Right Sided Heart Failure: A Case Study

One of the issues with the electronic systems in health care for MU is the ability to retrieve laboratory results during a patient’s visit. In 2013, Hinrichs and Zarcone reveal that over 70% of medical decisions are determined by laboratory results. In 2007, AU Health implemented Cerner Millennium PowerChart that displays clinical data to improve the point of care for patients. With the PowerChart solution, the patient’s information can be easily verified, vital signs can be entered, and family history can be updated. The Affordable Care Act (ACA) signed by President Obama in 2013 places emphasis on expanding insurance coverage of medical care for everyone. As part of the ACA, the improvements in the way these results are exchanged and transmitted will add value to quality, safety, efficiency of health information (Hinrichs & Zarcone, 2013). The transmission and availability of EHR affect how other health professionals send and receive information at the local, state, and national levels.

The U.S. Department of Health and Human Services (HHS) states that in order to realize meaningful use of the EHR technology, healthcare providers are obliged to apply the technology in a approach that enriches quality, safety, and efficiency of healthcare delivery; ebbs healthcare inconsistencies; involves patients and families; enriches care coordination; expands population and public health; and guarantees sufficient privacy and security guards for personal health information. (U.S Department of Health and

M.G., a “frequent flier,” is admitted to the emergency department (ED) with a diagnosis of heart failure (HF). She was discharged from the hospital 10 days ago and comes in today stating, “I just had to come to the hospital today because I can't catch my breath and my legs are as big as tree trunks.” After further questioning, you learn she is strictly following the fluid and salt restriction ordered during her last

Left-sided heart failure is the most common type of heart failure, and it is a result of left-ventricular dysfunction. This disease poses a significant threat to patients because the primary function of the left side of the heart is to provide sufficient oxygenated blood to satisfy the metabolic demands of the body’s cells. Understanding the main function of this portion of the heart will help with the understanding of other complications associated with this diseased. Left-sided heart failure is usually the result of the loss of heart muscle function, specifically in the left ventricle secondary to coronary artery disease, prolonged hypertension, or myocardial infection (Lewis et al. 2014, 766). The

When asked about an NP’s role in health care, the first response I received was, “What don’t I do?”, T. Smith (personal communication, September 4, 2016). Apparently, NP’s do much more than write those late night prescriptions. While talking with my interviewee, I realized just how much more they do. “We have to use our judgement constantly”, T. Smith (personal communication, September 4, 2016). They see new admissions, review patient’s home medications and determine which ones need to be continued, review lab results, and determine any diagnostic studies that need to be performed to further advance a patient’s care.

The success of NPs depends on practicing evidence-based care with competency in assessment, diagnosing, managing patients, and maintaining a caring practice. The nursing component of the NP role continues to be challenged from within nursing, as well as by large national physician organizations. NPs are extensions of nursing practice who are guided by nursing theory. The transformation from nurse to the advanced practice role of NP involves development of advanced knowledge and skills for listening, knowing, being with patients, connecting patients to their communities, promoting health,

Meaningful Use engages patients and families in their health care, improve care coordination, improve population and public health and maintain privacy and security ("CMS," 2015, para. 1). Healthcare providers must show CMS that they are using their EHRs in ways that can positively affect the care of their patients. To do this, providers must meet all of the requirements established by CMS for this program and be able to demonstrate Meaningful Use of their EHRs to receive incentive reimbursement. The Meaningful Use program is divided into 3 stages which span 2011 (data capture and sharing), 2013 (advanced clinical processes) and 2015 (improved outcomes).

AHIMA. "Assessing and Improving EHR Data Quality (Updated)." Journal of AHIMA 86, no.5 (May 2015): 58-64.

All staff directly or indirectly connected to the EHR will be educated in the safe and professional use of patient information. The first group of staff to be trained on the EHR will be “super users” (SU’s). The super users will be the clinicians provided with extensive training on the software program and its safety features. (Simmons 2013. Pg 53). These clinicians will be the mainstay in the building between the staff and the informatics department. Each department in the facility will have 3 super users, 2 full time employees and 1 part time employee to rotate and fill in the gaps ensuring there is never a day without a super user. These individuals will receive 6 months of training comprised of 3 days/week at 5 hrs/day. After this is completed, all staff will be educated including employees, medical staff, contractors, volunteers and students. These training events will be a time to ask for feedback on health information safety and HIPPA laws. The feedback received during training will be used to monitor risks to the facility. (MN DOH, 2014 pg 4). Also we will be “sending compliance reminder emails routinely” (MN DOH, 2014 pg

EHRs can positively influence workplace efficiency and communication and improve productivity with better access to and organization of patient data (McGinn, et al., 2011). EHRs can improve operational efficiency by providing the capability of sharing of information within the practice. Additionally, health information can be shared with external health care organizations provided the proper interoperability infrastructure is in place. Physicians can access patient information anytime and anywhere the system is enabled, enhancing patient safety as well as quality and continuity of care, particularly for physicians on call or working at multiple sites. They also can have access to drug recalls or other alerts provided through the EHR.

HIE face a range of challenges as they try to get hundreds and even thousands of participants in sharing data. Getting data in front of doctors and other clinicians is one of the biggest challenges HIEs face. Ideally, it would be delivered directly to a providers' EMR system, so when a patient goes to an outside lab for blood tests, the results would show up in the electronic record at the doctor's office, and the doctor would be notified that the results are there. However, with limited EMR use across the country, HIEs have had to provide alternative delivery methods. HIE is considered to be one of the key components of the national health IT infrastructure being established by the HITECH Act. Policymakers and health care providers believe this health IT infrastructure will produce a number of benefits, many of which are directly related to HIE.

Nationally, EHRs have become fairly popular and it is essential to realize they are resourceful to health care professionals. Canada Health Infoway INC. continues to help the federal government present EHRs to various health care institutions. The organization only puts funds forward for hospitals and clinics they believe the equipment will be successful in and consider the territorial and provincial standards. Also, Canada Health Infoway INC. plans on creating an authorized agreement for each individual territorial and provincial assignment, and guarantee that they fulfill the requirements.

Diagnosed with Congestive cardiomyopathy implies that the patient’s heart muscle has been debilitated by ailment and cannot sufficiently pump blood through the heart, which can lead to heart failure (“Columbia University Medical Center”, 2016). In this case study, the current situation of a male patient Mr. P., who is 76 years old, and frequently hospitalized with CHF is given. The purpose of this paper is to describe an approach to care with treatment plan recommendation, provide education to both the patient and his family, and a teaching plan.

Through statistical analysis, there were ten AHRQ inpatient quality indicators that are statistically different from that of the reference population. To determine which ones were significant, the reference population was compared to the risk-adjusted confidence interval. Those whose reference population was outside the risk-adjusted confidence interval were deemed as significantly different. These ten indicators are listed below in Table 1.

“An electronic health record (EHR) is a digital version of a patient’s paper chart. EHRs are real-time, patient-centered records that make information available instantly and securely to authorized users.” (healthit.gov) The EHR mandate was created “to share information with other health care providers and organizations – such as laboratories, specialists, medical imaging facilities, pharmacies, emergency facilities, and school and workplace clinics – so they contain information from all clinicians involved in a patient’s care.” ("Providers & Professionals | HealthIT.gov", n.d., p. 1) The process has proved to be quite challenging for providers. As an