Acute Myocardial Infarction (Heart Attack)

Each year, more than a million Americans have an acute myocardial infarction – a heart attack. A heart attack is an injury to the heart muscle resulting from a loss of blood supply. It usually occurs when a clot blocks the flow of blood through an artery that supplies blood to the heart itself. A heart attack can damage part of the heart, leading to heart failure. However, appropriate treatment of a patient with symptoms of a heart attack can prevent or lessen damage.

Aspirin at arrival – For patients having a heart attack, early treatment with aspirin can dissolve blood clots to  reduce the amount of damage to the heart.

Aspirin at discharge – Long-term use of aspirin after a heart attack can significantly reduce the chance of another heart attack, stroke, or death.

Beta-blocker medication at arrival – Beta-blocker medications can relieve high blood pressure, and help prevent a future heart attack. Beta-blocker medications given to patients during the initial hours of a heart attack can lessen the severity of the heart attack.

Beta-blocker medication prescribed at discharge – Beta-blocker medications are used to treat high blood pressure, to relieve chest pain and can help prevent a future heart attack. For those who have had a heart attack, beta-blocker medications are associated with a lower risk of long-term heart disease and death.

ACE inhibitor or ARB medication for left ventricular systolic dysfunction (LVSD) – Left ventricular systolic dysfunction (LVSD) occurs when the left ventricle, or chamber of the heart, pumps less blood than it should. If a patient has a heart attack and his or her left ventricle is not working properly, angiotension-converting enzyme inhibitors (ACE) or angiotension receptor blocker (ARB) medications make it easier for the heart to pump.

Smoking Cessation Counseling -- Smoking contributes to complications associated with a heart attack. Patients who are given advice on how to quit smoking by their health care provider during a hospitalization are more likely to stop smoking. Quitting smoking while in the hospital can also help the patient's recovery from a heart attack.

Percutaneous Coronary Intervention (PCI) -- Also known as angioplasty. PCI are procedures to open blocked blood vessel that cause heart attacks. Opening a blocked blood vessel can reduce damage to the heart during a heart attack.

Thrombolytic Medications -- Blood clots can cause heart attacks. Doctors may give this medicine to open a blocked blood vessel in the heart.

Heart Failure

Heart failure is a disorder in which the heart loses its ability to pump blood efficiently. Heart failure is almost always a chronic, long-term condition, although it can sometimes develop suddenly.

Left ventricular function assessment – Assessing the left ventricular function (LVF) of the heart helps evaluate the heart's ability to work efficiently. Without testing the function of the heart, a patient may not receive the care he or she needs to obtain the best function possible.

ACE inhibitor or ARB medication for left ventricular systolic dysfunction (LVSD) - Left ventricular systolic dysfunction (LVSD) occurs when the left ventricle, or chamber of the heart pumps less blood than it should. If a patient has heart failure because his or her left ventricle is not working properly, angiotension-converting enzyme inhibitors (ACE) or angiotension receptor blocking (ARB) inhibitor medications make it easier for the heart to pump.

Smoking Cessation Counseling – Smoking contributes to complications associated with congestive heart failure. Patients who are given advice on how to quit smoking by their health care provider during a hospitalization are more likely to stop smoking. Quitting smoking while in the hospital can also help the patient's recovery.

Discharge Instructions – Educating patients with heart failure and their families is critical to the home care of heart failure. Patients who do not understand and follow instructions from their health care providers are often re-hospitalized. Patients and their families should understand how to take prescribed medications, monitor their weight, exercise regularly and follow a healthy diet. In addition, patients should be seen by their health care provider for a follow-up appointment after they are hospitalized and know what to do if symptoms worsen.

Pneumonia

Pneumonia is a condition caused by a bacterial infection of the respiratory system. Although not all patients that have pneumonia are admitted to the hospital, those with more severe cases or those who have a weakened immune system may require hospitalization so that they can receive antibiotics and other treatments more quickly.

Time to first antibiotic dose – There is growing evidence of an association between timely administration of antibiotics and improved survival for patients admitted to the hospital with pneumonia. Based on these studies, the Infectious Diseases Society of America and the American Thoracic Society suggest that the maximum time to the administration of the first antibiotic should be 8 hours.

Oxygen assessment – Inadequate oxygen in the blood is a common effect of pneumonia and is known to increase the chance of dying. Pneumonia patients should have their oxygen level checked within 24 hours of coming to the hospital. If the oxygen level is low, supplemental oxygen can be given to reduce the chance of dying.

Pneumococcal screening and/or vaccination – Pneumococcal vaccination is indicated for person age 65 and older because it is up to 75% effective in preventing pneumococcal bacteremia (bacteria in the blood) and meningitis (inflammation of the lining of the brain and spinal cord). It is also an important vaccine due to an increase in bacteria that are resistant to antibiotics. Patients that are admitted to the hospital with pneumonia should be asked if they have received a pneumococcal vaccine. If they have not received the vaccine, it should be given to the patient before they leave the hospital.

Smoking Cessation Counseling – Smoking cessation is essential for patients with pneumonia. Patients who are given advice on how to quit smoking by their health care provider during a hospitalization are more likely to quit smoking. Quitting smoking while in the hospital can also help the patient's recovery from pneumonia.

Antibiotics on Admission -- Antibiotics are medicines that treat infection, and each one is different. Hospitals should provide the right antibiotic within 24 hours of admission.

Blood Culture -- A blood culture tells what doctors what type of pneumonia a patient has.  This information helps determine the antibiotics that will work best.

(Excerpt: Some information provided by Collaborative for Healthcare Quality.)

Error Prevention Goals

Over the past few years, hospitals and other health care providers have become more aware of the occurrence of errors in the health care delivery system. In response, they have developed safer processes to prevent the most common causes of error.

Procedure site marking – Marking the surgical site or the site of a procedure with a special marking pen can reduce the chance that an operation or procedure will be done on the wrong site when more than one option is available. For example, procedures that involve the left or right side of the body, or multiple structures like fingers and toes, should be marked prior to the surgery or procedure. When possible, the patient should be involved in marking the site since they know best where the surgery or procedure should occur.

Procedure verification process – Right before the start of a surgery or procedure, the members of the health care team should conduct a final verification process to be sure that they have the right patient, the right equipment, are planning to do the right procedure(s), on the right site(s). In many cases, the patient will not be aware that this is happening since they may already be sedated.

Eliminate dangerous medication abbreviations – Medication errors are frequently hard to detect but can occur for a number of reasons. One known cause of medication errors is the use of abbreviations, acronyms and symbols in medication orders that do not have common meaning, or can be misread by the pharmacist or person administering the medication. To reduce these errors, doctors and other health care professionals have identified the most common errors and are working to eliminate them through a variety of methods. For more information about medication errors, visit the Institute for Safety Medication Practices website at www.ismp.org.

Remove concentrated electrolytes – Concentrated electrolytes are solutions that are packaged in a concentrated form that requires that they be diluted before being given to a patient. Failure to dilute these solutions can lead to dangerous complications or even death. The most commonly used electrolytes are potassium chloride, potassium phosphate and sodium chloride. To prevent these concentrated solutions from being used, they should be removed from patient care area(s). In patient care areas where the concentrated form is required, access to the solution should be strictly controlled.

Medication Reconciliation - Research has shown that differences in the medications a patient is taking before coming to the hospital, and the medications ordered in the hospital can cause harm. The medication reconciliation process makes sure that all of the patient's current medications are reviewed when the patient is admitted to the hospital, is transferred to a different care unit, and is discharged to home or another care facility. Patients can help reduce the risk of this type of error by keeping an accurate list of current medications, and bringing this list to the hospital. This list should include the medication name, dose, when you take the medication and how you take the medication.

Surgical Infection Prevention

Timing of Antibiotics for Surgery: Research has shown that giving an antibiotic within one hour of making a surgical incision reduces surgical site infections.

Right Antibiotic for Surgery: Each surgery exposes the patient to infection caused by different bacteria. Receiving an antibiotic that kills bacteria most common for each surgery will reduce the chances of getting a surgical site infection.

Stopping the Antibiotic: Antibiotics to prevent a surgical site infection should be given to patients that have had surgery for no more than 24 hours after surgery.  Antibiotics given for longer periods of time may increase the risk of the bactiera becoming resistant to antibiotics.