Continuum improves CHF patient education
Continuum improves CHF patient education
Packet and checklist provide standardization
Education is an important component of the congestive heart failure (CHF) program implemented at Johnson Memorial Hospital in Franklin, IN, both for patients and health care professionals all along the continuum of care.
Program planners realized that an education program could not be successful if implemented in an inpatient vacuum. Patients did not have enough time to learn how to manage their disease while in the hospital. To make the educational process effective, teaching would have to be continued at the next level of care. Therefore, the CHF project team mailed the CHF teaching packet to physicians' offices, long-term care facilities, and home health agencies to familiarize staff at the next level of care with the teaching.
Inservices also were conducted at connection meetings, which are gatherings designed for the hospital staff to connect with physician office staff. These meetings are held quarterly at the hospital for representatives from physician offices. Staff from home health agencies, extended care facilities, and long-term care/acute care facilities were invited to attend Teach the Teacher classes that provided information about the CHF patient education teaching pathway.
"We are still in the process of continually going back and re-educating physician offices, long-term care facilities, home health care, and our own acute care staff about the program goals and also the teaching topics so they can be reinforced," says Jeanne Ernst, RN, BSN, CPHQ, performance improvement and quality utilization case management coordinator and CHF project team co-chair.
The CHF project was initiated in December 1997 after a team had assembled an educational packet and created a teaching checklist. The team consisted of representatives across the continuum of care, including representatives from home health and long-term care.
To determine what to include in the packet, the team conducted site visits and literature searches, and talked to peers. At meetings, the team would review patient education materials and decide as a group what would be the most beneficial.
The educational packet includes the following: a booklet on CHF, handouts on sodium, ways to simplify work to conserve energy, guidelines on symptoms that prompt a phone call to the physician, a treatment plan to hang on the refrigerator or in the bathroom, a medication schedule, and a chart to track daily weight. Patients who do not have a bathroom scale are given one to take home. According to Ernst, the $10 for the scale is money well spent because a readmission to the hospital could cost between $5,000 and $12,000.
A CHF video was selected to show patients upon admission to the hospital, and a teaching checklist was created to track teaching. This checklist is copied and sent with the patient to home health care, extended care, or assisted living following discharge. If the patient is sent home, a copy of the checklist is faxed to his or her physician's office. (See copy of the teaching checklist, inserted in this issue.)
When a patient is admitted to the hospital with CHF, a case manager or floor nurse gives him or her the packet and briefly reviews the information with the patient and family members. The video is shown, and the patient and family are encouraged to read the CHF booklet.
Following the checklist, nurses continue to teach the patient throughout the hospital stay. For example, when a patient learns when and how to monitor weight gain, that section is checked. If more education is required, the nurse makes a written note.
Use of the checklist and learning packet was initiated at Johnson Memorial Hospital because the CHF patient population had a higher readmission rate than other chronically ill patient groups, says Ernst. In spite of the statistics, there was no organized teaching plan or follow-up for CHF patients. Also, the Health Care Financing Administration (HCFA), the agency that monitors the quality of Medicare coverage, asked hospitals to look at quality of care issues to improve the care of their beneficiaries. "One of the ways they identified to improve care was through patient education," says Ernst. The project was initially financed with a $3,500 grant from the Partnership for a Healthier Johnson County.
Is education across the continuum of care improving outcomes for CHF patients? Hospital readmissions for the year to date are at 14%. The average rate of readmission for 1995, '96, and '97 was 22%. Recently, the team implemented follow-up calls to CHF patients to determine how much of the education they remembered.
Most could identify at least one symptom that would trigger a call to their physician. Also, they were weighing themselves each morning, which indicated they were attempting to make lifestyle changes. (For a complete list of questions included in the telephone process, see call-back survey, inserted in this issue.)
"We're trying to get CHF patients to take respon sibility for their own health. The reason for education is to help people be responsible for the things they can manage," says Ernst.
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