Table 1.

Overview of MaineHealth Home Diuretic Protocol^a

Enrollment criteria	Heart failure admission Advanced heart failure (NYHA Class III/IV) Eligible for home health services Telehealth monitoring ordered
Protocol initiation criteria	Weight gain of 2 pounds overnight or 5 pounds in one week
Day and criteria	Action	Follow-Up
1 If initiation criteria met	Double oral dose of diuretic Check serum electrolytes, renal function, magnesium Physical assessment	Physician notified when: Protocol initiated Protocol terminated Lab results abnormal Immediate physician or hospital referral if: Progressive symptoms Unstable vital signs Worsening examination results
2 If patient above baseline weight	Double oral dose of diuretic Administer metolazone Check serum electrolytes, renal function, magnesium Physical assessment
3 If patient above baseline weight	IV administration of diuretic, 1.5 times usual oral dose up to maximum Check serum electrolytes, renal function, magnesium Physical assessment
4 If patient above baseline weight	Immediate physician or hospital referral

^aThe current version of the protocol itself, along with other supporting materials, can be found at www.mainehealth.org/home-diuretic.

IV = intravenous; NYHA = New York Heart Association.