Paper
Sunday, November 13, 2005
This presentation is part of : Collaborative Research Initiatives
A Team Approach to Incorporating Evidenced-Based Practice in Caring for Patients With Decompensated Congestive Heart Failure
Jan Johnson, MSN and Amanda Hudson, RN, (BC), MSN, CCRN. Nursing Services/6 Main Medical Surgical, Medical Center of Central Georgia, Macon, GA, USA
Learning Objective #1: Discuss each team member's role in enhancing patient care through evidenced-based practices
Learning Objective #2: Identify improvements in patient outcomes attained through the implemenation of standardized order sets

With an estimated 500,000-700,000 new cases of Congestive Heart Failure (CHF) diagnosed annually in the United States, it is crucial for healthcare organizations to focus on the quality of care, containment of cost, and implementation of evidenced based practices in this rapidly growing patient population. The Medical Center of Central Georgia, a 637-bed acute care, not-for-profit organization, has developed an interdisciplinary team strategy for treating patients with CHF. This team approach has not only enhanced inpatient care outcomes, but has also strengthened the continuum of care upon discharge. One portion of the innovative strategy includes a Congestive Heart Failure order set, based on the latest ACC/AHA diagnostic and treatment guidelines. A component of this inpatient order set includes automatic interdisciplinary consults for nutrition services, respiratory care, cardiac rehab, and discharge planning for home health CHF monitoring. Through a pilot of the team approach and order set on two med-surg floors, 76 nurses received bedside consultation from a Clinical Nurse Specialist, in addition to intensive didactic sessions. Through education and a shared governance collaborative model, nurses were educated and empowered to impact crucial quality components including daily weights, the need for Foley catheters, proper medication usage, and education on smoking cessation. Preliminary data of the pilot has shown not only a decrease in length of stay from the national average of 4.28 length of stay days to 3.44 days, but also a variable cost reduction associated with the decrease in length of stay. Two indicators, which continue to be monitored in the ongoing data, are smoking cessation counseling by the RN to the patient and ensuring CHF patients receive disease-related discharge instructions. A daily report prints on each unit indicating patients that have not received smoking cessation counseling. The charge nurse then ensures follow up.