A new monitoring system for heart failure patients

Introduction

Managing patients with acute and chronic heart failure is complex, requiring clinicians to focus on overall patient well-being, monitor treatment responses, and anticipate complications throughout the care journey. The NICOR/National Heart Failure Audit suggests quality improvements, such as specialist multidisciplinary care and optimal drug therapy at discharge, to reduce one-year mortality following heart failure admissions. This project aimed to enhance these metrics. Currently, our workflow involves a daily weight chart for recording patient weights, the Web-ICE system for retrieving lab results, and Med-chart for prescriptions. Local guidelines for diuretic titration and fluid management are available on the intranet. This fragmented process is cumbersome and time-consuming during ward rounds, as staff must sift through paperwork and access multiple systems. Moreover, treatment responses and investigative trends are not consolidated in a single view. To address this, a new pro forma was introduced, replacing the existing systems and streamlining daily monitoring and record-keeping for the national audit.

Purpose

1. To enhance the monitoring of the daily progress of patients with heart failure in the Cardiology ward.

2. To provide comprehensive information necessary for managing patients with heart failure.

3. To facilitate data collection for the national heart failure audit (NICOR).

Methods

The introduction of the "Heart Failure Pro forma" (see picture 1) and the execution of two cycles of the Plan-Do-Study-Act (PDSA) methodology were undertaken to evaluate service improvements aligned with our objectives. Awareness was raised among junior and senior staff, as well as nurses in the Cardiology ward, to adopt the new monitoring system for all patients admitted with HF diagnosis. After a 10-week implementation period, the services were evaluated through case note reviews, questionnaires, and feedback from key users.

Results

Most superusers reported subjective assessments of the usefulness and effectiveness of patient monitoring. The compliance rate for completing the proforma significantly improved after the intervention and PDSA cycle. However, the sessions on recording BNP results and heart-failure medications were poorly received. Proforma use did not affect the length of hospitalization. This project’s short-term implementation has limitations in the study of record-keeping effectiveness.

Conclusion

A new heart-failure pro forma supplies essential information for monitoring, assessing treatment response, and managing patients admitted to the Cardiology Ward; while compliance still requires improvement, we anticipate it will improve over time, and we plan to introduce an electronic monitoring sheet system in the future.HF Pro formaFor image description, please refer to the figure legend and surrounding text.DataFor image description, please refer to the figure legend and surrounding text.