyze Care Delivery section has more information on and examples of process mapping.
Assessment item 1: Institutional support
- Are buy-in from administration and do you understand how your team fits into the organization’s clinical quality improvement structure? Do you have the resources available for forming a team and supporting its efforts in formulating order sets, protocols, educational programs, and metrics to optimize the care of the inpatient with heart failure?
A team working on an improvement effort this large is doomed to fail without the recognition by hospital administration and medical staff committees of the importance of heart failure care improvement. If you haven’t already done so, review the Institutional Support section will assist you in enrolling the administration in your cause and in defining the medical staff entities your team needs to report to.
Assessment item 2: Presence of a multidisciplinary team to address issues?
- Have you formed a truly multidisciplinary team or steering committee that works on the front lines of health care delivery, as outlined in Build a Team & Team Rules? If not, do so now! You won’t be able to complete the survey without the knowledge of representatives from all disciplines.
Assessment item 3: Institutional support
- What is the dashboard of measures that your institution uses to assess its care of patients with heart failure?
- Is the methodology for acquiring and recording heart failure measures standardized and reliable?
- Are potential gaps in patient care identified in real time or is the process retrospective?
- How are the data communicated to the front line caregivers?
- Are there any concerns about data integrity and accuracy?
Help on data flow, formulating metrics, and presenting data is available in Track Performance.
Assessment item 4: Standardized order sets for heart failure care
- What order sets/protocols for heart failure care and monitoring already exist?
- Do your order sets include evidence based practices such as use of ACEI/ARB and beta blockers?
- Do your order sets include standardized care processes such as monitoring I and O and daily weights?
- Does your order set help to achieve the Heart Failure core measures?
Assessment item 5: Nutritional dietary system
- What is the status of the nutritional/dietary system for patients with heart failure at your institution?
- Is there a routine process ensuring that patients receive sodium restricted diets, even if they are admitted during a time when the meal may not be prepared by the central dietary services? Are strategies for fluid restriction standardized?
Assessment item 6: Inpatient Heart Failure Management
- Who takes care of most of the heart failure patients? Are there different care strategies depending on the type of heart failure identified (systolic dysfunction, diastolic dysfunction etc….)
- How is the care coordinated with cardiology? Are specific aspects of heart failure care always managed by a cardiologist? How is the care coordinated among physicians?
- Are there specific patients that are always cared for by a specific physician group? Are there criteria for this triage decision?
- Is there a daily review process regarding a patient’s heart failure care?
- How well is a patient’s volume status managed? What proportion of patients is discharged at or above their admission weight?
- How is advance care planning integrated into the inpatient management plan?
- How is palliative care integrated into care delivery?
- How are patients evaluated for eligibility for devices such as AICDs or biventricular pacemakers?
- How are issues related to medications and polypharmacy assessed and managed?
Assessment item 7: Transitions in Care
- What is the readmission rate for patients with heart failure?
- What are the most common reasons for readmission?
- What is the relationship between readmission and core measure performance?
- Is the follow-up standardized?
- Are there any programs available for self-management after discharge?
- How is the care coordinated with the follow-up physician? What information is transmitted to the follow-up physician?
Assessment item 8: Educational issues
- Do you have a comprehensive heart failure patient educational process In place?
- Is there a template in place for ordering heart failure self-management education (HFSE) materials for patients?
- Who is responsible for the teaching?
- Do you routinely assess the learner as part of the educational process?
- Do you include information on community resources and further outpatient education if needed
- How is the care coordinated with the follow-up physician? What information is transmitted to the follow-up physician?
Staff education and certification
- Do you have a complete educational program in place for care of the inpatient with heart failure?
- Is it widely available via intra- or Internet access?
- Is it interactive in the form of learner-based modules?
- Are the modules tailored to the nurses? Tailored to physicians and other providers?
- If yours is a teaching institution, is education appropriately targeted at house staff?
- Does your program address institution-specific order sets as well as general principles?
- Is there mandatory participation by key providers?
- Is the educational program case based?
- Is there any method for tracking participation or competence/understanding of the most important concepts?
Pharmacy issues
- Do pharmacists review the use of ACEI/ARB medications and beta- blockers?
- Have formulary issues between the inpatient and outpatient setting been identified and resolved?
- How has medication reconciliation been integrated into HF care
Building and Implementing a Comprehensive Educational Program is designed to assist you in successfully building, implementing, and tracking the results of a comprehensive educational program. Performing an institutional assessment can be daunting at first. Remember, you don’t have to fix or assess everything at once, and prioritizing an area of care is important and can narrow the scope of the initial assessment.
TASK Perform an institutional assessment of your current practice
Download the Institutional Assessment of Current Care Task Sheet
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