175 Quality improvement project: optimising care and fluid balance assesments in patients with heart failure

Aim To promote a high standard of clinical excellence at the Hospital and ensure adherence to the NICE guidelines to encourage optimum patient care for patients presenting with decompensated heart failure. Nice guidelines: 1.2.2 - new suspected acute heart failure, use a single measurement of serum natriuretic peptides [BNP] 1.3.5 - Closely monitor the person's renal function, weight and urine output during diuretic therapy. Method Patient Population from cardiology and AMU wards admissions. Total Sample size: 60 patients in both the cycles individually Selection criteria: Admissions with signs and symptoms of heart failure. Time period: November 1 -30th 2022 Second cycle March 1–30th 2023 Data Collected: Weight on admission Daily weight chart Input/output chart Daily bloods (U &Es) BNP done on admission. Results Tabulated with comparison. Please see the attached file. Intervention Conducted AMU and cardiology department teaching to junior doctors and nurses. A heart failure indicator icon was designed and added to the ward inpatient software system (Bedview) and handover lists. Created posters. Provided laminates at patient's bedside. (laminate at end of abstract) Conclusion Data analysed in first audit, revealed all parameters were below standards as per the NICE guidelines. Consequently, after intervention, the second audit cycle demonstrated improvement. Factors were identified during the fishbone analysis of the quality improvement project. Included patient factors, equipment, and resources, working conditions and education. Emphasis on the significance of recording weight on the last day of admission was also done, on the discharge summaries, which would aid the community heart failure team management. Reference NICE guideline: https://www.nice.org.uk/guidance/cg187/chapter/1-Recommendations Conflict of Interest none