Evaluation of the MaineHealth Skilled Nursing Facility Congestive Heart Failure Protocol

Acute exacerbation of congestive heart failure (CHF) is the most common reason for Medicare patients to be readmitted to the hospital within 30 days of discharge. Data about managing CHF in the skilled nursing facility (SNF) is sparse and what exists has been extrapolated from guidelines for community dwelling older adults. The MaineHealth SNF CHF protocol is a nursing-triggered, but provider-driven, standardized procedure for monitoring patients with CHF that is ordered upon admission to SNF. Once a patient is identified, providers follow a step-wise algorithm for the day-to-day adjustment of diuretics based on the target weight with recommendations for laboratory monitoring and electrolyte replacement.