Core measures are Joint Commission required measures that were established using evidence based practice, and

over time have demonstrated better patient health care outcomes. The Joint Commission focuses on five core measures, but just like the national patient safety goals, this list will more than likely grow. The five measures that we are focused on right now are Acute Myocardial Infarction (AMI), Congestive Heart Failure (CHF), Community Acquired Pneumonia (CAP), Surgical Infection Prevention (SCIP), Childhood Asthma, Outpatient measures and Pregnancy Related Conditions. Many nurses do not understand the importance these measures have on patient outcomes. Nurses are feeling overwhelmed, and this is just one more thing they need to think about in their busy day. The requirements of these measurements can be time consuming an extra phone call to the physician to order the beta block or to stop an antibiotic, documenting patient education on smoking cessation, CHF patient education and documentation and the dreaded accurate Medication Reconciliation at time of discharge, which means it needed to be correct on admission. Yes, it can be overwhelming, yes, it is extra work for the nurse, YES, it will save your patients life! As nurses, we take an oath to do the right thing, so why do we try and take short cuts? Nurses, we need you to be on board with this initiative. These evidenced based practices combine medical care and nursing care to form a plan of care that is best for the patient. Nurses have been demanding for years to be taken seriously as a credible profession, and this is where we can have a significant impact on the future of the nursing profession. This week let us focus on the Acute MI. If a patient comes into your hospital, presenting with chest pain symptoms and ruled in as an AMI, he/she must receive the following interventions: Administration of aspirin to everyone who does not have a contraindication within the first 24 hours of admission. Aspirin must be administered, and documentation of the time given has to be on the chart for the measure to be complete. If aspirin is contraindicated, it must be clearly documented in the patients chart. Aspirin must be prescribed at discharge if not contraindicated. The order must be written and transcribed onto the medication list that is sent home with the patient. If aspirin is contraindicated, it must be clearly documented in the patients chart. Education on this new medication should be discussed and given to the patient - remember to document all education.

Beta Blocker administered on admission unless otherwise contraindicated. Beta blocker must be given in the first 24 hours of the onset of AMI, or contraindications must be clearly documented in the chart. Ejection Fracture less then 40%, the patient should be given an ACE Inhibitor at discharge unless contraindicated. If the patient is intolerant, the reason must be clearly documented in the chart. Otherwise, it must be clearly documented in the patients chart that an ACE Inhibitor was prescribed. The medication must be listed on the patients medication discharge list. Education on this new medication should be discussed and given to the patient - remember to document all education. Smoking Cessation Education to all patients with AMI. All patients that smoke or have smoked should be given specific education on smoking cessation and it must be documented in the chart. Beta Blocker must be prescribed for the patient at discharge, unless otherwise contraindicated. Contraindications must be clearly documented in the chart. Otherwise, a Beta Blocker has to be ordered at discharge and documented on the patients discharge medication list. Education on this new medication should be discussed and given to the patient, remember to document all education. Time specific documentation of administration of a thrombolytic. If appropriate the patient must receive a thrombolytic within 30 minutes of arrival. Cardiac Catheterization (PCI) within 90 minutes of arrival. Patients with an acute MI have to have a PCI to meet the AMI core measure. Statin ordered at discharge to achieve an LDL of less than 100. Again, this must be on the patients discharge medication list. Education on this new medication should be discussed and given to the patient - remember to document all education.

Congestive Heart Failure is one of the Joint Commission Core Measures. Core Measures are a systematic approach through evidence based practice to treating specific disease processes. Although there are seven core measures at the present time, in years to come we will see more quality indicators for specific disease processes. As nurses, the most important thing to remember is that these measures improve the outcomes for our patients, and documentation is the only way to measure our success.

Congestive Heart Failure measures were developed by the Joint Commission in conjunction with the Center of Medicare and Medicaid Services (CMS) and the American Heart Association (AHA). Four measures must be met to be in compliance. Left Ventricular Function (LVF): During hospitalization, patients should be assessed for LVF, either by having an Echocardiogram or cardiac catheterization. If this is not done during admission, it needs to be scheduled outpatient. Angiotensin-converting enzyme inhibitors (ACEI) for Left Ventricular Systolic Dysfunction (LVSD): Patients with Congestive Heart Failure and LVSD should be placed on an ACEI or Beta Blocker unless contraindicated. If contraindicated, it must be clearly documented in the patients medical record. Smoking Cessation: Smoking cessation education and counseling must be given to all CHF patients and clearly documented, regardless if the patient has ever smoked. Remember to clearly document in the patients medical record all education. Discharge Instructions and Medication Reconciliation: Written discharge instructions must be given to all patients with CHF. These instructions must include dietary instructions, exercise level, weight monitoring and discharge medications. All discharge medications must be clearly listed out with dose and schedule and given to the patient. If just one medication is missed on the discharge list the whole core measure is thrown out. Pneumonia and Flu Vaccine: Patients that meet the criteria for vaccinations should receive them during their hospital stay. Criteria includes but not limited to 65 years or older; resident of chronic care facility regardless of age; a history of CHF. Although this is not a mandatory measure it has been accepted by most facilities as standard practice. It does not seem like these standards would be hard to achieve, but many healthcare facilities are struggling with CHF core measures. The number one reason is the medication reconciliation process at discharge. It is important that the nurse look at all areas a physician may write home medications, including the orders, the discharge summary, and the patients list of home medications listed on admission. If there is any question, the nurse should call the physician and clarify before the patient is discharged home. Many facilities have adopted standard orders and clinical pathways to help facilitate in all of the core measures. The future of health care is moving toward pay for performance and the accuracy of the core measures will be at the front of the line. Community Acquired Pneumonia (CAP) is the third core measure that the Joint Commission recognizes. Pneumonia is the sixth leading cause of death in the United States. Oxygenation Assessment: O2 saturation is a quick and noninvasive

way to measure a patients oxygen level. It should be done in the Emergency Room and clearly documented in the patients record. Blood Cultures: There are many strains of pneumonia, and it is important to find the correct bacteria to treat the pneumonia appropriately. Pneumonia Vaccine: All patients over 65 should be screened for the pneumonia vaccine and documentation should be clear in the medical record. Patients who receive the pneumonia vaccine not only have a significantly lower chance of developing pneumonia, but have a much greater survival rate if they do. Smoking Cessation: Smoking decreases the lungs ability to fight off infection. Smoking cessation and counseling must be done with all pneumonia patients and clearly documented in the patients medical record. Initial Antibiotic within Four Hours: Antibiotics given within the first four hours of admission considerably decrease the risk of death. Appropriate Antibiotic with in 24 hours of Admission: Survival increases when the patient is treated with the proper antibiotic selection. It is important to obtain blood culture results as quickly as possible to ensure proper treatment. Pneumonia that has not been treated effectively can lead to many serious complications. Patients can become septic, go into complete respiratory failure, or develop pleural effusions. All of these complications can lead quickly to death. It is important that the above standards of care are followed when treating community acquired pneumonia because these six simple interventions will save your patients life.