Nurse-Led Programs Help Avoid Heart Failure Readmissions

Nurse leaders throughout Cleveland Clinic hospitals are learning that preparing acute care patients for discharge and educating patients and their caregivers begins at admission, that it must be reinforced throughout the hospitalization and after the patient is discharged home or to a care facility. Gone are the days when acute care focused exclusively on hospital procedures and the inpatient stay. Jackie Spence, BSN, RN, Nurse Manager, Cardiovascular Nursing, and Terri Murray, BSN, RN, Nurse Manager, Heart and Vascular Unit, at Cleveland Clinics Heart & Vascular Institute, are ramping up efforts to reach heart failure patients. A family class we offer focuses on heart healthy living, says Spence. We have a total of six classes a week, held at different times, so our classes mesh with caregiver schedules. We have a chance to do one on one because classes are small with usually three to four patients. The classes are advertised prominently in pa tient rooms and day rooms. Everything we teach is very simple, says Murray, whether we are focusing on food labels, weight gain, or medications. Laminated cards that patients can post on their home refrigerators show a bulleted list of key self management tips: weighing themselves each morning before breakfast and tracking it, taking medicine as prescribed, and checking for any swelling or chest pain. Heart failure zones on the patient education cards are very important in our teaching and we try to get across what each zone means for the patient. A green all-clear zone, a yellow zone where the patient may have no energy and a dry hacky cough, and a red zone when you must call the doctor because of severe shortness of breath, chest pain, or confusion, says Spence. Another strategy that is being used throughout Cleveland Clinics hospitals is the teach -back method, where patients are asked to explain back to nurses what they were taught in their own words. Its a technique Donna Ross, MSN, RN, Clinical Nurse Specialist and Heart Failure Coordinator, Lakewood Hospital, finds invaluable in determining whether patients understand how to take their medicines and monitor their condition. Having patients tell us in their own words what they are supposed to do quickly shows us that they understand how to take care of themselves. Annette Fogarty, MSN, RN, Heart Failure Coordinator and Advanced Practice Nurse at Fairview Hospital, knows that heart failure care is complicated. She sees the biggest need as being sure that the next caregiver knows how to manage these patients. She also knows that many patients dont come in with a primary diagnosis of heart failure, yet have it. Many patients come in with an infection or a respiratory problem, yet still need the knowledge to manage the symptoms of heart failure. Once the patients are identified, we make sure that it is listed and that they are part of our teaching and preparing for discharge. Fogarty says all of Fairviews education is multidisciplinary and collaborative, involving pharmacy, nursing and dietary, with preparation for discharge starting at admission. Prior to discharge, follow-up care is scheduled by the nursing staff through the Hospital-to-Home Initiative. At each facility, patients are given one number to call if they have questions. These programs are expanding across Cleveland Clinic hospitals and a new bar is being set for heart failure outcomes.