Multidisciplinary team for enhancing care for patients with acute myocardial infarction or heart failure

Pharmacists' involvement in a disease management program for the improvement of care of patients with acute myocardial infarction (MI) or heart failure (HF) is described.

Beginning in 2002, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) implemented evidence-based measures in several performance areas, including MI and HF. In 2003, a multidisciplinary team consisting of physicians, clinical pharmacists, nurses, cardiac rehabilitation specialists, nutrition specialists, and case managers was established at Allegheny General Hospital. As of January 2004, hospitals were required to select three core measure sets in order to meet JCAHO accreditation requirements. Pharmacists provided medication evaluation and education for patients in an effort to augment adherence with the JCAHO core measures. These services were facilitated by pharmacists' participation in the development of preprinted orders, clinical pathways, patient-evaluation forms, and written educational materials. Patients targeted for intervention were admitted with a principal diagnosis of MI or HF. JCAHO core measure data for MI and HF were presented from first quarter (Q1) fiscal year (FY) 2005 through Q1 FY 2006. For MI, a consistent improvement in performance to 100% was demonstrated for four of the six criteria. For HF, increases were demonstrated for left ventricular (LV) function assessment, angiotensin-converting-enzyme inhibitor for LV systolic dysfunction, and smoking-cessation counseling. Despite documentation issues regarding discharge instructions, results overall compared favorably with the referenced standard.

A multidisciplinary team that included pharmacists improved JCAHO core measures for hospitalized patients with MI or HF.