Nursing News:
Kansas heart care providers cooperate on paperwork

by PHYLLIS JACOBS GRIEKSPOOR Cardiac care providers in Wichita, Kansas, soon are all going to be on the same page. At least as far as their paperwork is concerned. The Wichita Citywide Cardiac Collaborative, a nurse-led initiative, has been working since last November to develop standard doctorsı order forms, discharge forms and patient education materials for use at all five of the Wichita hospitals that offer cardiac care. This past may they launched the program they have developed, rolling out uniform paperwork for use at every hospital in town.
The goal is to improve the quality of patient care by making it easier to follow national guidelines. Wesley Medical Center, Via Christi Regional Medical Center, Via Christi Riverside, Kansas Heart Hospital and Galichia Heart Hospital are all represented in the collaborative. Darrell Youngman, a cardiovascular disease specialist with Cardiovascular Consultants of Kansas, said the program demonstrates an unprecedented level of cooperation among institutions. ³As far as I know, Wichita may be the only city in the nation where hospitals in competition with each other are cooperating in an effort like this,² he said.
Specifically, the program provides a checklist to help doctors and nurses make sure that guidelines, including the administration of recommended cardiac drugs such as aspirin, beta blockers and ACE inhibitors, are followed. ³Itıs easy for something to get overlooked in the flurry of activity that is often going on at the time a patient is first admitted,² said Susan Hendrickson, a registered nurse and leader in the collaborative effort. The new procedures will lessen the chances of that happening, she said. Though doctors are encouraged to adhere to the procedures outlined in the forms, there may be reasons to deviate from them.
In that case, the checklist includes a section for doctors to indicate that a guideline was not followed for a specific reason. The extra information could let a nurse know that not ordering a specific medication was deliberate. ³Under the current system, a nurse may notice that the guideline was not followed. But thereıs no way to know if it was an oversight or if there was a specific reason for it. That means the nurse has to track down the doctor and ask,² Hendrickson said. ³This puts everything in writing.²
The Wichita initiative comes at a time when health care providers nationwide are being urged to consistently follow guidelines proven to improve patient outcomes. Wichitaıs program grew out of the Centers for Medicare and Medicaid Services quality initiative, Hendrickson said. Under the initiative, CMS will publish data on its Web site, documenting how well hospitals across the country follow recommended guidelines in caring for patients who have suffered an acute heart attack or are coping with congestive heart failure. Wichita hospitals could have chosen to use CMSı published data as another opportunity to compete, but instead chose to work together. ³We looked at the guidelines for patient care, the evidence that following the guidelines improves patient outcomes and decided that we should make a citywide effort to improve compliance with the guidelines at every hospital,² said Henderickson, who also serves as director of quality assurance at Via Christi. ³Weıve seen improvement in compliance already in the pilot program. We think 100 percent (compliance) across the city is a goal we can achieve.²
Youngman said a collaboration like this would have been harder to do five years ago because many doctors werenıt sure the guidelines made any significant difference. ³Now, there is general agreement that this is the correct treatment,² he said. Using standard paperwork at every hospital in town gives doctors, nurses and other caregivers a common language, said cardiologist Donald Vine, a faculty member at the University of Kansas School of Medicine in Wichita.
³It provides a way to be sure that everybody is saying the same thing,² he said. He said a small donation from pharmaceutical companies has been used to pay for printing patient education materials, but most of the money to launch the program has come from the hospitals. Nancy Miller, a veteran of the nursing profession currently working at the Kansas Heart Hospital, said that in her 29-year career, sheıs never seen clinical nurses, pharmacists, physicians, physicianıs assistants and administrators all on board with a single program. ³This truly is an effort being done for the patients,² she said.
Copyright, The Wichita Eagle, 2004. Reprinted with permission