Heart failure resources

1. Research Methods in Nursing NUR 602
Celeste Connelly, Kelly Gibson,
Ashley McCann Rogers & Amy Squire

2. Introduction
 5.7 million Americans live with heart failure (HF).
 The cost of care of HF patients was $37.2 billion dollars
in 2009.
 Rapid readmission (readmission to an acute care
facility within 30 days of discharge) for Medicare
patients was 26.9% in 2010.
 Management of heart failure consumes more resources
than any other diagnosis….
 We need to improve care and cut costs.

3. Purpose of the Study/Hypothesis
• To determine if a nurse-delivered discharge planning
bundle that includes a follow-up phone call within 1
week of discharge will decrease the rate of unplanned
admissions among patients with a primary or
secondary diagnosis of HF.
• The addition of a follow-up phone call to a discharge
care bundle will reduce the rapid readmission of
patients with HF to the hospital.

4. Procedures
 January 1 – June 30 – Retrospective chart review to determine
number of rapid readmissions conducted by Quality Improvement
Department of a local hospital. IRB approval obtained from
University of North Carolina at Greensboro. Study was deemed
exempt Category #4. All information was de-identified before
included in the study.
 July 1 – September 30 – Staff education/preparation of unit for
introduction of new discharge care bundle that will include HF
patients - #1 admitting diagnosis on the unit
 October 1 – December 31 – Implement the discharge planning
bundle that includes follow-up phone call.
 January 1 – June 30 - Collect data about rapid readmissions
following implementation the new care bundle.

5. Sampling and Setting
 Target Population: Patients hospitalized for HF.
 Setting: An inpatient 20 bed telemetry unit of a local hospital staffed with
30 RN’s/10 CNA’s /4 Monitor Tech’s
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1.
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3.
Inclusion Criteria:
Age 65 or older
Discharge diagnosis of HF (as the primary or secondary diagnosis)
Alert and competent to read, understand and speak English
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1.
2.
3.
Exclusion Criteria:
Skilled Nursing Facility (SNF) patients
Department of Correction residents
Pregnant women
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1.
Protection of Human Rights:
All demographic information was stored on a secure server with
protection by a 2 password system
Patients gave consent to be contacted by telephone following hospital
stay
2.

6. Discharge Care Bundle
 Patients will receive an educational plan that follows the
Self Care of Heart Failure Index (SCHFI) developed in
studies done by Riegel, Lee, Dickson & Carlson (2004).
 Education Concepts/Goals - Self-care maintenance, Self-
care management and Self-care monitoring/confidence.
 The intention of the follow-up phone call is to monitor the
patient understanding of the goals of the program and to
follow their progress as well as answer any questions they
may have. A graduate nurse researcher will attempt to
contact all patients within a week of discharge.

7. Follow-up Phone Call
 Medications:
What medications are you taking and are you taking them as prescribed?
Do you have any questions about your medications?
• Activity:
Are you able to participate in some type of physical activity daily?
 Weight:
Do you weigh yourself daily? Has your weight stayed the same, increased
by > 3# in a day or >5# in a week?
 Diet: Are you following a low sodium diet?
 Symptom Management:
Do your feet/ankles/hands swell? Are you short of breath when you climb
stairs or get dressed in the morning? Are you tired all the time? Can you
participate in your usual activities?
• Follow-up:
Have you seen your primary care provider for your follow-up appointment?
• Can I help you with any other information?

8. Self care of Chronic Illness
A Middle Range Theory
•
•
•
•
Diet
Medications
Exercise
Smoking cessation
Self-care
maintenance
Self-care
monitoring
• Weigh daily
• Monitor B/P HR
• Recognize changes
• Adjust treatment in
response to
changes
• Seek primary care
follow up
Self-care
management

9. Research Approach/Design
 This study will use a Quantitative approach to define if an
enhanced educational program and follow-up phone call
(independent variable) would reduce rapid readmission
(dependent variable) of HF patients after hospitalization.
 This is a Quality Improvement study that will attempt to
show a relationship between the enhanced educational
program and better outcomes for HF patients.
 We will use a pretest/posttest design as we are collecting
information about rapid readmission both before the
discharge planning bundle is initiated and after to
determine the change in rapid readmissions.

10. Outcomes/Statistics
 At the end of our study we will report the number of
readmissions that occurred during the six month period
following the introduction of the discharge planning
bundle.
 Additionally, we may be able to identify any areas of the
educational program that can be improved, indicating
further Quality Improvement opportunities.
 We will employ a graduate student statistician to assist
with the evaluation of the study.

11. Limitations
 We will have a small sample because we have limited
the initiation of the discharge care bundle to one
specific unit in one hospital.
 We have chosen to use a convenience sample which
may limit the ability to apply our findings to a larger
population.
 The discharge planning bundle is being introduced as
a new standard of care but we do not know if the
education is completed or delivered in a consistent
manner with each HF patient.

12. Budget
 Materials /copying fees
 Professional services of statistician
 Total Cost of study
50
500
$ 550

13. Resources
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American Heart Association. (2012). ACCF/AHA/AMA-PCPI 2011 Performance Measures for Adults with Heart Failure.
doi:10.1161/CIR.06013e3182507bec
Bradke, P. M. & Brubjerm E. (2011). To reduce heart failure readmissions use the teach-back method. Patient Education Management, 18(10),
109-120.
Centers for Medicare & Medicaid Services Readmissions Reduction program. (2013). Retrieved 2013 ACCF/AHA guideline for the management
of heart failure: executive summary. from CMS.gov: http://www.cms.gov/Medicare-Fee-forService
Coleman, E. A. (2003). Fallling through the cracks: Challenges and opportunities for improving transitional care for persons with continuous
complex care needs. Journal of the American Geriatrics Society, 49, 549-555.
Hart, P. L., Spiva, L. & Kimble, L. P. (2011). Nurses' knowledge of heart failure education principles survey: a psychometric study. Journal of
Clinical Nursing, 20, 3020-3028.
American Heart Association. (2013). Retrieved from Heart Disease and Stroke Statistics-2013 Update/Heart Failure:
http://www.heart.org/HEARTORG/General/Heart-and-Stroke-Association-Statistics_UCM_319043_SubHome Page.jsp#
Hines, P. A., Yu, K. & Randall, M. (2010, March-April). Preventing heart failure readmissions: Is your organization prepared? Nursing
Economic$, 28(2), 74-86.
Jaarsma, T., Stromberg, A., Gal, T. B., Cameron, J., Driscoll, A., Hans-Dirk, D. & Inkrot, S. (2013). Comparison of self care behaviors of heart
failure patients in 15 countries worldwide. Patient Education and Counseling, 92(1), 114-120.
McHugh, M. D., & Ma, C. (2013). Hospital nursing and 30 day readmissions among medicare patients with heart failure, acute myocardial
infarction and pneumonia. Medical Care, 51(1), 52-59.
Paradis, V. Cossette, S., Frasure-Smith, N., Heppell, S. & Guertin, M. C. (2010). The efficacy of motivational nursing intervention based on the
stages of change on self-care in heart failure patients. Journal of Cardiovascular Nursing, 25(2), 130-141.
Polit, D. F. & Beck C. T. (2012). Nursing research: Generating and assessing evidence for nursing practice. Philadelphia: Wolters
Kluwer/Lippincott Williams & Wilkins.
Riegel, B. & Dickson, V. V. (2008). A situation-specific theory of heart failure self-care. Journal of Cardiovascular Nursing, 23(3), 190-196.
Riegel, B., Lee, C. S., Dickson, V. V. & Carlson, B. (2009). An update on the self-care of heart failure index. Journal of Cardiovascular Nursing,
24(6), 485-497.
Riegel, B., Jaarsma, , T. & Stromberg, A. (2012). A middle-range theory of self-care of chronic illness. Advances in Nursing Science, 35(3), 194204.
Silow-Carroll, S., Edwards, J. N. & Lashbrook A. (2011). Reducing hospital readmissions: Lessons from top-performing hospitals. The
Commonwealth Fund.
Yancy, C. W., Jessup, M., Bozkurt, B., Butler, J., Casey, D. E. Drazner, M. H. & Fonarow, G. C. (2013). 2013 ACCF/AHA guideline for the
management of heart failure: executive summary. Journal of the American College of Cardiology, 62(13), 1495-1539.