McQuaid, B. (2011) A Nurse Driven Conversation To Decrease Re- Admissi

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A Nurse Driven Conversation Regarding supportive care To Decrease Re- Admissions and Increase Patient and Family Satisfaction with Care of Stage III and IV Congestive Heart failure (CHF) patients :

A Nurse Driven Conversation Regarding supportive care To Decrease Re- Admissions and Increase Patient and Family Satisfaction with Care of Stage III and IV Congestive Heart failure (CHF) patients Barbara J. McQuaid BSN, RN-BC

Objectives:

Objectives Identify signs and symptoms of stage III and IV congestive heart failure Identify supportive services offered at VA Pittsburgh Incorporate three strategies to reduce readmission rates and increase patient and family satisfaction with care

Why Is This Important ?:

A progressive and eventually fatal illness The nature of the disease makes it difficult to predict how much time a person has As the disease progresses decisions in care and treatment options should be discussed Why Is This Important ?

CHF Statistics:

CHF Statistics 5.8 million people in 2006 670,000 new cases diagnosed each year Cost for treating CHF patients is $39.2 billion for 2010 in lost productivity, medications, and healthcare costs

CHF Statistics:

CHF Statistics Hospital costs are $20.9 billion = 1million hospitalizations Incidence increases with age ranging from 2-5 per 1000 people, at 40 it is 1 in 5 chance of lifetime risk

Statistics About CHF and VA PGH:

Statistics About CHF and VA PGH 2004 a CHF clinic was started to coordinate the care of problematic CHF patients The goal was to efficiently care for patients by recognizing symptoms of fluid overload In the first year the CHF clinic reduced readmissions by 74%

CHF Committee:

CHF Committee In 2006 CHF committee was started Nurse practitioner led Representation from all medical surgical units 1 Pharmacist 2 Cardiologists Meet monthly Review readmission data and performance measures r/t CHF and AHA performance measures

Why a Committee:

Why a Committee Utilization of a team approach allows more areas of patient care to be addressed A full perspective from all disciplines affords greater problem solving capabilities Use evidence based practice to improve quality of care by utilizing performance measures specific to CHF

Why We Do What We Do:

Why We Do What We Do Integrity Commitment Excellence Accessibility

Where Do We Make Improvements:

Where Do We Make Improvements Joint Commission Performance Measures FY 2010 less than 100% compliance Diet/ weight/ medication instructions at discharge 96% Joint Commission Performance Measures FY 2010 less than 100% compliance Diet/ weight/ medication instructions at discharge 96%

Background:

Background CHF affects men slightly more than women African Americans have a higher prevalence and acquire at a younger age 30 day readmission rates approach 25% At 6 months 45%

VA How Do We Compare:

VA How Do We Compare May 2011 VA Pittsburgh had no female admissions 24% of CHF patients admitted were African American Average age of African Americans 66.5 Caucasian 72.76

Readmission Rates:

Readmission Rates 1 st Quarter FY 2011 VA Pittsburgh readmission rate for CHF = 20.28% National average of readmission for CHF = 26.9%

Phone Follow Up:

Phone Follow Up

VA Pittsburgh Readmission Rate:

VA Pittsburgh Readmission Rate

VA Length of Stay:

VA Length of Stay For readmissions: 2008 LOS = 9.42 2009 LOS = 6.61 2010 LOS = 4.12 For initial admissions: 2005 LOS = 8.01 2006, 2007, 2008 LOS=7.50 2009 LOS = 6.60 2010 LOS = 5.55

Plan Do Check Act for Stage III/IV CHF patients:

Plan Do Check Act for Stage III/IV CHF patients PLAN Increase patient education regarding supportive care; specifically diet, weight, and medication DO Provide 5West telemetry RN’s small group educational sessions regarding S/S CHF, and supportive care to allow pt’s to stay at home CHECK Analyze data warehouse information regarding supportive care performance indicators and compare to CHF patients receiving standard care. ACT Provide process standardization for formal training to be expanded to all VA Pittsburgh medical surgical floors

Uncertainty in Illness:

Uncertainty in Illness Can be applied to the education of staff The education of the patient

About the Theory:

About the Theory Uncertainty is the inability to determine the meaning of illness Cognitive Schema Event Familiarity New View of Life

Why a Nurse:

Why a Nurse Legal Institutional Professional standards

A Study by Koelling MD:

A Study by Koelling MD One hour nurse education session resulted in increases clinical outcomes Decreased readmission rates of those patients receiving extended nurse education The cost of care for standard education was $2823 more than those receiving extra education r/t extended LOS

Cost of Education:

Cost of Education Educators cost = $ 153 for 3.5 hours of education Staff costs for 27 tele nurses = $2362.50 Total cost $2515.50

How Will We Track Results:

How Will We Track Results Phone follow up week one and week three Check list for extended education Data warehouse information Compare with standard education

Future Investigations:

Future Investigations Continued education of supportive and palliative care Depression screens and poor social support

Questions:

Questions Contact me Barbara.McQuaid@va.gov

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