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------=_NextPart_01C5BAAA.A00117C0 Content-Location: file:///C:/A208EA35/AHAPresentation_0905_files/pres.xml Content-Transfer-Encoding: quoted-printable Content-Type: text/xml; charset="utf-8" ------=_NextPart_01C5BAAA.A00117C0 Content-Location: file:///C:/A208EA35/AHAPresentation_0905_files/slide0057.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="windows-1252" Mercy Cardiovascular Services Cedar Rapids, Iowa ABC’= S of AMI Care
= Premier Quality Improvement Program for Hospitals Multi-Disciplinary Teams
<= b>Get With The Guidelines-CAD
= l
= lTheresa Lyons Flanders, MSPH
= lDirector, Quality Improvement
= lAmerican Heart Association
= lSt. Louis, Missouri
------=_NextPart_01C5BAAA.A00117C0 Content-Location: file:///C:/A208EA35/AHAPresentation_0905_files/master35_image001.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhAgBbAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAEAAQAB AFkAgAAAAAAAAAIIjI+py+0PXwEAOw== ------=_NextPart_01C5BAAA.A00117C0 Content-Location: file:///C:/A208EA35/AHAPresentation_0905_files/master35_image002.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhMABNAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAu AEsAggAAADMAZmaZmczMANjY7AECAwECAwECAwP/CBAc+otB1dy8+FWpK9xWJkZbV1LgKIIha3oq 5qInCcdXTXNviOe8T9D0KxqPyKRyubztfLaLYCqIpZ6+q4JKHc1sjR6PO/Vqv19yOYM+a9UqHXgi J+OGKDb0sWb6/4CBgk90TgB2EIgPA4wDWGIhcHyKAI2NbTVqVVuSlpdumZKHnZ6OoDeio1wQpXNC YYmrsV2LloO3uLl/eKoYfROMd4aUqr+Vtitvopq1yHqhiswKpY7PqMuirWbXspzdx87WUMTE4brn 6Ok4tBPsrMEXjRcE9JPuxZvN8NOeEPT/BKTh60NN3z4AAOkJFFiQXz+ECQNiU9QQnLwHEQfO+qXN l+FFBRmLSTFmMd5HjP/UqVyJ65tDkwdBplSR6qHHgyEzMOxYMaevbDw7RiQgYqfNnglpurR5019S pfneVQMWUyZRlliz3mJqcarVek7BjggazqdPmM6QPoUIcCxZZ0NRrkX7UW3br2IzcOU6l21eEVWP ZfiLUqthXVez9h2x+EfcGGeLPFYx2UhlEZcdR8awWfNMHI0fJAAAOw== ------=_NextPart_01C5BAAA.A00117C0 Content-Location: file:///C:/A208EA35/AHAPresentation_0905_files/slide0089.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="windows-1252" Mercy Cardiovascular Services Cedar Rapids, Iowa ABC’= S of AMI Care


Get With the Guide= lines - CAD
l<= i>” The illusion of adequacy, slain by the reality = of data.”
= l
qGuidelines for primary and secondary prevention of CAD
q
qAHA/ACC target= by 2010: to reduce to mortality rate from heart disease and stroke by 25%
q
q2004: Mandatory reporting of hospital data for CMS of AMI measures; matches the GWTG-CAD measures
l
<= span style=3D'visibility:hidden'>l
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Get With the Guidelines - CAD
l Eligibili= ty:
qAll AMI patients
qMonitors 5 fundamental discharge interventions = ;
q12 consecutive months of a minimum compliance rate= of 85%
Ø
ØABC Hospital compliance rates are as follows:
qSmoking cessation counseling: 100%
qAspirin at discharge:   99%
qBeta blocker at discharge:   99% =
qACE-Inhibitor for EF < 40% at discharge:   98%
qLipid-lowering assessment and medication:   97%
Ø
Ø
l
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= How do Hospitals Receive
National Recognition for GWTG?=
=
=
l
qTEAMWORK INSTEAD OF AUTONOMY: <= /span>
q Assembled multidisciplinary teams for ongoing review of the care of the patient with CAD.
q
qSYSTEMS INSTEAD OF SOLO PRACTICE:
q Ordersets, checklists, etc. used to ensure strict adherence to evidence-based guidelines.
q
qCONTINUOUS IMPROVEMENT INSTEAD OF CONTINUOUS LEARNING:
q Ordersets and checklists continuously updated as new Class I recommendations are published.
q
qPROBLEM SOLVING INSTEAD OF BLAME:
q Continuous monitoring of the processes to ensure th= at the systems in place allow s= taff and physicians to easily follow evidence-based guidelines.
q
qCHANGE INSTEAD OF KNOWLEDGE:
q As the ACC/AHA guidelines are updated and revised, staff and physicians are educated about these changes.
l
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= Breakdowns or Barriers
in Achieving Success
qLack of administrative support <= /div>
qLack of documentation—if it’s not documented, it d= idn’t happen!
qPhysician education
qStaff education
qNo order sets
qUnder utilization of order sets =
qNot knowing the ACC/AHA’s broadened definition of AMI
qNot knowing your hospital’s MI decision limit =
qNot knowing when the clock starts and stops for yo= ur time to treat numbers&= #13;
l
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= ACC-AHA Broadened
Definition of AMI
l<= b> Non ST Elevation MI (NSTEMI):
l
lAT LEAST ONE BIOCHEMICAL INDICATOR:
qTroponin T or I  > the MI decision limit o= n at least one occasion during the first 24 hours aft= er the index clinical event
qABC Hospital uses Troponin I: MI decision limit is > 0.4= 3;
qCK-MB > 2x= the upper limit of normal on one occasion
qTotal CK- 2x = the upper limit of normal
q
lAND ONE OF THE FOLLOWING:
qST segment depressio= n or T wave changes
qIschemic symptoms with or without chest pain that may include:
§unexplained nausea = and vomiting, OR
§persistent shortnes= s of breath, OR
§unexplained weaknes= s, dizziness, lightheadedness, or syncope.
l
l
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Multidisciplinary Team Members
l
qAdministrator, Heart/Lung/Vascular (HLV) Service Line
qCV Research Nurse (GWTG-CAD Coordinator)
qCardiology Medical Director
qNurse Manager, Cardiac-Stroke Center
qDirector of Care Management
qCardiac Outcomes Manager
qManager, CV Labs