Policy and Organizational Behavior

Running head: HEART FAILURE CLINIC 1

HEART FAILURE CLINIC 2

Heart Failure Clinic – Discharge Education Plan

Samantha M. Tallarine

Capella University

Nursing Leadership & Management

Heart Failure Clinic Care Plan

April, 2019

Heart Failure Clinical Care Plan – Discharge Education Plan

Heart failure (HF) is one of the three leading causes of death, and the most prevalent chronic disease in the United States. “Readmission rates for HF patients are astronomically high, with up to 25% of hospitalized patients with HF requiring readmission within 30 days of discharge. The Hospital Readmissions Reduction Program (HRRP) of the Patient Protection and Affordable Care Act aims to address these concerns by financially penalizing institutions with unacceptably high risk-adjusted 30-day readmission rates for HF patients.” (Smith, Fleming, & Gros, 2018) With this new act, they are putting added pressure on already stretched thin hospital organizations. In making a completely separate outpatient clinic strictly devoted to heart failure, the hospital is taking a step to help decrease the astronomically high readmission rates, and offering the community much needed resources.

Patient education is critical in order to decrease readmission, and to reduce the chance of complications and unnecessary hospitalizations. That being said, the most important part of this new clinic will be in discharge planning, and teaching patients and their caregivers accordingly. It needs to be understood by the patient and their family that heart failure is not going to be cured, but it can be managed and the symptoms can be treated. Medication management and dietary changes are the best way to combat the symptoms of heart failure, so before the patient can be discharged we must ensure that they understand what medications they are taking, why they are taking them, and how they should be taken.

“It has been long noted in literature that nursing care can reduce costs, improve patient satisfaction, and improve health.” (Mensik, 2013) With greater nursing care comes a lower cost for healthcare, and fewer readmissions. The brunt of this pressure falls upon the shoulders of the nurse leaders across the country. In this specific scenario, nurse leaders are extremely important because nurses will run this clinic with the assistance of cardiologists. Day to day responsibilities fall under the nurse’s jurisdiction, which means the leaders, will be accountable for all their subordinates. The whole staff needs to come together and work as one in order to provide exceptional patient care and education.

“Unfortunately, nursing divided the nursing scope into different functions to be completed by individual RNs, as opposed to being a part of the overall scope of all RNs. This division of labor is seen as today’s case managers, utilization managers, patient care coordinators, and others who are separate from clinical RNs. Clinical RNs in many settings have been limited to part of their professional scope, such as assessments, interventions, and education, and no longer feel care coordination may be a part of their role or professional responsibility. If nursing is to have an active role in transforming health care, it will need to shift more nursing care from the bedside in a hospital to the outpatient and community settings through care coordination.” (Mensik, 2013) That being said, it is up to the nursing leaders to include all team members in each aspect of the day-to-day operations in order to make this clinic run smoothly and efficiently. Accountability falls on each nurse individually as well as their leader; to reduce errors, and make sure the staff is working in peak form there must be safe nurse to patient ratios, and adequate staffing in all areas.

In order to manage the clinic efficiently there are many questions that need to be addressed regarding day-to-day operation, and how to make sure the patients are receiving optimal care. There needs to be a clear cut discharge plan, and it needs to start as soon as the patients are admitted. Although there are current standards for heart failure, the staff needs to realize that every case is not textbook, and they need to treat each patient individually. In doing so, the patients will feel more motivated to take part in their care, and this will hopefully lead to compliance with medications and lifestyle outside of the clinic.

Upon admission, in compliance with the most recent heart failure guidelines, the first thing that will be explored is the patient’s biomarkers with a simple blood test, and along with that, a baseline complete blood count (CBC) and complete metabolic panel (CMP). In doing this first before any treatment is administered it allows the staff to see the patient’s initial results, and establish a baseline of which to work with and they will know what goals to set for each individual patient. Next, symptomatic treatment will happen in order to ease the patient’s anxiety that they are sure to be feeling. This will most likely include medications, and continuous monitoring of vital signs. Throughout all of the steps in the admission process, teaching needs to occur; even if the patient says that they already know everything they’re being told. Education is the key component in reducing readmissions, and therefore it needs to have the biggest emphasis in the clinics care of plan.

Along with patient education, their family members and loved ones also need to be educated in order to help care for them once they are discharged. The number one way to ensure that our teaching is effective is to have the patients and their caregivers use the teach back method, and reiterate everything back to the staff members. With education being so important the staff needs to start giving the patients their discharge information upon admission, and throughout their whole stay. There also should be information sessions set up on a weekly basis that people can attend when they are outpatient.

The staff is sure to come across patients of different races and ethnicities, which can be challenging when it comes to educating them. “Recommended techniques to increase cultural competence in heart failure management include: the use of professional interpreting services, the use of appropriate education materials, the recruitment of ethnic minority and bilingual staff and the training of staff in cultural competency.” (Brennan, 2015) These are all different ways the clinic can accommodate those whose first language is not English, and make sure the patient feels comfortable receiving help from the staff, and that they fully understand their plan of care.

This clinic can be extremely helpful in reducing readmissions within 30 days for patients with heart failure. The nursing staff will be in control, and in doing so will ensure that patients are receiving the highest level of care. Each patient will be treated according to current heart failure guidelines and be made to fully understand their care of plan, as well as their discharge plan. All patients will receive the same level of care, and will be accommodated accordingly even if they are not fluent in English. Translation services will be available for all possible languages (including American Sign Language), and there will also be bilingual staff on hand. In taking all the proper precautions and ensuring proper education, we will be able to measure the clinic’s effectiveness over time by the reduced admission rates.

Resources

Brennan, E. J. (2015, November 11). 1004BritishJournalofNursing,2015,Vol24,No20©2015MAHealthcareLtd Heart failure care for patients who do not speak English. Retrieved from http://web.a.ebscohost.com.library.capella.edu/ehost/pdfviewer/pdfviewer?vid=1&sid=71a866e8-901c-4dda-a053-1d488a0f878e@sessionmgr4010

Hobbs, J. K., Escutia, D., Harrison, H., Moore, A., & Sarpong, E. (2016). Reducing hospital readmission rates in patients with heart failure. Medsurg Nursing, 25(3), 145-152. Retrieved from http://library.capella.edu/login?qurl=https%3A%2F%2Fsearch.proquest.com%2Fdocview%2F1798714013%3Faccountid%3D27965

Mensik, J. S. (2013). Nursing's role and staffing in accountable care. Nursing Economics, 31(5), 250-3. Retrieved from http://library.capella.edu/login?qurl=https%3A%2F%2Fsearch.proquest.com%2Fdocview%2F1460567198%3Faccountid%3D27965

Smith, K., Fleming, J. P., & Gros, B. (2018). Editorial: Transitional care clinics to reduce 30-day readmissions in heart failure patients. Cureus, 10(1) doi:http://dx.doi.org.library.capella.edu/10.7759/cureus.2069

Sterne, P. P., Grossman, S., Migliardi, J. S., & Swallow, A. D. (2014). Nurses' knowledge of heart failure: Implications for decreasing 30-day re-admission rates. Medsurg Nursing, 23(5), 321-329. Retrieved from http://library.capella.edu/login?qurl=https%3A%2F%2Fsearch.proquest.com%2Fdocview%2F1617324563%3Faccountid%3D27965

Tait, G. R., Bates, J., LaDonna, K. A., Schulz, V. N., Strachan, P. H., McDougall, A., & Lingard, L. (2015, August 19). Adaptive practices in heart failure care teams: Implications for patient-centered care in the context of complexity. Retrieved from https://www-ncbi-nlm-nih-gov.library.capella.edu/pmc/articles/PMC4547636/

Yancy, C. W., Jessup, M., Bozkurt, B., Butler, J., Casey, D. E., Colvin, M. M., . . . Westlake, C. (2017, April 28). 2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure. Retrieved from http://www.onlinejacc.org/content/early/2017/04/20/j.jacc.2017.04.025?_ga=2.96365141.896462440.1554532261-762466827.1551779369

Zaya, M., Phan, A., & Schwarz, E. R. (2012). The dilemma, causes and approaches to avoid recurrent hospital readmissions for patients with chronic heart failure. Heart Failure Reviews, 17(3), 345-53. doi:http://dx.doi.org.library.capella.edu/10.1007/s10741-011-9256-0