title: Managing congestive heart failure in long-term care: development of an interdisciplinary protocol.
abstract: Congestive heart failure is common among assisted living and nursing home residents. Nationally recognized guidelines for diagnosis and management have been promulgated but are poorly used in clinical practice. This article describes the efforts of one facility to implement an interdisciplinary protocol to improve heart failure care. The protocol addressed identification of residents with heart failure, appropriate use of ACE inhibitors, weight monitoring, resident and family education, and preventive immunization. Following implementation of the guideline, quality indicators were monitored and process improvements addressed. Diagnostic information, use of ACE inhibitors, nursing assessment, and symptom management improved. While episodes of clinical deterioration occurred, most cases were able to be managed in the long-term care setting.
authors.affiliation: St. John Health System, Warren, Michigan 48092, USA.
authors.forename: Mary
authors.initials: M
authors.lastname: Martinen
authors.forename: Margaret
authors.initials: M
authors.lastname: Freundl
mesh_terms: D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D002985:Clinical Protocols / Q000592:standards*; D003266:Continuity of Patient Care / Q000458:organization & administration; D005851:Geriatric Nursing / Q000458:organization & administration*; D006333:Heart Failure / Q000175:diagnosis / Q000451:nursing / Q000517:prevention & control*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008134:Long-Term Care / Q000458:organization & administration*; D024802:Nurse's Role; D009730:Nursing Assessment; D015403:Nursing Evaluation Research; D009937:Organizational Objectives; D010043:Outcome and Process Assessment, Health Care; D010347:Patient Care Planning / Q000458:organization & administration; D010348:Patient Care Team / Q000458:organization & administration*; D010353:Patient Education as Topic; D017410:Practice Guidelines as Topic; D016730:Program Development; D015397:Program Evaluation; D019984:Quality Indicators, Health Care; D012866:Skilled Nursing Facilities; D014611:Vaccination; D015430:Weight Gain
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors