Core Measures

Checklists must be incorporated into Gatorounds to assure that the most up-to-date medical treatments are incorporated into our patients’ care. Completion of these checklists are required by Medicare and is a process measure that is used to assess the quality of care.

Sepsis

  • Within the first 3 hours
    • MEWs 5 or greater
    • Measure BP –  MAP <65, or SBP <90 noted 2 times = hypotension
    • Blood cultures drawn before antibiotics given
    • Antibiotics given within 3 hr
    • 30 cc/kg crystalloid IV over 30 min unless EJF < 35 then slower
    • Follow urine output, should be > 0.5cc/kg/hr
    • Serum Lactate > 2  consistent with sepsis
    • Assess volume status (jugular veins, pulse) skin color and capillary refill < 3 sec
  • 6 hour follow up
    • BP, and urine output
    • Repeat Lactate
    • Reassess volume status (jugular veins, when possible ultrasound of vena cava), peripheral pulses, skin color and capillary refill
    • If volume status adequate and hypotension begin vasopressors.

Acute Myocardial Infarction

  • Aspirin at arrival
  • Aspirin at Discharge
  • ACEI or ARB for LVSD (if not given, indicate why)
  • Beta Blocker Prescribed at Discharge
  • Adult Smoking Cessation Advice/Counseling if a smoker             

Heart Failure

  • Evaluation of LVS function (document EF %)
  • Our cardiology service recommends furosemide 2.5 x home dose IV acutely, (spironolactone rather than oral potassium is preferred)
  • ACEI or ARB for LVSD (if not given, indicate why: poor renal fx etc.). Cardiology recommends beta blocker started before discharge
  • Discharge instructions (activity level, reportable signs and symptoms: wt gain, diet, follow-up, home meds need to be reconciled)
  • Make sure ALL discharge meds in dictated discharge summary MATCH meds listed on patient’s discharge instructions!
  • Adult Smoking Cessation Advice/Counseling if a smoker