1. Mann, Marion G. MSN, RN, CNS

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The initial purpose of this project was to implement evidence-based best practice guidelines for the outpatient management of a small population of chronic heart failure patients through the administration of Nesiritide infusions. For positive clinical outcomes, the protocol would be based on the most recent clinical trials that produced the best results. During the process, it became evident that the financial implications were a threat to the viability of the program. Thus, the next objective was to implement a strategy to improve financial outcomes.



Medicare, as well as private insurance, continues to scrutinize expensive medical treatments for the management of congestive heart failure. Many times, it is the lower cost treatments that are approved for payment, leaving many patients at a loss for the best care for their condition.



Congestive heart failure is a difficult and expensive disease to manage. Thus, many patients become noncompliant due to the complexity of the management of their disease. Finding a protocol that produces good clinical and financial outcomes is a challenge worth working for.



Through research of the most recent drug trials, a protocol to produce positive clinical outcomes was developed. Further, by analyzing financial data, a management protocol was developed to insure financial stability which improved the viability of the program.



Twelve weeks after the new protocol was implemented, there were positive clinical outcomes to indicate the success of the program. All 6 patients had significant improvement, with 1 being successfully weaned off the treatment. With the new management protocol, compliance for payment guidelines has gone from 0 to 100%.



Through the implementation of evidence-based practice, the Memorial Health University Medical Center has built a solid foundation for a viable congestive heart failure program which is producing positive clinical and financial outcomes.