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Acute Myocardial Infarction (AMI) JCAHO Core Measure Project

Acute Myocardial Infarction (AMI) JCAHO Core Measure Project. Loyola University Medical Center Team Members: K. McLean MD, M. Morrow MSN, J. Cochran BSN, M. Cosentino MSN, V. Grant BSN MPH, M. Jarotkiewicz, C. Mazzuca MHA RHIA, S. Oglesby BA RHIT CCSP, A. Porter RN PhD, J. Saulters MSN.

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Acute Myocardial Infarction (AMI) JCAHO Core Measure Project

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  1. Acute Myocardial Infarction (AMI)JCAHO Core Measure Project Loyola University Medical Center Team Members: K. McLean MD, M. Morrow MSN, J. Cochran BSN, M. Cosentino MSN, V. Grant BSN MPH, M. Jarotkiewicz, C. Mazzuca MHA RHIA, S. Oglesby BA RHIT CCSP, A. Porter RN PhD, J. Saulters MSN

  2. Opportunity for Improvement • JCAHO established a standard set of core measures based on AHA/ACC Coronary Heart Disease guidelines to examine and improve the care of all AMI patients and they mandated that all hospitals use these measures • LUMC needed to establish a process to • Meet the JCAHO requirements by 7/1/02 • Review results from AMI data collection • Initiate quality improvements as needed • Data collected in CCU during 2002 indicated • 93.7% of AMI patients were given ASA within 24 hours • 85.4% of AMI patients received Beta blockers • 72.5% of AMI patients were given ACE Inhibitors • 59.7% of AMI patients received a lipid-lowering drug

  3. Aspirin within 24 hours before or after arrival Aspirin prescribed at discharge ACE-Inhibitor prescribed at discharge in patients with left ventricular systolic dysfunction (LVSD) Adult smoking cessation advice to all patients who have smoked within the last 12 months Beta blocker prescribed at discharge Beta blocker within 24 hours after arrival Time to thrombolysis in patients with an ST elevation AMI Time to PTCA in patients with an ST elevation AMI Lipid profile drawn within 24 hours of arrival Patients with abnormal lipid profile results with documented plan for lipid management Inpatient mortality JCAHO AMI Core Measures

  4. Most Likely Causes for the Improvement Opportunity • The hospital stay tends to concentrate on acute problems rather than prevention. • The complexity and emergent nature of the care of AMI patients makes it difficult to implement all aspects of the guidelines. • Tools to follow the guidelines, such as standing orders, were not in place. • Care of patients may be transitioned to different teams/units during hospital stay.

  5. Solutions Implemented • Formed AMI Core Measure committee (5/02) • Developed and implemented AMI Discharge Progress Note Addendum (6/02) • Educated cardiology attendings, residents and nursing staff on AMI initiative (6/02) • Began AMI data collection (7/02) • Developed brightly colored sticker for front of chart to designate AMI patients (10/02) • Added representative from ED to AMI committee (12/02)

  6. Solutions Implemented (con’t) • Revised AMI Discharge Progress Note Addendum to include contraindications to meds (1/03) • Established process with Cath Lab to obtain precise wire cross times for PTCA (1/03) • Developed draft of pre-printed unstable angina/non-ST elevation MI physician order set (2/03) • Formed Smoking Cessation Task Force to implement hospital-wide smoking cessation program (4/03)

  7. Acute Myocardial Infarction - Inpatient Mortality JCAHOCore Measure Data 15% 10% Performance Rate 5% 0% CY02 Q3 CY02 Q4 LUMC LUMC LUMC LUMC Obs Exp Obs Exp Rate % Rate % Rate % Rate %

  8. Time to Percutaneous Transluminal Coronary Angioplasty JCAHO Core Measure Data 500 450 400 350 300 Minutes 250 200 150 100 50 - CY02 Q3 CY02 Q4 UHC LUMC LUMC UHC Median Median Median Median

  9. AMI Core Measure - Ace Inhibitor for LVSD 100% 98% 96% 94% 92% 90% Performance Rate 88% 86% 84% 82% 80% CY02 Q3 CY02 Q4 LUMC UHC LUMC UHC Mean Mean Mean Mean

  10. AMI Core Measure - Aspirin 100% 98% 96% 94% 92% Performance Rate 90% 88% 86% 84% 82% 80% CY02 Q3 CY02 Q4 Aspirin Aspirin Aspirin Aspirin Aspirin Aspirin Aspirin Aspirin at at at at at at at at Arrival Arrival Disch Disch Arrival Arrival Disch Disch Lumc UHC Lumc UHC Lumc UHC Lumc UHC

  11. AMI Core Measure - Beta Blocker 100% 98% 96% 94% 92% Performance Rate 90% 88% 86% 84% 82% 80% CY02 Q3 CY02 Q4 Beta Beta Beta Beta Beta Beta Beta Beta Blocker Blocker Blocker Blocker Blocker Blocker Blocker Blocker at at at at at at at at Arrival Arrival Disch Disch Arrival Arrival Disch Disch Lumc UHC Lumc UHC Lumc UHC Lumc UHC

  12. AMI – Smoking Cessation AdviceJCAHO Core Measure Data Percent of Smokers Receiving Advice

  13. Next Steps • Complete implementation of pre-printed unstable angina/non-ST elevation MI orders • Continue with establishing a comprehensive system-wide smoking cessation program • Present findings to physician and nurse groups to promote their participation and obtain their input/suggestions • Develop and implement AMI care pathway, discharge protocol form and patient education materials. • Develop and implement ST elevation MI pre-printed order set

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