EDUCATE THE PATIENTSWITH HEART FAILURE TOREDUCE THEREADMISSION RATE Emiliy Moore, Calle Lindén, The Dinh Thi
Task Key finding of QI summarized for the funder of your project
Background 20% among those 70-80 years in the western world have heart failure. (Rosamond et al., 2008) Heart failure is the most common reason for hospitalization in Sweden for people over the age of 65 (Swedish National Board of Health and Welfare (Socialstyrelsen), 2008).
Our typical patient we want tohelp Patient 65-85 years Heart failure, NYHA Class I-III Living at home or at a home for elderly peoples Slightly decreased memory and understanding Risk of going back to hospital Reduced Knowledge Self-care risk för readmission
Why educate? Reduced risk of readmission More knowledge Better compliance about their to self-care condition Improved mental Improved physical health and quality health of life
Quality issueReduce the readmission rateamong patients with heart failure. Measure the readmission rate Educate and give the patient knowledge to better be able to perform self-care
• Make a new PDSA • Quality issuses among cycle according to patients with heart the data we failure. What do we need receive from to know about our measurments patients and also which theories. How can we improve the situation ACT PLAN STUDY DO• Describe our • Improve the self- measured results care through discharge education and telephone follow up along with web- based services
Intervention Web- Discharge Telephone based education follow up services
Leadership1. LeadershipSetting and reaching collective goals, and toempower individuals autonomy andaccountability• Ask -- raise the issue• Advise -- increase awareness of risk andbenefits related to behaviour• Assist -- help the patient to identify a negotiatedSMART(specific, measurable, achievable, realistic, timed) goal related to behaviour change andsignpost if appropriate.
Measurments Make two groups with the same kind of patients, one receiving the intervention one is not, Count each time a patient in the study achieves one of the possibilitiesEffect Intervention Control g Reductio (P-value and or g n CI) Using statistical tools like the chi-square to seePossiblity 1 x (n) y (n) % value if the the outcome is significantPossiblity 2Possiblity 3Possiblity 4Possibilty 5
Example of measure Patients who readmit to the ward n=100; 50 in each groupEffect Intervention Control Reduction group groupNo readmission 20 10 50%One or more 10 20 -50%readmissionTwo or more 10 10 -readmissionReadmission but 5 5 -because of somethingelseDied 5 5 -
Ethical consideration This is a very cost effective way to reduce the readmission rate among this group of patients The education most be performed at a first class level to meet the demands of the global society needs. Nurses educating the patients are required to have a deep understanding and exceptional knowledge about heart failure and self-care.
Education and readmissionAuthor, year Outcome 1 Outcome 2Koelling, Johnson, Cody Fewer days in hospital Reduced risk of& Aaronson, 2005 readmissionKrumholz, Amatruda, Reduced risk of Fewer days in hospitalSmith, Mattera, readmissionRoumanis, Radford,Crombie & Vaccarino,2002Kwok, Lee, Woo, Lee & Reduced risk ofGriffith, 2008 readmissionDomingues, Clausell , Reduced number ofAliti, Dominguez & visits to the emergencyRabelo, 2011 room
What do we need to begin theproject Access to databases including but not Funding, 10000 limited to euro before 15/5 patients journal and work schedule Soon™, when it’s ready, contacts with healthcare leaders in the community
References Albert, N., Collier, S., Sumodi, V., Wilkinson, S., Hammel J.,Vopat, L. et al. (2002). Nurses’ knowledge of heart failure education principles. Heart & Lung: The Journal of Acute and Critical Care, 31,(2), 102-112. Hart, P., Spiva, L., Kimble, K. (2011). Nurses’ knowledge of heart failure education principles survey: a psychometric study, Journal of Clinical Nursing, 20, 3020–3028. Lesman-Leegte, I., Jaarsma, T., Coyne, J., Hillege, H., Van Veldhuisen, D., Sanderman, R. (2008). Quality of life and depressive symptoms in the elderly: a comparison between patients with heart failure and age- and gender-matched community. Journal Of Cardiac Failure, 15(1), 17-23. New York Heart Association Functional Classification, 2009 Rosamond, W., Flegal K., Furie K., Go, A., Greenlund K., Haase, N. et al. (2008). Heart disease and stroke statistics--2008 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 117, 125–146. Socialstyrelsen. (2008). Nationella Riktlinjer för hjärtsjukvård 2008. Stockholm: Socialdepartementet. Strömberg, A. (2005). The crucial role of patient education in heart failure. The European Journal of Heart Failure, 7, 363–369