Going the Extra Mile for Patients with Endocarditis and Substance Use

MOSAIC brings holistic care during and after hospitalization

MOSAIC Program

Infective endocarditis, which occurs when bacteria enter the bloodstream and settle in the heart, damages the heart valves. Frequently, heart valve repair or replacement is needed. Patients with a history of intravenous drug use can be particularly prone to infective endocarditis and heart valve dysfunction. In many cases, patients need repeated interventions because of ongoing drug use.


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In recent years, Cleveland Clinic has seen a growing number of these patients. Under the direction of Shinya Unai, MD, the care team at the Sydell and Arthur Miller Family Heart, Vascular & Thoracic Institute’s Endocarditis Center has developed a proactive approach when it comes to treating opioid use disorders and patients with infective endocarditis.

“As clinicians, our goal is to care for the patient as a whole,” notes Mary McLaughlin Davis, DNP, ACNS-BC, CCM, Senior Nursing Director of Cardiovascular Medicine. “Patients with infective endocarditis require extensive inpatient care. While we help them recover from their heart disease and surgery, the question is how to also address the root cause. Their time with us is an opportunity to provide the necessary resources to assist in their recovery from addiction and hopefully help them heal — mind, body and spirit.”

To better serve these patients, the Endocarditis Center’s multidisciplinary team — including nursing, infectious disease, cardiothoracic surgery, cardiology, behavioral health and care management — launched MOSAIC, which stands for Management of Substance Abuse Disorder and Heart Infections in Cardiovascular Patients.

Using a holistic approach, MOSAIC offers support to patients through a variety of avenues, such as care management “Every person on this team truly wants the best for these patients and to see them succeed,” says Natalie Salvatore, MSN, MBA, RN, CCRN, Manager, HVTI Patient Resources and Outreach. “We can fix their heart. We can fix their valve, but unless we fix the underlying problem, they are highly likely to be right back here. So, how can we meet the patient where they are and give them the necessary care? Through collaboration and a coordinated effort.”

Success requires that all members of the multidisciplinary team work synchronously to keep patients connected to care, Salvatore adds.


Peer-driven support

Using a workflow created by the nursing and care management teams, the staff identifies patients with infective endocarditis and a substance use disorder. Throughout their hospital stay, patients have access to the entire MOSAIC team as well as its resources.

A key aspect of MOSAIC is its emphasis on peer-to-peer support. Through a partnership with Supporting Opiate Addiction Recovery (SOAR) — a local peer support program — infective endocarditis patients with a substance use disorder now have access to additional support and guidance.

Support does not end when patients leave the hospital. MOSAIC team member Kimberly Wolfe, RN, a resource nurse, follows up with patients one week, one month, three months, six months and one year after discharge. Wolfe makes every effort to connect with patients, exhausting all available contacts and reaching out multiple times. “I do everything in my power to follow up with patients to check in and ensure they are receiving the care they need,” Wolfe says.

Nursing’s pivotal role

While the success of MOSAIC depends on a multidisciplinary approach and the expertise of every member of the team, nursing has an especially important role to play in the care of these patients. They are there 24/7, notes Dr. McLaughlin Davis.

“When a patient is frightened or anxious in the middle of the night, our nurses are there,” she says. “They are by their bedside during an incredibly difficult time.”


Caring for these patients can be especially challenging, and the stigma associated with drug use can add a layer of complexity. “Patients know they may be looked at differently due to their history, but I have had so many tell me how grateful they are for the kindness they received at Cleveland Clinic, and especially from our nursing team,” Wolfe says.

“Our nurses treat the patient, not the disease,” says Salvatore. “The person who is in that bed is more than endocarditis or a substance use disorder. They are a person with a life and a family and a story. Even though their story may not be like yours or mine, their worth is not any less than ours.”

The MOSAIC team hopes the impact of the program will continue to grow. Plans include ongoing education for bedside nurses and other caregivers, as well as efforts to build additional partnerships. “We are committed to finding partner organizations that share our passion and the level of quality that is important to Cleveland Clinic,” says Dr. McLaughlin Davis. “We must be confident that we are sending our patients to a good facility that will help ease their transition to sober living and their ongoing recovery.”

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