Download A Novel Method to Reduce Heart Failure Readmissions Objectives

03/27/2014
Objectives
A Novel Method to
Reduce Heart Failure
Readmissions
Rebecca C. Swierz, RPh, PharmD
PGY-1 Pharmacy Resident
Southwest General Health Center
Pharmacist Objectives:
 Explain the basics of the Heart Failure Exacerbation
Rescue Kit
 Discuss workflow for administering a Rescue Kit from
admission to discharge in a hospital system
 Describe the cost‐benefit analysis of a Heart Failure
Exacerbation Rescue Kit
Technician Objectives:
 Explain the preparation of the Heart Failure
Exacerbation Rescue Kit
Kit Basics
Objectives
Medications
Information for Physicians
HEART FAILURE EXACERBATION KIT
Education for Nurses
THE BASICS
Education for Patients
Kit Basics
Objectives
Medications
For MDs
For RNs
For Pts
 Reduce hospital readmission by
early recognition and treatment of
heart failure symptoms
 Dispense to all Heart Failure
patients under the care of SWG
Home Health Care unless
contraindicated
Kit Basics
Objectives
 Loop Diuretic:
– Torsemide 20 mg # 10
Medications
For MDs
For RNs
For Pts
 Thiazide Related Diuretic:
– Metolazone 5 mg # 2
 Electrolyte Supplement(s):
– Potassium Chloride 20 mEq # 6
– Magnesium L-lactate # 6
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Kit Basics
 “Dear Physician” Letter
 How to order the Rescue Kit
 Visual materials
Objectives
Medications
For MDs
– Poster board
– Mock kit
For RNs
 Inform PCP
For Pts
Objectives
Medications
For MDs
For RNs
For Pts
Kit Basics
Objectives
Objectives
Medications
Medications
For MDs
For MDs
For RNs
For RNs
For Pts
For Pts
Objectives
Medications
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 In services
 Educational materials
**Vital to the success of the Kit!**
Objectives
Medications
For MDs
For MDs
For RNs
For RNs
For Pts
For Pts
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Objectives
Objectives
Medications
Medications
For MDs
For MDs
For RNs
For RNs
For Pts
For Pts
Kit Basics
Objectives
Medications
For MDs
For RNs
For Pts
 Patient must be HF SWG HHC
 Discharge counseling required
– Address four main questions
•
•
•
•
WHEN to use it?
WHAT is it for?
WHAT is in it?
HOW much does it cost?
Kit Basics
 Warning Labels on Kit
– Do not open unless
instructed by your
Home Health Nurse or
Physician
– Do not use past
– Not for daily use
– Yellow Zone use only
HEART FAILURE EXACERBATION KIT
WORKFLOW
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Workflow
Workflow
HHC Liaison is
alerted of SWG
HHC patient
Patient is
discharge with
SWG HHC and HF
Kit and closely
monitored by HHC
RN for yellow
zone symptoms
HHC Liaison
contacts HF team
to evaluate patient
for
appropriateness of
Kit
Once Kit is ready, it
is brought to
patient’s floor where
Discharge RPh or HF
team member will
counsel patient
 After hours?
 Weekends?
Kit Rxs are printed
and signed by MD
then faxed to SWG
Community
Pharmacy and filled
by technicians
Workflow
Workflow
HHC Liaison is
alerted of SWG
HHC patient
 HF Exacerbation:
Patient is
discharge with
SWG HHC and HF
Kit and closely
monitored by HHC
RN for yellow
zone symptoms
HHC Liaison
contacts HF team
to evaluate patient
for
appropriateness of
Kit
Once Kit is ready, it
is brought to
patient’s floor where
Discharge RPh or HF
team member will
counsel patient
– Unrelieved shortness of breath
– Worsening edema
• Swelling in the legs, ankles, or abdomen
– Weight gain of 2 pounds in one day or 5
pounds in one week
Kit Rxs are printed
and signed by MD
then faxed to SWG
Community
Pharmacy
Workflow
!
Workflow
Exacerbation Day 1
Exacerbation Day 2 IF NOT RETURNED TO BASELINE
 Loop Diuretic: Torsemide
 Loop Diuretic: Torsemide
– If the patient is taking torsemide as a routine home
med, the regular dose is doubled in the morning
– If the patient is taking furosemide as a routine home
med:
• Furosemide morning dose is replaced with the same mg
dose of torsemide in the morning
• The patient’s normal evening dose of furosemide is still
taken if applicable
– Max torsemide dose is 200 mg PO daily
– Repeat torsemide using exacerbation day 1 dose
 Thiazide Related Diuretic: Metolazone
– Add metolazone 5 mg 30 minutes prior to torsemide
 Electrolyte supplements: KCl, Mg
– Administered if potassium levels < 3.5 mEq/L or
magnesium levels are < 1.7 mEq/L
– Max KCl is 60 mEq per dose
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Workflow
 Exacerbation Day 3
– If weight not back to baseline or weight
increased, refer to emergency department
for review of systems
HEART FAILURE EXACERBATION KIT
COST BENEFIT
Cost Benefit
 Cost of Heart Failure
Readmission
– Considerations:
$$$
• Average LOS: 5.8 days
• Average Cost/Day:
$1200-2000
• Average Medicare
Readmittance: 27% in 30
days
 Cost of Heart Failure
Kit
– Supplies: ~$2/kit
•
•
•
•
Labels
Bags
Bottles
Tamper Tape
– Medications: ~$6/kit
Conclusions
 The Heart Failure Rescue Kit is piloted in a
closely monitored group of patients
 Education to all members of the patient’s care
team is vital for the Rescue Kit’s success
 Dispensing workflow – a work in progress
 Opportunities for decreased readmission rates
and decreased hospital cost are possible with
the Heart Failure Rescue Kit
Bogaev R. Cost Considerations in the Treatment of Heart Failure. Texas Heart Institute Journal. 2010: 37, 557-558
Ross J.S., Chen J., Lin Z., Recent national trends in readmission rates after heart failure hospitalization. Circ Heart Fail. 2010;3:97-103.
Acknowledgements
Stacey Zorska, PharmD
Director of Pharmacy
Southwest General Heath Center
Dave Ferris, PharmD
Residency Program Director
Southwest General Health Center
[email protected]
QUESTIONS?
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References
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Ross J.S., Chen J., Lin Z., Recent national trends in readmission rates after heart failure hospitalization. Circ Heart
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