My clinical rotation for NURN 236 is unique in that all patients I care for at Union Memorial Hospital in Baltimore, Maryland have a diagnosis of heart failure (HF). HF occurs when the heart is unable to pump adequate blood supply, resulting in insufficient oxygen and nutrients to the tissues of the body (Smeltzer, Bare, Hinkle, and Cheever, 2012). Approximately 670,000 Americans are diagnosed with HF each year and is the most common hospital discharge diagnosis among the elderly (Simpson, 2014). Moreover, according to the Centers for Medicare and Medicaid Services (CMS), HF is the leading cause of 30-day hospital readmission followed by acute myocardial infarction (AMI) and pneumonia (medicare.gov|Hospital Compare, 2013). This information along with my weekly HF patient cohort prompted my curiosity regarding impacts of HF readmissions, factors of HF readmission, and to compare suggested evidence based practice with policies utilized at Union Memorial for reducing the 30-day readmission rate for HF.
Hospital readmission can impact the patient, nursing practice, the hospital, and the health care system. The patient’s quality of life can be altered physically, psychologically, and economically (Whittaker, 2014) and recurrent hospitalization is a good predictor of increased risk of mortality (Hummel, Katrapati, Gillespie, DeFranco, & Koellig, 2013). Moreover, a patient in an acute care setting has an increased risk of contracting hospital-acquired infections such urinary tract infections, sepsis, C. difficile, and methicillin resistant Staphylococcus aureus (medicare.gov|Hospital Compare, 2013). Nursing practice is impacted as patients spend the majority of their acute care stay with the bedside nursing staff. According to...
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...y hired nurses on the heart failure floor since discharge education remains one of the responsibilities. I believe knowledge is an important factor to empower the patients about heart failure care and nurses spend nearly 24 hours a day with hospitalized patients; therefore, nurses can be patient advocates by reinforcing teaching. Most importantly, I believe that catering to the patient’s individual needs and establishing a good nurse-patient relationship enhances trust and learning which in the long run, is very beneficial to both nursing practice and the quality of life of the patient. Overall, what I discovered about heart failure is that there is no simple solution in preventing heart failure hospital readmission. Even with the recommended evidence-based practice suggestions, hospital readmission rates for HF still seem to remain high throughout the country.
Monitoring staff levels is an important factor. Also leveling the flow of patients in and out institutions could help to reduce wide fluctuations in occupancy rates and prevent surges in patient visits that lead to overcrowding, poor handoffs, and delays in care. Studies show that overcrowding in areas such as the emergency rooms lead to adverse outcomes, because physicians and nurses having less time to focus on individual patients. One study found that for each additional patient with heart failure, pneumonia, or myocardial infarction assigned to a nurse, the odds of readmission increased between 6 percent and 9 percent (Hostetter and Klein, 2013). All of which costs the hospital money.
Building on the successful work of health care providers will help with the campaign of saving 100,000 lives. Through his speech, Dr. Berwick introduce six changes that every hospital needs to implement in order to save lives that will bring family together. The six changes Dr. Berwick wish every health care organization needs work on that will help save these lives are to deploy rapid response team, deliver reliable care for acute myocardial infarctions, prevention of ventilator associated pneumonia bundles, prevention of central venous line bundles, prevention of surgical site infection prophylaxis medication and prevention of adverse drug events with reconciliation. Even though the lives save may not know who they are, it will bring community and family together. According to Dr. Berwick “The names of the patients whose lives we save can never be known. Our contribution will be what did not happen to them. And, though they are unknown, we will know that mothers and fathers are at graduations and weddings they would have missed, and that grandchildren will know grandparents they might never have known, and holidays will be taken, and work completed, and books read, and symphonies heard, and gardens tended that, without our work, would never have
Studies show that patients forget at least half of the information explained to them (Tamaru-Lis, 2013, p. 268). In addition, low health literacy correlates with poor disease management, readmissions, and poor compliance to treatments (Eadie, 2014, p. 9). The goal of teach-back, therefore, is to improve recollection and increase health literacy. Nursing practice is aimed towards meeting these goals. Ultimately, nursing practice will improve as nurses are better able to deliver quality care, promote patient safety, and increase patient satisfaction. As a result, patient outcomes are optimized because teach-back minimizes communication errors and encourages participation. Participation allows patients to make appropriate decisions which direct health care professionals to provide patient-centered care.
Recognition, response and treatment of deteriorating patients are essential elements of improving patient outcomes and reducing unanticipated inpatient hospital deaths (Fuhrmann et al 2009; Mitchell et al 2010) appropriate management of the deteriorating patient is often insufficient when not managed in a timely fashion (Fuhrmann et al 2009; Naeem et al 2005; Goldhill 2001). Detection of these clinical changes, coupled with early accurate intervention may avoid adverse outcomes, including cardiac arrest and deaths (Subbe et al. 2003).
Although nurses do not wield the power of doctors in hospital settings, they are still able to effectively compensate for a doctor’s deficits in a variety of ways to assure patient recovery. Nurses meet a patient’s physical needs, which assures comfort and dignity Nurses explain and translate unfamiliar procedures and treatments to patients which makes the patient a partner in his own care and aids in patient compliance. Nurses communicate patient symptoms and concerns to physicians so treatment can be altered if necessary and most importantly, nurses provide emotional support to patients in distress.
Jeon, Y., Kraus, S. G., Jowsey, T., & Glasgow, N. J. (2010). The experience of living with chronic heart failure: a narrative review of qualitative studies. BMC Health Services Research. doi:10.1186/1472-6963-10-77
For patients requiring longer acute care than what is generally given at an inpatient acute care hospital, The Long Term Acute Care Hospital is an option. To be admitted to an LTACH, patients are required to have “medically complex situations with a mean length of stay > 25 days” (Munoz-Price, 2009, p. 438 ). Examples of patients with complex acute care needs are those with multiple comorbidities who need mechanical ventilator weaning, administration of intravenous antibiotics, and those with complex wound care (Munoz-Price, 2009, p. 438). According to Landon Horton, CNO of Select Specialty Hospital in Fort Smith, Arkansas, “The services provided by LTACH facilities allow the patients to get home who would not otherwise, have a higher level of functioning at discharge, and increase their quality of life” (personal communication, March 7, 2014).
This assignment is a case study that aims to explore the biospychosocial impacts of a myocardial infarction on a service user. It will focus on the interventions used by healthcare professionals throughout the patient’s journey to recovery. To abide by the NMC’s code of conduct (2015) which states that all nurses owe a duty of confidentiality to all those who are receiving care, the service user used in this case study will be referred to as Julie. Julie is a 67 year old lady who was rushed to her local accident and emergency following an episode of acute chest pain and was suspected to have suffered from a myocardial infarction. Julie who lives alone reported she had been experiencing shortness of breath and
Standardizing The Hospital Discharge Process for Patients with Heart Failure to Improve the Transition and Lower 30 day Readmission. http://www.cfmc.org/integratingcare/files/Remington%20Report%20Nov%202011%20Standardizing%20the%20Hospital%20Discharge.pdf
Heart failure is a major clinical, social and economic problem in the United Kingdom according to the Department of Health [DH] (2013).The National Institute for Health and Clinical Excellence [NICE] (2010) reported that about 900,000 people suffer from heart failure in the United Kingdom. The National Institute for Cardiovascular Outcomes Research [NICOR] (2011) conducted a national audit which found that one in every 20 people over the age of 65 is diagnosed with heart failure which demonstrates that it mainly affects the elderly. As a leading cause of mortality, heart failure contributes to more than 6,000 deaths each year (NICOR, 2011). Newly diagnosed cases of heart failure have a 40% risk of dying within a year (NICOR, 2011). Despite advances in therapy, mortality is still high and only half of patients are alive five years after being diagnosed with heart failure (NICE, 2010).
Lesle, S. J., Hartswood, M., Meurig, C., McKee, S. P., & Slack, R. (2006). Clinical Decision Support Software for management of chronic heart failure: Development and Evaluation. Computers in Biology and Medicine vol. 36, 495-506.
A study conducted by the Centers for Disease Control and Prevention shows that “annually approximately 1.7 million hospitalized patients acquire infections while being treated for other medical conditions, and more than 98,000 of these patients will die as a result of their acquired infection” (Cimiotti et al., 2012, p. 486). It was suggested that nursing burnout has been linked to suboptimal patient care and patient dissatisfaction. Also, the study shows that if the percentage of nurses with high burnout could be reduced to 10% from an average of 30%, approximately five thousand infections would be prevented (Cimiotti et al., 2012). In summary, increasing nursing staffing and reduction burnout in RNs is a promising strategy to help control urinary and surgical infections in acute care facilities (Cimiotti et al.,
Hospitals recognized the need for the case management model in the mid 1980’s to manage the lengths of stay of hospitalized patients and the treatment plans (Jacob & Cherry, 2007). In 1983, the Medicare prospective payment program was implemented which allowed hospitals to be reimbursed a set payment based on the patient’s diagnosis, or Diagnosis Related Groups (DRG), regardless of what treatment was provided or how long the patient was hospitalized (Jacob & Cherry, 2007). To keep the costs below the diagnosis related payment, hospitals ...
... patients with heart failure: Impact on patients. American Journal of Critical Care, 20(6), 431-442.
Hospitals play an important role in the health care system (Hospitals, n.d.). They are health care institutions that have an organized medical and other professional staff, and inpatient facilities, and deliver medical, nursing and related services 24 hours per day, 7 days per week. Hospitals offer a varying range of acute, convalescent and terminal care using diagnostic and curative services in response to acute and chronic conditions arising from diseases as well as injuries and genetic anomalies. In doing so they generate essential information for research, education and management. Traditionally oriented on individual care, hospitals are increasingly forging closer links with other parts of the health sector and communities in an effort