The Development of an Order Set for Adults Admitted for Acute Heart Failure at a National University Hospital in the Philippines.

Q4 Medicine
Acta Medica Philippina Pub Date : 2025-02-28 eCollection Date: 2025-01-01 DOI:10.47895/amp.vi0.8404
John Vincent U Magalong, Felix Eduardo R Punzalan, Marie Kirk Patrich A Maramara, Frederick Berro B Rivera, Zane Oliver O Nelson, Bai Sitti Ameerah B Tago, Cecileen Anne M Tuazon, Ruth Divine D Agustin, Lauren Kay M Evangelista, Michelle Marie Q Pipo, Eugenio B Reyes, John C Añonuevo, Diana R Tamondong-Lachica
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引用次数: 0

Abstract

Background and objectives: Heart Failure (HF) remains a major health concern worldwide. In the Philippine General Hospital (PGH), HF is consistently a top cause of mortality and readmissions among adults. The American College of Cardiology (ACC) and European Society of Cardiology (ESC) published guidelines for interventions that improve quality of life and survival, but they are underused and untested for local acceptability. Hospitals overseas used order sets created from these guidelines, which resulted in a considerable decrease in in-hospital mortality and healthcare costs. We aimed to develop an order set for adult patients with acute heart failure (AHF) admitted to the PGH Emergency Department (ED) to improve care outcomes.

Methods: This study utilized a mixed methods approach to create the AHF order set. ESC and ACC HF guidelines were appraised using the AGREE II tool. Class I interventions for AHF were included in the initial order set. Through focused group discussions (FGD), clinicians and other care team members involved in the management of AHF patients at PGH ED modified and validated the order set. Stakeholders were asked to use online Delphi and FGD to get a consensus on how to amend, approve, and carry out the order given.

Results: Upon review of HF guidelines, 29 recommendations on patient monitoring, initial diagnostic, and therapeutic interventions were adopted in the order set. Orders on subspecialty referrals and ED disposition were introduced. The AHF patient was operationally defined in the setting of PGH ED. The clinical orders fit the PGH context, ensuring evidence-based, cost-effective, and accessible care responsiveness to patients' needs and suitable for local practice. Workflow changes due to COVID-19 were considered. Potential barriers to implementation were identified and addressed. The final order set was adopted for implementation through stakeholder consensus.

Conclusion: The PGH developed and adopted its own AHF order set that is locally applicable and can potentially optimize outcomes of care.

菲律宾一所国立大学医院急性心力衰竭成人住院医嘱的制定
背景和目的:心力衰竭(HF)仍然是世界范围内的一个主要健康问题。在菲律宾总医院(PGH),心衰一直是成人死亡和再入院的首要原因。美国心脏病学会(ACC)和欧洲心脏病学会(ESC)发表了改善生活质量和生存率的干预措施指南,但这些指南没有得到充分利用,也没有经过当地接受度的测试。海外医院使用了根据这些准则创建的订单集,从而大大降低了住院死亡率和医疗费用。我们的目的是为PGH急诊科(ED)收治的急性心力衰竭(AHF)成年患者制定一套订单,以改善护理结果。方法:本研究采用混合方法建立AHF顺序集。使用AGREE II工具对ESC和ACC HF指南进行评估。AHF的第一类干预措施包括在初始顺序集中。通过焦点小组讨论(FGD),临床医生和其他护理团队成员参与了PGH ED AHF患者的管理,修改并验证了顺序集。利益相关者被要求使用在线德尔福和FGD来就如何修改、批准和执行给定的命令达成共识。结果:在审查心衰指南后,29条关于患者监测、初步诊断和治疗干预措施的建议被按顺序采纳。介绍了亚专科转诊和急诊科处置的命令。AHF患者在PGH ED的背景下进行手术定义。临床医嘱符合PGH的背景,确保循证、成本效益、可获得的护理响应患者的需求,并适合当地实践。考虑了COVID-19导致的工作流程变化。确定并解决了实施的潜在障碍。通过利益相关者的共识,采用最终的顺序集进行实施。结论:PGH开发并采用了自己的AHF顺序集,适用于当地,可以潜在地优化护理结果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Acta Medica Philippina
Acta Medica Philippina Medicine-Medicine (all)
CiteScore
0.40
自引率
0.00%
发文量
199
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