Every year, about one million people suffer a heart attack or acute myocardial infarction (AMI). Scientific evidence indicates that the following measures represent the best practices for the treatment of AMI. The goal is to achieve 100% on all measures.
Heart failure is the most common hospital admission diagnosis in patients age 65 or older. Substantial scientific evidence indicates that the following measures represent the best practices for the treatment of heart failure. The goal is to achieve 100% on the measures.
Heart failure patients with documentation in the hospital record that left ventricular function (LVF) was assessed before arrival, during hospitalization, or is planned for after discharge.
Heart failure patients with left ventricular systolic dysfunction (LVSD) and without angiotensin converting enzyme inhibitor (ACE inhibitor) contraindications or angiotensin receptor blocker (ARB) contraindications who are prescribed an ACE inhibitor or an ARB at hospital discharge.
Heart failure patients discharged home with written instructions or educational material given to patient or care giver at discharge or during the hospital stay addressing all of the following: activity level, diet, discharge medications, follow-up appointment, weight monitoring, and what to do if symptoms worsen.
Heart failure patients with a history of smoking cigarettes, who are given smoking cessation advice or counseling during a hospital stay.
Pneumonia is a major contributor to illness and mortality in the United States, causing 4 million episodes of illness and nearly one million hospital admissions each year. Scientific evidence indicates that the following measures represent the best practices for the treatment of community-acquired pneumonia:
Pneumonia inpatients that receive within 6 hours after at the hospital. Evidence shows better outcomes for administration times less than six hours.
Pneumonia inpatients age 65 and older who were screened for pneumococcal vaccine status and were administered the vaccine prior to discharge, if indicated.
Pneumonia inpatients who receive an oxygenation assessment, arterial blood gas (ABG), or pulse oximetry within 24 hours of hospital arrival.
Pneumonia patients whose initial hospital blood culture specimen was collected prior to first hospital dose of antibiotics
Pneumonia patients with a history of smoking cigarettes, who are given smoking cessation advice or counseling during a hospital stay.
Immunocompetent patients with pneumonia who receive an initial antibiotic regimen that is consistent with current guidelines.
Hospitals can reduce the risk of complications after surgery including infection and development of blood clots by providing the right treatment at the right time. Studies show a strong association of reduced incidence of post-operative infection and other complications when following the recommended treatments. The goal is 100% compliance.
Surgical patients who received prophylactic antibiotics within 1 hour prior to surgical incision.
Surgical patients whose prophylactic antibiotics were discontinued within 24 hours after surgery end time.
Percent of surgery patients who were given the right kind of antibiotic to help prevent infection Surgical wound infections can be prevented. Medical research has shown that certain antibiotics work better to prevent wound infections for certain types of surgery. Hospital staff should make sure patients get the antibiotic that works best for their type of surgery.
Percent of all heart surgery patients whose blood sugar (blood glucose) is kept under good control in the days right after surgery Even if heart surgery patients do not have diabetes, keeping their blood sugar under good control after surgery lowers the risk of infection and other problems. "Under good control" means their blood sugar should be 200 mg/dL or less when checked first thing in the morning.
Percent of surgery patients needing hair removed from the surgical area before surgery, who had hair removed using a safer method (electric clippers or hair removal cream - not a razor) Preparing a patient for surgery may include removing body hair from skin in the area where the surgery will be done. Medical research has shown that shaving with a razor can increase the risk of infection. It is safer to use electric clippers or hair removal cream.
Percent of surgery patients whose doctors ordered treatments to prevent blood clots after certain types of surgeries Certain surgeries increase the risk that the patient will develop a blood clot (venous thromboembolism). When patients stay still for a long time after some types of surgery, they are more likely to develop a blood clot in the veins of the legs, thighs, or pelvis. A blood clot slows down the flow of blood, causing swelling, redness, and pain. A blood clot can also break off and travel to other parts of the body. If the blood clot gets into the lung, it is a serious problem that can cause death. To help prevent blood clots from forming after surgery, doctors can order treatments to be used just before or after the surgery. These include blood-thinning medications, elastic support stockings, or mechanical air stockings that help with blood flow in the legs.
Percent of patients who got treatment at the right time (within 24 hours before or after their surgery) to help prevent blood clots after certain types of surgery Many factors influence a surgery patient's risk of developing a blood clot, including the type of surgery. When patients stay still for a long time after some types of surgery, they are more likely to develop a blood clot in the veins of the legs, thighs, or pelvis. A blood clot slows down the flow of blood, causing swelling, redness, and pain. A blood clot can also break off and travel to other parts of the body. If the blood clot gets into the lung, it is a serious problem that can sometimes cause death. Treatments to help prevent blood clots from forming after surgery include blood-thinning medications, elastic support stockings, or mechanical air stockings that help with blood flow in the legs. These treatments need to be started at the right time, which is typically during the period that begins 24 hours before surgery and ends 24 hours after surgery.
Asthma is the most common chronic disease in children and for children, is one of the most frequent reasons for admission to hospitals with approximately 200,000 admissions in the United States each year. Under-treatment and/or inappropriate treatment of asthma are recognized as major contributors to asthma complications and death.
Scientific evidence indicates that the following measures represent the best practices for the treatment and management of asthma in the hospital:
Admission screening for violence risk, substance use, psychological trauma history and patient strengths completed - Professional literature suggests that these factors are under-identified yet integral to current psychiatric status and should be assessed in order to develop appropriate treatment. Similarly, persons admitted to inpatient settings require a careful assessment of risk for violence and the use of seclusion and restraint. Careful assessment of risk is critical to safety and treatment. Effective, individualized treatment relies on assessments that explicitly recognize patients' strengths.
Hours of Physical Restraint and Seclusion Use - Mental health providers that value and respect an individual's autonomy, independence and safety seek to avoid the use of dangerous or restrictive interventions at all times. The use of seclusion and restraint is limited to situations deemed to meet the threshold of imminent danger and when restraint and seclusion are used; such use is rigorously monitored and analyzed to prevent future use.
Patients Discharged on Antipsychotic Medication and Appropriate Justification for More Than Two Medications - Research studies have found that 4-35% of outpatients and 30-50% of inpatients treated with an antipsychotic medication concurrently received 2 or more antipsychotics. Practice guidelines recommend the use of a second antipsychotic only after multiple trials of a single antipsychotic have proven inadequate
Post Discharge Continuing Careplan and Transmission to Next Provider of Care - Patients may not be able to fully report to their next level of care health-care provider their course of hospitalization or discharge treatment recommendations. The aftercare instructions given the patient may not be available to the next level of care provider at the patient's initial intake or follow-up appointment. In order to provide optimum care, next level of care providers need to know details of precipitating events immediately preceding hospital admission, the patient's treatment course during hospitalization, discharge medications and next level of care recommendations.
