Protocol 4-125 - Chronic Heart Failure Management

CMH EMS & MIH Protocols


Condition GREEN: All Clear Zone... This is the safety zone.
Indications:
  • None of the YELLOW or RED indications are present.
What you can do:
  • Weigh yourself in the morning before breakfast and write your weight down.
  • Track your daily sodium intake.
  • Take your medications as ordered.
  • Follow healthy eating habits: low salt and low sodium foods.
  • Balance activity and rest periods.
  • Monitor for swelling in your feet, ankles, legs, and stomach.
  • Keep all medical appointments.
What your CHW might do:
  • Review health history and PCP care plan prior to visit.
  • Answer any questions and address any concerns you have.
  • Review any discharge instructions from any hospital, emergency room, and/or doctor visits.
  • Review goals from previous visit:__________
  • Assess adherence to care plan, including diet, exercise, medications, and keeping appointments.
  • Review sodium intake log and weight log.
  • Perform a 12-lead ECG.
  • Review disease process and prevention measures with you including how and when to correctly take your medications.
  • Education on heart disease is to be expected for every encounter specific to your diagnosis(es).
  • Education on healthy eating and living habits is to be expected for every encounter.
  • Specific education on diuretics as it relates to increasing weight gain and fatigue will be provided.
  • Inspect and discuss CPAP equipment and usage.
  • Complete a History and Physical Exam.
  • A complete Medications Reconciliation is to be expected at every encounter.
  • Complete a Safety Assessment.
  • Complete a Social Assessment.
  • Facilitate a Telehealth visit, if scheduled.
  • Follow any verbal orders as obtained via telehealth, phone call, or electronic messaging.
  • Schedule follow-up appointment(s) as needed that might include, but not limited to: Primary Care Provider, Addiction Recovery, Behavioral Health, Dental Care, Dietician, Home Health, Home Medical Equipment, Hospice, Pharmacy Services, Therapy Services, Public Health, Wound Care
  • Establish goals for next visit:__________
What your CP might do:
  • Ensure completion of applicable CHW items above.
  • Perform venous blood draw for the following test panel:
    • BNP
    • BUN
    • CBC
    • CMP
    • Creatinine
    • Lipids
    • Troponin
  • Perform heart Ultrasound.
Condition YELLOW: Warning Zone... This is the watch zone.
Indications:
  • None of the RED indications are present.
  • Weight gain of three (3) pounds or more in one day,
  • Weight gain of five (5) pounds or more in one week,
  • Increased swelling of your feet, ankles, legs, or stomach,
  • Difficulty breathing when lying down or feel the need to sleep up in a chair,
  • An uneasy feeling or you know something is not right,
  • Fatigue or no energy,
  • Dry hacking cough,
  • Other indication set by your doctor:____________________
What you can do:
  • You may need an adjustment to your medications.
  • Improve your eating habits.
  • Increase your activity level.
  • Call your CHW or CP:____________________
  • Call your PCP:____________________
    • If outside business hours, 24-hour triage nurse screening is available by calling your PCP's number.
What your CHW might do:
  • Ensure completion of applicable items in the GREEN zone above.
What your CP might do:
  • Ensure completion of applicable CHW items above.

Condition RED: Medical Alert Zone... This is the danger zone.
Indications:
  • Severe difficulty breathing,
  • Unrelieved shortness of breath while sitting still,
  • Chest pain,
  • Altered mental status, confusion, or inability to think clearly,
  • Dizziness,
  • SpO2 less than 88%,
  • Other indication set by your doctor:____________________
What you can do:
  • You need immediate evaluation by a medical professional.
  • Call your CHW or CP:____________________
  • Call your PCP:____________________
    • If outside business hours, 24-hour triage nurse screening is available by calling your PCP's number.
  • Call 9-1-1
What your CHW might do: What your CP might do:
  • Ensure completion of applicable CHW items above.
  • Provide CPAP through your home device, a disposable device, or Ventilator using CPAP mode with PSV (BiPAP).
  • Administration of Nitroglycerine 0.4 mg SL (may repeat every 5 min). If more than three doses are required, transport to an Emergency Room is needed.
  • Administration of Albuterol 2.5 mg Neb.
  • Assist you in the administration of your own prescribed medications.

NEMSIS Protocol: 9914175 - General-Community Paramedicine / Mobile Integrated Healthcare

Citations:


Change Log:

DateLink to
previous
version
Description of change
03/16/23Created this section.
04/28/23pdfFirst draft using green, yellow, red format.
05/26/23pdfAdded review of discharge instructions. Added repeat Nitro with a max of three before ER visit. Nitro repeat and three max is per Dr. Butvilas on 5/22/23.

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