The Henderson Repository is a free resource of the HonorSociety of Nursing, Sigma Theta Tau International. It isdedicated to the dissemination of nursing research, research-related, and evidence-based nursing materials. Take credit for allyour work, not just books and journal articles. To learn more,visit www.nursingrepository.org

Item type Presentation

Format Text-based Document

Title Evaluation of Written Inpatient Heart Failure Education toSupport Self-Care at Discharge

Authors Frame, Amanda Leigh

Downloaded 19-May-2018 08:58:16

Link to item http://hdl.handle.net/10755/601955

Heart Failure in America

(CDC, 2014)

(CDC, 2014)

Heart Failure in Georgia

• 5.1 million Americans

• 1 in 9 will die from Heart Failure

• Cost approximately $31 billion year

• 43% will die within 5 years

• Heart Disease is the #1 killer in GA

Heart Failure Facts

(CDC Fact Sheet, 2014)

Problem: Readmission

• Heart Failure exacerbations account for > 1 million readmissions a year

• 50% of Heart Failure readmissions could be prevented with better patient disease management

• Cost institutions $32 billion annually, up to $12,000 per patient per hospital stay

(CDC Heart Failure Fact Sheet, 2014; Daley, 2010)

HF Readmission Rates

18% 20% 22% 24% 26%

University HospitalTotal

University HospitalMedicare

US

Georgia

Readmission Rate

Readmission Rate

(University Data: (Lytle, PPT slides, 2014); data from 2012United States: (Becker Hospital Review; Gamble, 2012); data from 2012 *Georgia: (CMS, 2014); data from 2006 to 2009

Evidence Summary

Compare the impact of discharge education on admission rates for adults admitted to the hospital with heart failure.

Nine articles (4- II/B, 2- III/A, 1- I/B, 1- III/D, 1-IIa/B)

Twelve articles were reviewed

Three articles were excluded

Databases Searched: CINAHL, OVID Medline, Google Scholar, PubMed

“heart failure or congestive heart failure” (196170)

“discharge education” (196 )

“heart failure readmission” (89)

“adult literacy or health literacy” (4629)

“red/yellow/green tool kit” (2)

Single v. Multisession HF Education

Decreased readmission in persons with low literacy with multisession HF education sessions

(Incidence rate ratio, 0.75; 95% CI; 0.45-1.25)

All cause readmission did not differ by group

(Incidence rate ratio 1.01, 95% CI; 0.83-1.22)

Literacy is an independent predictor for improved self–care

(Dewalt et al, 2011)

Nurse led Self-Care HF Education

RCT (n=114) one-on-one HF discharge teaching

RCT (n=223) 60-minute HF discharge teaching

Nurse group had higher HF knowledge (P=.007)

Readmissions had low HF knowledge (P=.002)

Improvement in self-care in nurse led education

Increased self-care 30 & 90-days post discharge (P=.001)

Fewer readmissions (P=.009)

Savings of $2823

per patient (P=0.035)

(Kommuri, Johnson, & Koelling, 2012; Koelling, Johnson, Cody, & Aaronson, 2005)

Literacy

Low Literacy

Correlates with age

(P=<.001) and education

(P=.017)

Decreased HF

knowledge (P=<.001)

High 30-day readmission rate (P=.116)

Adverse Event 1.5 to 3 times more likely

A cross sectional descriptive (n=95) (Dennison et al, 2011)

Disease Specific Education

Red/Yellow/Green Tool (n=113)

Improved Self-Care

(95% CI;.06,2.3)

No increase in HF knowledge

Decreased readmission with single face nurse

education session(Dewalt et al., 2003)

Transitional Care Programs

Decrease in readmission rate:

20.2% to 15.8% in 9 months

Emergency department

education and referral to clinic

Written education materials with self-

care focus

Palliative care referrals were made when appropriate .7-day Follow up appointments a hospital based clinic or cardiologist

(Daley, 2010)

Conceptual Framework: Health Belief Model

Individual Perception Modifying Factors Likelihood of Action

Perceived severity of heart failure

Socio-psychological and demographic variables

Perceived barriers and benefits of self care with heart failure.

Likelihood of following HF self-care guidelines.

Perceived threat of heart failure

CUES TO ACTION

Mass media, advice from others, education,

family, and friends

(Polit & Beck, 2008)

Practice Site: University Hospital

“How can we reduce HF readmissions globally in our organization?”

Purpose

0 Revise written HF education materials to the appropriate literacy level

0 Align with the ACC/AHA standards.

0 Compare current practice, policies, and procedures related to the distribution of HF education materials to current EBP recommendations

Aim of Project

Compliance with ACC/AHA standards

Review current HF education materials

for literacy level.

Revise HF education:

-Self-care management

-4th /5th grade literacy level.

Compare UH current practice,

policies, and procedures related to HF education to

literature.

Create written HF written education

in Spanish language.

GOAL:

Reduction in Heart Failure

Readmissions!

Fry Readability scale to test literacy level.

Bilingual written education forms at 4th /5th grade

System wide nurse led HF education intervention at discharge.

Current HF Written Education

• Self-care goals unclear (ACC e171)

• 8th grade literacy level

• 25-page front and back booklet in black and white

• Poor organization of sections

• Patient unable to individualize goals

(University Hospital, patient education, 2004: ACC, 2013)

(Readabilityformulas.com, 2014)

Adult Literacy in Augusta-Richmond County

18%

47%

35%

Population Literacy

FunctionallyIlliterate

Eight Grade orless

Ninth Grade orabove

Total Population 139,504

(US Department of Education, 2003)

New HFWritten

Education

• Meets ACC /AHA guidelines

• 4th grade literacy level

• Clear self-care themes that are evidence based

• Available in English and Spanish languages

• Savings of $8880 per year

(ACC, 2013: Joint Commission, 2012)

(Readabilityformulas.com, 2014)

$10,500

$1,620

Annual Cost

Heart Failure Booklet Cost Comparison

New Education

Old Education

Recommendations for University HF Program

System use of new HF written education

Evaluate nursing staff on HF self-care teaching at

bedside

Reevaluation of HF written education

based on ACC/AHA updates

Use Fry Scale or GRID for literacy testing of written

materials

Increase use of HF educators

HF Educator coverage in ED

Dissemination of Information

Inpatient written

education evaluation

Tele-Health

Evaluation

LACE Model

Presentation to UH April 17, 2014

“How you do anything is how you do everything” M. A. Bowman, MD

Project Outcomes

Integration into the EMR

Post Admission Survey with Telehealth

Cardiology Office Education

• Patient tracking• Information availability• Home health, inpatient

and outpatient use

• Identify strength and weakness

• Communication across the care continuum

• Identify high risk patient

• Added validity• Increased patient

exposure to information• Addition of HF clinic

Readmission Reduction

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

40.0%

University2013

University2015

21.2%17.9%

17.4%

11.9%

Medicare Readmission

Total Readmission

17.4%

University Data: (Lytle, PPT slides, 2014); data from 2012-2015

Influence and Action

University Hospital

Accountable Care Organization

Unless we are making progress in our nursing every year, every month, every week, take my word for it we are going

back. ~ Florence Nightingale

Deepest Gratitude……..

Dr. Murphy, Dr. Bentley, Dr. Landrum, Terri DeFusco, Heidi Nelson, Dr. Mac Bowman, Becky Echols, Dr. Chandler, Gabe

Law, Pauline Curry, Jenny and Makenna Baldwin, my husband Matt Frame, the University Hospital staff, GRU CON and

COGS staff, friends, and family.

“It takes a village.” -Hillary Clinton

References0 About Us. (2013). Retrieved from http://www.universityhealth.org/body.cfm?id=387100 Bradley, E., Curry, L., Horwitz, L., Sipsma, H., Thompson, J., Elma, M., ... Krumholz, H. (2012).

Contemporary evidence about hospital strategies for reducing 30 day readmissions. Journal of the American College of Cardiology, 60(7). DOI:10.1016/j.jac.2012.03.067

0 Centers for Disease Control. (2014). Heart failure fact sheet. Retrieved from http://www.cdc.gov/dhdsp/data_statistics/fact_sheets/fs_heart_failure.htm

0 Centers for Medicaid and Medicare Services. (2011). Readmission reduction program. Retrieved from http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/Readmissions-Reduction-Program.html

0 Daley, C. (2010). A hybrid transitional care program. Critical Pathways in Cardiology, 9(4), 231-234. DOI:10.1097/HPC.0b013e3182018838

0 DeWalt, D. A., Schillinger, D., Ruo, B., Bibbins-Domingo, K., Baker, D. W., Holmes, G. M., ... Pignone, M. (2012, May 9, 2012). Multisite randomized trial of a single-session versus multi-session literacy sensitive self-care intervention for patients with heart failure. Circulation, 125:2854-2862. DOI:10.1161/circulationaha.111.081745

0 Dennison, C., McEntee, M., Samuel, L., Johnson, B., Rotman, S., Kielty, A., & Russel, S. (2011). Adequate health literacy is associated with higher heart failure knowledge and self-care confidence in hospitalized patients. Journal of Cardiovascular Nursing, 26(5), 359-367. DOI:10.1097/JCN.0b013e3181f16f88

0 Dewalt, D. A., Pigone, M., Malone, R., Rawls, C., Kosnar, M., George, G., ... Angel, B. (2003). Development and pilot testing of a disease management program for low literacy patients with heart failure. Patient Education and Counseling, 55, 78-86. DOI:10.1016/j.pec.2003.06.002

0 Doughty, R., Wright, S., Pearl, A., Walsh, H., Muncaster, S., Whalley, G.,...Sharpe, N. (2002). Randomized, controlled trial of integrated heart failure management. European Heart Journal, 23(), 139-146. DOI:10.1053/euhj.2001.2828

0 Grady, K. L., Dracup, K., Kennedy, G., Moser, D. K., Piano, M., Stevenson, L. W., & Young, J. B. (2000). Team management of patients with heart failure: a statement for healthcare professionals from the cardiovascular nursing council of the American heart association. Circulation, 2443-2456. Retrieved from http://www.circulationaha.org

0 Koelling, T. M., Johnson, M. L., Cody, R., & Aaronson, K. D. (2005). Discharge education improves clinical outcomes in patients with chronic heart failure. Circulation, 111, 179-185.

0 Kommuri, N. V., Johnson, M. L., & Koelling, T. M. (2012). Relationship between improvements in heart failure patient disease specific knowledge and clinical events as part of a randomized controlled trial. Patient Education and Counseling, 86, 233-238. DOI:10.1016/j.pec.2011.05.019

0 Melnyk, B., & Finout-Overholt, E. (2011). Evidence Based Practice in Nursing & Healthcare. Philadelphia, PA: Wolters Kluwer Lippincott Williams & Wilkins.

0 O’Connell, B., Hawkinson, M., Buchbinder, R., & Baker, L. (2099). Providing information to stroke survivors: lessons from a failed randomized controlled trial. Journal of Australian Rehabilitation Nurses Association, 12(3), 4-10.

0 Reigel, B., Moser, D., Anker, S., Appel, L., Dunbar, S., Grady, K.,...Whellan, D. (2009). Promoting Self-Care in persons with heart failure a scientific statement from the American Heart Association. Circulation, 120, 1141-1163. DOI:10.1161/CIRCULLATIONAHA.109.192628

0 Schmeida, M., & Sarvin, R. (2010). Heart Failure Rehospitalization of the Medicare FFS Patient. Professional Case Management, 17(4), 155-161. DOI:10.1097/NCM.0b013e31824c5fca

0 Stetler, C., Rucki, S., Morsi, D., Broughton, S., Corrigan, B., Fitzgerald, J.,...Sheridan, E. (1998). Utilization-focused integrative reviews in a nursing service. Applied Nursing Research, 11(4), 195-206. DOI:PMID99852663

0 University Hospital Practice Committee (2012). Heart Failure Standard of Practice . Retrieved from www.uhcs.org

0 US Department of Education. (2003). State and county literacy estimates. Retrieved from http://nces.ed.gov/naal/estimates/index.aspx

0 Vreeland, D. G., Rae, R. E., & Montgomery, L. L. (2011). A review of the literature on heart failure and discharge education. Critical Care Nursing Quarterly, 34(3), 235-245. DOI:10.1097/CNQ.0b013e31821ffe5d

0 Yancy, C., Jessup, M., Bozkurt, B., Butler, J., Casey, D., Drazner, M., Fonarrow, G., Geraci, S., Horwich, T., Jarizzi, J., Johnson, M., Kasper, E., Levy, W., Masoudi, E., McBride, P., McMurray, J., Mitchell, J., Peterson, P., Riegel, B., Sam, F., Stevenson, L., Tang, W., Tsai, E., & Wilkoff, B. (2013). 2013 acc/aha guideline for the management of heart failure: a report of the American college of cardiology / American heart association task force on practice guidelines. Circulation, 128, 1-375. Retrieved from http://circ.ahajournals.org/content/early/2013/06/03/CIR.0b013e31829e8776.full.pdf