Heart Failure Capstone Project Renee Boone NU 480

Heart Failure Capstone Project Renee Boone NU 480

Heart failure • “An estimated 20 million people across the world have been diagnosed with heart failure” (Hobbs, Escutia, Harrison, Moore, & Sarpong, 2016, p. 145). • According to Centrella-Nigro et. Al. , (2016), • There approximately 5. 7 million people who are living with heart failure in the United States alone. • Each year over 670, 000 patients are newly diagnosed with heart failure, which ranks #2 for admissions behind childbirth. • Annually there are over 1 million patients that are admitted to hospitals for heart failure and after discharge a fourth of these patients are readmitted within 30 days. • Hospitals can now receive a penalty under the Hospital Readmission Reduction Program if their hospital readmission rates for heart failure are higher than the national average.

Research Question Hospitals are now using the teach-back method in order to reduce 30 -day readmissions and increase patient satisfaction. Does using the teach-back method reduce 30 -day readmission rates and increase patient satisfaction?

Literature Review • Patient satisfaction significantly increased on discharge instructions in Florida hospital when using the teach back method (Putney & Kelly, 2015). • A study by Brown, Mack, Guzzetta and Tefera (2014), showed a decrease in 30 -day readmission rates after using the teach-back method. • 189 patients were studied post CABG. The teach-back method was used and the results showed a significant decline in 30 -day readmissions from 25. 8% to 12% (Bates et al. , 2014). • A study by Haney and Shephard (2014), used 23 high-risk patients studied when given education using the teach-back method for 60 minutes. • Readmission rates decreased. • 10 of these patients made changes to diet and weight monitoring due to the teach-back method.

Literature Review Cont. A study by White et al. (2013), Used the teach-back method on 276 patients over the age of 65. Results showed no significant changes in readmissions. Showed significant increase in knowledge retention. These studies, as well as many studies reviewed , showed significant increases in patient knowledge and retention. Some studies did not show a decrease in 30 -day readmission rates, but none reviewed showed an increase in readmissions. The reviewed literature showed that using the teachback method has positive outcomes.

Current status on Telemetry Unit 34 bed telemetry unit 23 nurses on unit Unit receives majority of heart failure patients in the hospital. Education provided to the patients and families varies from patient to patient. Multiple different kinds education throughout hospital about heart failure. Nurses floated to the unit often give different printed education on heart failure. Discharge education is inconsistent and may not have all the needed information.

Current status on Telemetry Unit cont. Heart failure patients on unit frequently have home medications changed and/or new medications added at discharge. Education on new medications inconsistent leaving room for medication errors at home, not understanding what medication is for or how to take the medication, and what the possible side effects are. Teach-back method introduced many years ago, but not maintained over the years. New nurses have not received the teach-back education.

Current status on Telemetry Unit cont. Education happens at the time of discharge and not throughout stay. Nurses feel rushed to discharge patient and patients are ready to be discharged quickly. Not all heart failure patients receive heart failure education.

Survey Nurses observed discharging patients to evaluate teaching methods and education given. 8 nurses observed discharging patients. 2 out of 8 nurses used the teach-back method. Majority of nurses observed taught the patient verbally and ended with “do you have any questions”? This method does not allow the nurse to assess if patient truly understood the information and how much they retained. 4 out of 8 nurses printed medication education for the patient.

The Goal/Proposal Identify all heart failure patients on the unit. All heart failure patients will receive the same education. Nurses will use the teach-back method when educating patients. Heart failure education packet will be created in order for the education to be consistent. Education will include the stoplight method. Patients will understand new medications. Common medications prescribed on the unit will be preprinted and readily available for nursing to educate patients. Will begin to receive education on admission and not only at discharge. Patient will be able to recite back education. Process will be created to identify all heart failure patient at time of admission.

Implementation-Education Packet Searched hospital systems to find all education currently available on heart failure. Nursing shift managers on the unit along with the director, went through education to determine what is needed for the packet that will be used. The “discharge instructions for heart failure patients should include diet, daily weight measurement, medication use, signs and symptoms that their condition is worsening, and follow-up plans” (Stella, para. 11, 2013). The stoplight on heart failure will also be used in the packet.

Implementation-Identifying Heart Failure Patients Currently, the system flags only heart failure patients needing education at the time of discharge and only those who have a primary diagnosis of heart failure. Determined that all night shift nursing shift managers would check for new patients needing heart failure education. Shift managers will check to see if education was given/documented daily. Night shift nursing shift managers will place education packet on day shift nurses daily assignment sheets.

Implementation-New Medication Education Wall unit created to house a slot for all common heart failure medications prescribed. Medications chosen for unit at this time include: angiotensin converting enzyme inhibiters, angiotensin receptor blockers, beta blockers, diuretics, and Digoxin. Unit secretaries will maintain the wall unit and make sure there always copies.

Implementation-Teach-back method and Educating Nursing Teach-back method obtained from staffing education and development and shown to floor nurses in mandatory meeting. Nurses educated on heart failure packet created, using the teach-back method, new wall unit housing medications, and the new process and why we were using this new process/method. Shift managers on the unit will be monitoring and assisting with the new process and randomly rounding on patients to see if education was done.

Implementation cont. Nursing shift managers will be call discharged heart failure patients at home couple of weeks after implementing the new process. A month after implementing new process, reports will be printed monthly to look at the compliance rate on heart failure patients receiving education. The goal is to be at 100%. At 3 -month intervals surveys will be looked at to see if there are improvements on scores. 30 -day readmission rates will also me monitored.

Conclusion Heart failure discharge education has been the center of many discussions around the nation because of the national core measures that have been placed on hospitals to meet. The teach-back method is becoming more popular in healthcare organizations around the nation. Many studies that have shown that using the teach-back method increases patient knowledge and reduces 30 -day readmissions in hospitals. Patients can understand diagnosis and instructions by receiving proper education and education that helps them retain and understand their diagnosis. Education will start at the time of admission up until the time of discharge. The teach-back method allows nursing to evaluate if the patient is comprehending and understanding the instructions given to them. Readmission rates, survey scores, and heart failure patients given the education will be monitored in intervals to determine if the teach-back method has shown positive changes after implementation.

References Bates, O. , O’Connor, N. , Dunn, D. , & Hasenau, S. (2014). Applying STAAR interventions in incremental bundles: Improving post-CABG surgical patient care. Worldviews on Evidence. Based Nursing, 11(2), 89 -97. Brown, M. , Mack, K. , Guzzetta, C. , & Tefera, E. (2014, Jul/Aug). The feasibility of using teach -back to reinforce discharge instructions and its influence on the number of 30 -day readmissions of heart failure patients. Heart & Lung, 43(4), 379. Centrella-Nigro, A. , Bognar, L. , Burke, K. , Faber, K. , Flynn, V. , La. Forgia, M. , & Wiklinski, B. (2016, May-June). The readmitted patient with heart failure. Medsurg Nursing, 25(3), 163167. Haney, M. , & Shepherd, J. (2014). Can teach-back reduce hospital readmissions? American Nurse Today, 9(3), 50 -52. Hobbs, J. K. , Escutia, D. , Harrison, H. , Moore, A. , & Sarpong, E. (2016, May-June). Reducing hospital readmission rates in patients with heart failure. Medsurg Nursing, 25(3), 145. Putney, L. , & Kelly, A. (2015, April). EB 102 teach-back technique improves satisfaction of patients with heart failure. Critical Care Nurse, 35(2). Stella, L. , (2013, February). Understanding core measure for heart-failure treatment. American Nurse Today, 8(2). Retrieved from https: //www. americannursetoday. com/understanding-core-measures-for-heart-failuretreatment/ White, M. , Garbez, R. , Carroll, M. , Brinker, E. , & Howie-Esquivel, J. (2013). Is ’teach-back’ associated with knowledge retention and hospital readmission in hospitalized heart failure patients? Journal of Cardiovascular Nursing, 28(2), 137 -146. https: //doi. org/10. 1097/JCN. 0 b 013 e 31824987 bd