CONCLUSION: HF patients self-defined their QOL activities as being independent from physical symptoms or functional limitation associated with their condition. The QOLAS may provide a promising way to evaluate QOL that is related, but distinct, from the established measures. Our findings suggest that information from the QOLAS may be incorporated into counselling programs for HF patients, in order to reinforce motivation to adhere to self-care behaviors such as exercise.BACKGROUND: Variation in administration and monitoring of intravenous loop diuretics in heart failure patients may result in suboptimal quality of care. We implemented the MSH La6 Protocol as a practice innovation that standardized and optimized the efficiency of diuretic administration. It was designed to eliminate delays by consolidating monitoring and delivery of furosemide with the point of care RN. We have previously demonstrated excellent safety and adherence to the MSH La6 Protocol. OBJECTIVES: We tested the overall effect of the MSH La6 Protocol on markers of quality HF care and rational diuretic prescription prior to and after implementation. METHODS: Data was obtained retrospectively on all patients admitted with a primary diagnosis of HF over a 2-year period prior to and then prospectively for 8 months post implementation of the La6 protocol. The post implementation cohort included all HF patients, treated both on and off the La6 protocol, to evaluate the global impact of the practice change at our institution. We examined markers of quality care including timeliness of patient weights; more specifically, recording of at least 2 weights over 48 hours. We also examined for evidence of rational furosemide prescription and adjustment. Run chart analysis was performed for these measures in both groups. RESULTS: There were 348 patients included in the preimplementation control group between a total of 132 patients were included in the postimplementation group of which 38 patients were enrolled in the La6 Protocol. In the control group 42% of patients were weighed at least twice within 48 hours; in the post implementation group that proportion increased to 80%. Within that group, 94% of patients treated with the MSH La6 Protocol were weighed twice. The mean dose of furosemide received in the first 48 hours was 158AE109mg in the preimplementation cohort and 171AE122mg in the post-implementation cohort.
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