HEART FAILURE CLINICAL PATHWAY



HEART FAILURE CLINICAL PATHWAY

|Date | | | | |

|Day | Admission – Day 1 |Day 2 |Day 3 |Day 4 and Discharge |

| |□ Pt. starting to diurese |□ Weight / edema down |□ Weight / edema down |□ Weight / edema down |

|Expected Outcomes |□ Improved lung sounds |□ Labs within acceptable range |□ Labs within acceptable range |□ Labs within acceptable range |

| |□ O2 sat > 90% |□ Diuresing continues |□ Tolerating increased activity |□ Tolerating increased activity |

| | |□ Resp.status improves |□ Resp.status improves |□ Resp.status improves |

|Nutrition | □ ___Gm Na+ diet |___Gm Na+ diet |___Gm Na+ diet |___Gm Na+ diet |

| |Previous home restrictions |Previous home restrictions |Previous home restrictions |Previous home restrictions |

| | | | | |

|Test / Treatments |Foley needed? |May d/c foley if present and diuresing | | |

| |BMP |decreased | | |

| |BNP | | | |

| |CBC |BMP |BMP |BMP |

| |Dig level if on Dig | | | |

| |HgA1C if diabetes | | | |

| |Lipid Profile |ECHO_____% | |If ECHO not documented this admission why not? |

| |TSH | | | |

| |PT if on Coumadin | | | |

| |CXR | | | |

| |EKG |Accurate I&O documented and weights |Accurate I&O documented and |Accurate I&O documented and weights recorded |

| |ECHO_______% date________ |recorded |weights recorded | |

| |Accurate I&O documented | | | |

|Medications |Saline lock | | |Reconcile discharge medications with physician |

| |ACE Inhibitor / ARB (if not, why not?) | | | |

| |Aldactone | | |Discharged on ACE / ARB? If not, why not? |

| |Anticoagulant – Heparin / Lovenox | | | |

| |Beta Blocker (if not, why not?) | | |Discharged on Beta Blocker? Coreg / Toprol |

| |Bowel protocol | | | |

| |Digoxin po / IV | | | |

| |Lasix IV | | | |

| |KCl | | | |

| |Reconcile home medications with physician | | | |

| | | | | |

| | | | | |

| | | | | |

|Activity |As per physician order: |Progress activity as tolerated |Patient tolerating increased activity? Order| |

| |Bedrest | |PT/OT if needed. | |

| |Up with assistance | | | |

| |BRP | | | |

| |Up ad lib | | | |

|Physicial Assessment |Wt__________ Ht_________ |Wt__________ |Wt__________ |Wt__________ |

| |Nursing assessments |Nursing assessments |Nursing assessments |Nursing assessments |

| |Dig level (if drawn) ____________ |K+_____________ |K+_____________ |K+_____________ |

| |K+_____________ |BUN/CR_______________ |BUN/CR_______________ |BUN/CR_______________ |

| |BUN/CR_______________ |Hgb__________________ |Hgb__________________ |Hgb__________________ |

| |Hgb__________________ |BMP_________________ |Pulse ox______________ |Pulse ox______________arrange home O2 if needed |

| |BNP_________________ |Pulse ox______________ |Telemetry |Telemetry |

| |Pulse ox______________ |Telemetry | | |

|Date: |Telemetry | | | |

| | Admission – Day 1 |Day 2 |Day 3 |Day 4 and Discharge |

| | | | | |

|Patient Education |Orient to patient pathway, unit and routines |Confirm consults have seen patient |Continue to reinforce information: |Patient able to verbalize understanding of the need for: |

| |Assess readiness to learn |Begin reviewing discharge instructions |Need to weigh daily at the same time wearing |Weighing daily at the same time wearing the same amount of |

| |Begin education if appropriate |with patient: |the same amount of clothing |clothing |

| |Initiate other consults if needed: |Need to weigh daily at the same time |Low sodium diet |Low sodium diet |

| |Skin Care |wearing the same amount of clothing |Medications |Medications |

| |Nutrition Services |Low sodium diet |Signs / symptoms when to notify physician |Signs / symptoms when to notify physician |

| |Social Work (assistance with meds, no insurance)|Medications |Need to keep follow-up appointments |Need to keep follow-up appointments |

| |PT/OT if needed |Signs / symptoms when to notify |Activity restrictions |Activity restrictions |

| | |physician | | |

| |CHF discharge orders and instructions are |Need to keep follow-up appointments |Patient to view CHF video or watch the CHF | |

| |appropriately placed in patient’s chart |Activity restrictions |education of the Patient Channel |Patient has viewed CHF education and questions have been |

| | | | |answered. |

| |Smoking Cessation documented (if applicable) |CHF discharge orders and instructions |Smoking Cessation documented (if applicable) | |

| | |are appropriately placed in patient’s | |Smoking Cessation documented (if applicable) |

| | |chart |CHF discharge orders and instructions are | |

| | | |appropriately placed in patient’s chart |CHF discharge orders and instructions are appropriately |

| | | | |placed in patient’s chart |

|Discharge Planning |Patient’s living situation: |Care manager to address discharge needs.|Discharge needs addressed / finalized |Needs addressed / finalized. |

| |Alone | | | |

| |Family | |Home care___________ |Home care / rehab arranged if needed |

| |Current with home care? | | | |

| |SNF / ALF | |Rehab__________ |Transportation arranged |

| | | | | |

| |Plan for transportation home? _______________ | |SNF___________ |Home O2 set up and patient has tank |

| | | | | |

Signature __________________ Signature __________________ Signature __________________ Signature __________________

Signature __________________ Signature __________________ Signature __________________ Signature __________________

Signature __________________ Signature __________________ Signature __________________ Signature __________________

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