JCAHO has four (4) Core Measures of quality for the heart failure inpatient population (which also includes renal failure with volume overload):

• Assessment of LV function -- can be done prior to, during, or after the hospitalization, but the assessment must be mentioned in the chart;
• Prescription of an ACEI or ARB at discharge if LVEF < 40 percent or documentation of contraindication;
• Smoking Cessation education, if patient is a current smoker;
• Discharge Instructions on: activity level, diet, weight monitoring, what to do if symptoms worsen, follow-up appointment and Discharge Medications.

Due to the excellent quality care provided by its physicians, Cedars-Sinai consistently ranks in the JCAHO top 10th percentile for the first three quality indicators listed; and due to the excellent nursing care here, we consistently rank high in providing discharge education on five of the six discharge items listed above. However, we are not yet meeting our target of providing consistently accurate Discharge Medication lists to patients -- a goal that requires close physician and nurse collaboration.

ACCURATE DISCHARGE MEDICATION LISTS
Clinical goal -- provide accurate lists to a patient to avoid medication safety problems;
In-hospital requirement -- complete Discharge Medication List prior to hospital discharge, to be distributed by nursing to patient (approved by MEC);
Dictation requirement -- to be completed within 14 days and to have no more medications (and the same medications) as listed on the Discharge Medication List (JCAHO requirement).

The MEC has approved the requirement of providing matching discharge list and discharge summary medications to patients.

DISCHARGE MEDICATION FORMS ON WEB/VS
The CHF task force has designed a "Discharge Med List" in a form suitable to give to patients To access the form on Web/VS:

1) Select the most recent inpatient medication list;
2) Click the "Discharge Med List" button at the bottom of the page;
3) Print the form and complete it by indicating medications to continue, discontinue, or add;
4) Afterwards, place the form in the chart and notify the patient's nurse. Nurses will make a copy for the patient and provide education on the medications listed;
5) We strongly recommend dictating your discharge summary based on this exact list, when it is in front of you;
6) For convenience, the medication list will be scanned back into Web/VS within 48 hours of discharge and will be available for reference for discharges done prior to the 14-day window.

RESOLVING MEDICATION PROBLEMS
Upon completion of the dictated summary, the patient's discharge medication list will be compared to the dictated medication list. If there are discrepancies, the physician will be contacted by a member of the CHF task force to assist in resolving the inaccuracy.

For more information, please call Dani Hackner, M.D., at (310) 423-4683 or Clement Yang, M.D., at (310) 385-3437.