Heart Failure (HF) is the single cardiovascular disease that is growing in incidence prevalence and occurrence. The disease is responsible for repeated illness, decreased quality of life, and hospital readmissions. Across the nation heart failure is a primary adult diagnosis in most hospitals, with associated adverse outcomes to the patient, families and society in general. HF is a prolonged devastating disease that affects millions of people yearly. Individuals with HF are confronted with enduring physical symptoms, emotional stress, and major financial problem.
HF has a tremendously high percentage of readmission, with up to 45% of patients readmitted to the hospital within a period of six months after discharge. Current studies have indicated that multidisciplinary disease management programs can significantly decrease the hazardous behavior issues such as non-adherence with prescriptions, diet and postponement in obtaining preventive care leading that may lead to a reduction in rehospitalization. Introduction Health care systems and hospitals are focusing on improving performance and patient outcomes in cardiovascular services with an exact focal point on heart failure.
There is a huge attention on heart failure management in avoiding readmissions by decreasing the cost per case, and develop the quality and satisfaction for this exact patient population (Hines, Yu, &Randall, 2010). The Medicare payment advisory commission informs congress of the unnecessary re-hospitalizations as a big high cost and low quality concern. These reports have brought attention to leaders of health care systems around the country to start focusing on preventing heart failure re-hospitalization in hope of possible changes in the healthcare industry.
Issel’s model for problem explanation was utilized to build the problem statement. The problem is declared as a greater than before incidence of hospital readmissions between adult patients 17 years of age with exacerbation of identified heart failure problem. All of these readmissions are connected to the physiological equilibrium making the body vulnerable to certain co-morbidities. It is understood that the re- hospitalizations are predisposed by a lack of sufficient primary care clinician education and standard follow up concerning disease management, prevention and the patients’ personal health behaviors.
Objectives in the management of heart failure are to delay the disease development, reduce symptoms, and avoid worsening of HF that led to hospital readmission. With the prevalence of heart failure growing yearly, it is vital to ensure effective disease management approaches. It is essential to follow those recommendations defined by evidence-based practice for a successful disease management program. The purpose of this project is to review recent evidence-based practice in an effort to maintain heart failure self-care after discharge to reduce rehospitalization.
An education approach to increase adherence and permit patients to care for their illness would considerably decrease the frequency of readmission and death for individuals with heart failure. This project will concentrate on patient education, evaluation of understanding this disease management, and continuation through a multidisciplinary method to management of care. Heart failure disease management programs have shown to improve outcomes and education that is taught to patients will enhance their ability to provide self-care after hospital discharge.
Institute of Medicine (IOM) stated if the important problem is the system’s design then amelioration in care cannot be reached by further exhausting the present systems of care. The present system will not be able to do the job. Hard attempt to do the job will not work but changing systems of care will work. Improvements in the quality of care for individuals with chronic illness require more than evidence about effective treatments and tests.
They also need evidence regarding the systems changes that offer better care and quality improvement approach to put these changes in action. Heart failure re-hospitalizations may also be avoided by identifying barriers to system wide development, and management across the continuum of care. For example Institute for Healthcare Improvement promoted a (STAAR) State Action on Avoidable Re-hospitalization which is an approach designed to promote the delivery of successful Heart Failure care (Delgado, 2006).
Other efforts to improve the progress and decrease readmissions includes Improvement in collaborative care which stresses on developing a model changeover for hospitalized patients with an intent to decrease the 30 day readmission rates by 35 percent and increase patient satisfaction with the most favorable and management of care. The current hospital 30-day heart failure readmission rate is high, a prominent increase since 2008. Accomplishment in refining transitions of care and decreasing unnecessary re-hospitalizations entails engaging providers and clinicians throughout the organization.
Reducing re-hospitalizations among heart failure patients will involve organized work among organizations and providers (Chan, 2008). Lastly, the engagement and participation of patients and families is crucial to improving management of care and gain access to care in the right place, at the right time that serves the necessities of the individual. Disease management programs objective is to address the obstacles to effective treatment by patient education and multidisciplinary organization.
Poor discharge practices, lack of suitable follow-up, doubt concerning self-management responsibilities, and misperceptions about medications all result in highly flexible care at times of transitions and influence a large percentage of Heart Failure patients (Jacobs, 2008). Implementation Heart failure is linked with high rehospitalization rates, frequently due to avoidable complications resulting from individual’s failure to effectively self-manage the disease. Programs that offer sufficient instructions at discharge, proper medication management, and suitable follow up can decrease readmission rates and enhance quality of care.
Heart Failure is a complex illness which necessitates lifestyle modifications pertaining to multiple drug regimens, maintaining sufficient exercise and nutritional precaution and closely monitoring daily weights (White, Howie-Esquivel, ; Caldwell, 2010). The majority part of heart failure care is done at home by the patient or caregiver; on the other hand if these people are not aware of the requirements or fail to notice the importance, or face challenges to engage in self-care, they will not play a successful part in the process. (Lindenfeld, Albert, Boehmer, Collins, Ezekowitz et al. , 2010).
While this notion brings awareness among healthcare providers, there are facts suggesting that patients remain unsure about their part in managing this condition (White et al. , 2010; Chan, Heidenreich, Weinstein, ; Fonarow, 2008). A literature review was conducted to appraise evidence concerning intervention strategies in heart failure and disease management which provide significant evidence leading to specific changes and needed interventions before discharging patients from the hospital to home to reduce upcoming readmissions.
HF is the main reason of rehospitalization and is connected with a significant financial problem with expenses over $30 billion in past years. Almost two-third of heart failure patients are back in the hospital within 30 days of discharge. Hospitalized patients are generally subject to insufficient discharge teaching that result to medical deterioration and raise the probability of rehospitalization. Problem Currently the hospital 30 day readmission rates are increasing since 2009.
Victory in successful conversions of care and decreasing preventable re-hospitalizations involves providers and clinicians across the organization (Boutwell, Jencks et al. , 2009). According to Chan et al (2008) programs in disease management goal are to address the barriers to effective treatment with patient instruction and multidisciplinary direction. Poor discharge practices, lack of appropriate follow-up, doubt concerning self-management tasks, and misunderstandings about medicines all result in different care at times of changeovers and affect a enormous percentage of heart patients (Boutwell, Jencks et al. , 2009).
Nursing care associated with heart failure patients was not constant among nurses and interdisciplinary team members. This led to unreliable and insufficient heart failure teaching during hospitalization which may have been a reason to lack of patient comprehension regarding the long term effects of heart failure and significance of continuing post discharge self- care. Information on Heart Failure in my facility has conventionally been delivered by nurses through care notes or through quick verbal communications while hospitalized that may not have sufficient information for effective post-discharge activities to control HF for a long period of time.
Most heart failure instruction was given at time of discharge leaving less time for patient questions to be answered. Purpose The aim of this report was to study existing HF management approaches and to deliver references concerning the practice of a combined method of care through education, compliance with the treatment program, promotion of hospital and avoiding heart failure readmissions.
Teaching and treatment of heart failure patients are critical aspects of patient care that support clinical consistency. The influence of education outcomes for patients with heart failure was emphasized in a latest study by Hines et al. An organized idea of patient teaching is important to the realization of good results. Indications of HF and related signs are instructed to patients. Given the complication of the evidence, a team tactic is tremendously beneficial in assisting patients to comprehend and remember material about the discharge process.
All members in the team play significant part in this development. Videotapes and printed materials are a supplementary priceless source for patient instruction but should assist as additions but not swap for one-on-one learning. Teaching should be clear, logical, and simple facts of the overview of heart failure should be explained thoroughly. Some research has surveyed patient associated issues, such as lack of adherence that result to HF and rehospitalization.
Another significant cause that leads to patient rehospitalization is insufficient discharge preparation and follow-up after discharge. Nursing plan Nurse theorist Orem (2001), defined self-care as obligatory for positive management of health problems. When deficit in self-care happens which is either unintentional may results in rehospitalization. The context is utilize to recognize deficits in self- care in heart failure patients, and pinpoints potential approaches to help patient to sustain self-care.
HF is a long-lasting and advanced disease which frequently leads to disproportion among demand in self-care and capability As HF develops, new complications arise that need more comprehensive actions (White et al. , 2010). Nurses help patients to meet their self-management to support a patient’s care in reducing disease development, decreasing the necessity for re-hospitalization, and lower the risk of death from heart failure. Nurses need to create a supportive care to guarantee that patients discharge from the hospital with a good comprehension of low sodium diet.
Patients should plan activity as tolerated and know when to notify provider. This kind of learning method has confirmed constructive effects in the past and was confirmed in nursing studies on the constructive effects of structured, scheduled instruction that improved self-care activities (Grady et al, 2008). Solution A learning plan should be developed by introducing an education packet which comprised a heart failure book such as a “Stronger pump “explaining the main elements in living with heart failure and how to manage their symptoms after discharge.
An education packet would be presented which contained a heart failure book detailing the main causes in living with the disease and strategies to manage symptom. Given the changeability of the results for heart failure discharge teachings, occasions for improvement happened in covering several gaps by making sure all patients with heart failure are given sufficient and proper teaching and discharge advices Accomplishment with this attempt meant achieving all fundamentals of performance for The Joint Commission to support self-management.
For teaching to be effective heart failure patients discharged home must have written instructions or informative material. These resources must address activity level, nutrition, weight monitoring, discharge medications. A program to transition patients home should emphasized on assessment of the patient’s needs. On admission a discharge assessment should be done to evaluate the expected discharge teaching plan. The program must inform patients of all possible concerns for non-adherence with suggested treatments.
The program will assess the patient’s and family willingness and capability to support self-management behavior when required. Components recommended include an extensive counseling and education personalized to each patient’s needs; self-care promotion consisting of self-adaptation of diuretic regimen in applicable patients or caregiver; importance on behavioral approaches to increase compliance, attentive follow-up after hospital discharge, increased access to health care providers; early recognition of signs and symptoms of fluid overload, and help with financial issues.
The program encompasses patients in decision making about their medical care. The program assesses barriers to lifestyle changes and evaluates the participant’s response to suggested standard of living changes. A reliable clinician should be responsible for the actual discharge of the patient. Different organizations may be consulted if patient is to be discharged to a nursing agency. A superior teaching and education process is executed to confirm that they comprehend discharge instructions.
Outpatient heart failure class that stresses the learning material should be used when patients are discharged and start feeling better. The use of interdisciplinary teams provides great extensive care from several practiced viewpoints, and enhanced the patient experience. Individual who are sent home have the best opportunity to control HF, avoid heart failure rehospitalization and increase quality of life (Hines et al, 2010). Data Collection Data collected will be organized and connected to study propositions.
The validity of the research will comprise of using several data sources and forming a chain of evidence through the use of a database. Reliability will be ensured through the use of a study protocol and case study database. The timeframe process for completion of the case study will take approximately three months. Heart failure readmission is a national problem. Review and analyze heart failure readmissions to identify failures in the current process. A line chart with a 30-day readmission rate was created in patients with heart failure was to track past and future data.
Evidence The Joint Commission standard in supporting self-management for heart failure classifies areas in which the nurse can provide care to assist in supporting heart failure self-management. (The Joint Commission, 2009). Patients who can manage themselves have a better result. A systematic review of randomized control trials that studied effects of heart failure self-management interventions on health outcomes in 867 patients found that self-management of HF reduced all-cause hospital readmissions and heart failure readmissions, and caused in cost savings reported between $1400 to $7615 per patient yearly (Boutwell et al, 2009).
In a prospective, randomized clinical trial, Naylor et al found noticeable reductions in the hospital readmission rates of elderly patients after a complete, multidisciplinary discharge planning program. Based on the results of Naylor et al, discharge planning should be initiated within hours upon hospital admission. Current practice strategies offer a basis for the treatment of patients with heart failure.
In one study of forty-five HF patients, utilization of a complete inpatient learning program and discharge planning by a cardiac registered nurse educator was proven to considerably decrease readmission rates. (Landro, 2009). Patients that attended education sessions had better self-management adoption than non-attendance according to an experimental education program of 187 patients, those who did not accept these approaches were found to be at higher risk for readmission (Landro, 2009).
These results are supported by two studies that demonstrate how planned education during hospitalization can improve self-care behavior (Grady, 2008) implied that nurse-led educational interventions for all heart failure patients hospitalized can be done to improve post-discharge heart failure self-management and best outcomes including decrease 30-day heart failure readmissions. Approval The entire project will be presented to my department leadership team for evaluation and approval using handouts and power point presentation.
Then it will be forwarded to the chairman of cardiovascular services who serves as a liaison to the executive team and consultant physicians regarding heart failure issues when appropriate. Information will be given on strategies to reduce hospitalization with a focus on patient education, self-care management, and counseling along with formulating a post discharge plan to discuss the individualized issues of bad discharge outcomes. Written education would be presented to the executive group. Continuing education would be given to the nursing staff via the healthcare learning computerized system.