Quality standard
Quality statement 4: Review after changes in medication
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. [2016]
Rationale
Medication to treat chronic heart failure can cause 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
The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.
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 to dose or type of medication.
Denominator – the number of changes to dose or type of chronic heart failure medication in adults with chronic heart failure.
Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records.
Outcome
Hospital admissions due to heart failure.
Data source: The National Heart Failure Audit contains data on hospital admission rates for heart failure.
What the quality statement means for different audiences
Service providers (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, specialist multidisciplinary heart failure teams, and clinical pharmacists with an interest in chronic heart failure) 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 (integrated care systems) 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.
Adults with chronic heart failure are seen by the appropriate 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
Chronic heart failure in adults: diagnosis and management. NICE guideline NG106 (2018), recommendations 1.7.1 and 1.7.3
Definitions of terms used in this quality statement
Review when medication is changed
Review should include as a minimum:
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clinical assessment of functional capacity, fluid status, cardiac rhythm (minimum of examining the pulse), cognitive status and nutritional status
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review of medication, including need for changes and possible side effects
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an assessment of renal function.
Reviews may need to be adjusted based on the medication that has been introduced or changed, for example testing within 2 weeks of introduction of a sodium-glucose co‑transporter 2 inhibitor may show irregular results for some tests. More detailed monitoring is needed if the person has significant comorbidity or if their condition has deteriorated since the previous review. [Adapted from NICE's guideline on chronic heart failure in adults, recommendations 1.7.1 and 1.7.2 and expert opinion]