Quality statement 4: Review after changes in medication

Quality statement

Adults with chronic heart failure have a review within 2 weeks of any change in the dose or type of their heart failure medication. [new 2016]

Rationale

Medication to treat chronic heart failure can cause significant side effects, including dehydration, low blood pressure, a low heart rate and renal impairment. Some may initially and temporarily make heart failure symptoms worse. When the dose or type of medication for chronic heart failure is changed, the person should have a review within 2 weeks to monitor the effects. This can also include a review of the effectiveness of the medication and whether any further changes or referral to other members of the multidisciplinary team are needed.

Quality measures

Structure

Evidence of local arrangements to ensure that adults with chronic heart failure have a review within 2 weeks of any change in the dose or type of their heart failure medication.

Data source: Local data collection.

Process

Proportion of changes to dose or type of chronic heart failure medication in which the person is reviewed within 2 weeks of a change.

Numerator – the number in the denominator in which the person is reviewed within 2 weeks of the change in medication.

Denominator – the number of changes to dose or type of chronic heart failure medication in adults with chronic heart failure.

Data source: Local data collection.

Outcome

a) Renal impairment.

Data source: Local data collection.

b) Hospital admissions, inpatient hospital days and readmissions.

Data source: Local data collection.

What the quality statement means for service providers, healthcare professionals and commissioners

Service providers (such as GP practices, hospitals and community providers) ensure that systems are in place so that adults with chronic heart failure have a review within 2 weeks of any change in the dose or type of their heart failure medication.

Healthcare professionals (such as GPs, specialists in cardiac care, heart failure specialist nurses and specialist multidisciplinary heart failure teams) ensure that they carry out a review for adults with chronic heart failure within 2 weeks of any change in the dose or type of their heart failure medication. The multidisciplinary heart failure team will decide who is the most appropriate team member to do this, for example, the GP may lead the care in consultation with other members of the team.

Commissioners (such as clinical commissioning groups and NHS England) ensure that they commission services in which adults with chronic heart failure have a review within 2 weeks of any change in the dose or type of their heart failure medication.

What the quality statement means for patients, service users and carers

Adults with chronic heart failure are seen by their healthcare professional within 2 weeks of any change in the dose or type of medication they are taking for heart failure, to check for any problems and make sure that the medication is working.

Source guidance

Definitions of terms used in this quality statement

Review when medication is changed

Review should include as a minimum:

  • clinical assessment of functional capacity, fluid status, cardiac rhythm (minimum of examining the pulse), cognitive status and nutritional status

  • review of medication, including need for changes and possible side effects

  • blood pressure, serum urea, electrolytes, creatinine and eGFR (estimated glomerular filtration rate).

More detailed monitoring is needed if the person has significant comorbidity or if their condition has deteriorated since the previous review.
[Adapted from Chronic heart failure in adults (NICE guideline CG108), recommendations 1.4.1.1, 1.4.1.2, 1.2.2.6 and 1.2.2.8]