Discharge
Heart Failure-Specific Discharge Planning ChecklistThis checklist includes a list of elements critical to the transition of the heart failure patient from the inpatient setting. This checklist was inspired by the original SHM Discharge Planning Checklist which focuses on the discharge transition for the aging patient.
Developed by the SHM Heart Failure Initiative Discharge Planning Workgroup (View the project team page for information on the workgroup members).
View the Heart Failure-Specific Discharge Planning Checklist
View the Ideal Discharge for the Elderly Patient: A Hospitalist checklist
Cardiac Discharge Instructions
Cardiac Discharge Instructions (Presbyterian Hospitals, North Carolina)
Title of the Tool: Cardiac Discharge Instructions
Purpose of the Tool:
- To improve education for the cardiac patient at the time of discharge.
- To address all relevant quality indicators.
Submitter: John E Gardella, MD FCCP
Tool Author: Cathy Rabb RRT-RCP Manager - CV Outcomes
Email contact information: jegardella@novanthealth.org
Date Tool Implemented: Late May 2005
Name of Institution:
- Presbyterian Hospital - Charlotte, NC
- Presbyterian Hospital Matthews - Matthews, NC
- Presbyterian Hospital Huntersville - Huntersville, NC
Description of Institution: The Presbyterian Hospital system is a not-for-profit group of community hospitals in western North Carolina affiliated with Novant Health. The main hospital is 500+ beds with the smallest being 50 beds.
Tool Format: Paper-based
Key Advantages Using this Tool: 1. Assures that all necessary information is transmitted to the patient at discharge 2. Addresses all the cardiac CMS quality indicators 3. Received kudos from Joint Commission during their survey
Tips on Using this Tool:
- Place the form on the chart of all patients who might be coded as HF.
- Consider carbons so that the form can be filled out in triplicate - one for the patient, a second for the MD, and a final copy for the chart.
Important Pitfalls:
- There was concern from some physicians and staff that some of the terminology used is too much for patients. Some MDs commented that the form is more "core measure friendly" than "patient friendly."
- The form refers to Presbyterian Hospital resources (e.g. the "Living with Heart Failure" book). Other institutions will therefore need to modify the form.
Resources Used to Develop Tool: HF and AMI Best Practice Teams (includes physicians) as well as a subcommittee of bedside nurses.
HF Discharge Pathway
HF Discharge Pathway (Saint Joseph Mercy Hospital, Ann Arbor, MI)
Title of the Tool: HF Discharge Pathway
Purpose of the Tool: To improve and standardize the HF discharge for patients
Submitter: Lakshmi K. Halasyamani, MD
Tool Author: Lakshmi K. Halasyamani, MD
Email contact information: halasyal@trinity-health.org
Date Tool Implemented: 2004
Name of Institution: Saint Joseph Mercy Hospital, Ann Arbor, MI
Description of Institution: a 487-bed academic community-based tertiary care hospital located in southeast Michigan.
Tool Format: Integrated into our CPOE system
Key Advantages Using this Tool:
- Integrated into our CPOE system
- Standardizes the content of the HF discharge
Tips on Using this Tool: Ensure that it is easily accessible and if possible, you build in alerts to trigger its use.
Important Pitfall: Ensure that it integrates with other aspects of the discharge process so that re-work does not occur or is minimized.
Resources Used to Develop Tool: Institutional IT support, Cardiac care collaborative practice team (has evolved now to a separate HF collaborative practice team), physician and nursing.
Heart Failure Discharge Orders
EMMC Heart Failure Discharge Orders
Purpose of the Tool: Consolidate discharge orders for CHF patients, ensure QI measures me.
Submitter: Tim Capstack, MD
Tool Author: (if not the same as the submitter): EMMC HF Orderset Committee
E-mail contact information: tcapstack@emh.org
Date Tool Implemented: Revised version Jul 2006, initial version 2004
Name of Institution: Eastern Maine Medical Center
Description of Institution: 400-bed community-based regional tertiary referral center
Tool Format (paper-based, computer-based, on handheld etc….): Paper-based, though could easily be adapted to CPOE or interactive Adobe PDF format as we have done with many other ordersets
Key Advantages Using this Tool:
- Everything's in one place!
- Check-and-go convenience.
Tips on Using this Tool:
- Review each field for completeness.
- Use as a template for discussing regimen changes with patients.
Important Pitfalls:
- None
Resources Used to Develop Tool:
- National guidelines
General Medication Calendar
Medication Calendar
Purpose of the Tool: To provide patients with an easy to understand list of medications that includes indications as well as dose, route, frequency and specific timing recommendations.
Submitter and Tool Author: Lindsay M. Arnold, Pharm.D., BCPS
E-mail contact information: Lindsay.arnold@bmc.org
Date Tool Implemented: September 2005
Name of Institution: Boston Medical Center
Description of Institution: 547-bed academic, inner-city medical center
Tool Format (paper-based, computer-based, on handheld etc….): Paper based. Medications & instructions are typed out and provided to patients prior to discharge.
Key Advantages Using this Tool:
- Provides the patient with a list they can bring to a primary care appointment to discuss and update with changes.
- Provides space for additional comments about specific medications, ie take with food, take one hour before meals, etc.
- Provides more specific time options for patients on a more complex medication regimen.
Tips on Using this Tool:
- Should be provided in conjunction with verbal education.
- Should be provided enough time prior to discharge to allow patient to review and have time for questions.
Important Pitfalls:
- May be time intensive as it cannot be linked to current medication list in CPOE system, so all medications are typed out individually.
- Currently limited to English, or the languages of the provider.
Resources Used to Develop Tool: Clinical experience, feedback from patients
Medication Calendar - Around the Clock
Medication Calendar - Around the Clock
Purpose of the Tool: To provide patients with an easy to understand list of medications that includes indications as well as dose, route & frequency.
Submitter and Tool Author: Lindsay M. Arnold, Pharm.D., BCPS
Tool Author (if not the same as the submitter): Gail Burniskie, Pharm.D., BCPS and Lindsay M. Arnold, Pharm.D., BCPS
E-mail contact information: lindsay.arnold@bmc.org
Date Tool Implemented: September 2005
Name of Institution: Boston Medical Center
Description of Institution: 547-bed academic, inner-city medical center
Tool Format (paper-based, computer-based, on handheld etc….): Paper based. Medications & instructions are typed out and provided to patients prior to discharge.
Key Advantages Using this Tool:
- Provides the patient with a centralized medication list that can easily be posted at home, separate from other discharge instructions.
- Provides the patient with a list they can bring to a primary care appointment to discuss and update with changes.
Tips on Using this Tool:
- Should be provided in conjunction with verbal education.
- Should be provided enough time prior to discharge to allow patient to review and have time for questions.
Important Pitfalls:
- May be time intensive as it cannot be linked to current medication list in CPOE system, so all medications are typed out individually.
- Currently limited to English, or the languages of the provider.
Resources Used to Develop Tool: Clinical experience, feedback from patients
Medication Calendar-As Needed Medications
Medication Calendar - As Needed Medications
Purpose of the Tool: To provide patients with an easy to understand list of medications that includes indications as well as dose, route & frequency.
Submitter and Tool Author: Lindsay M. Arnold, Pharm.D., BCPS
Tool Author (if not the same as the submitter): Gail Burniskie, Pharm.D., BCPS and Lindsay M. Arnold, Pharm.D., BCPS
E-mail contact information: lindsay.arnold@bmc.org
Date Tool Implemented: September 2005
Name of Institution: Boston Medical Center
Description of Institution: 547-bed academic, inner-city medical center
Tool Format (paper-based, computer-based, on handheld etc….): Paper based. Medications & instructions are typed out and provided to patients prior to discharge.
Key Advantages Using this Tool:
- Provides the patient with a centralized medication list that can easily be posted at home, separate from other discharge instructions.
- Provides the patient with a list they can bring to a primary care appointment to discuss and update with changes.
Tips on Using this Tool:
- Should be provided in conjunction with verbal education.
- Should be provided enough time prior to discharge to allow patient to review and have time for questions.
Important Pitfalls:
- May be time intensive as it cannot be linked to current medication list in CPOE system, so all medications are typed out individually.
- Currently limited to English, or the languages of the provider.
The American Heart Association (AHA) Get with the Guidelines (GWTG)
The AHA GWTG site provides Discharge Orders, Discharge Instructions, Post Discharge Medication Tools via the GWTG site.
View the Discharge Pathways via the AHA GWTG site
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