Use of education programs to minimize the 30-day readmission of patients with congestive heart failure

Garnering from Colleagues and Leadership

Hospitals are proper research settings that facilitate evidence-based inquiry and enable health professionals to find answers to critical health issues. However, the sensitivity of nursing research makes it necessary to seek approval from relevant authorities before commencing a research process. Ideally, medical or nursing research is sensitive because it involves human participants whose privacy, safety is paramount at each level, and research outcomes become a reference for many practicing health practitioners. Weierbach, Glick, Fletcher, Rowlands, & Lyder (2010) indicated that individuals intending to conduct research in a health institution should seek approval from Institution Review Board (IRB). Typically, IRB assesses the proposed project and determine the protection of participants and other critical aspects of the project. IRB reviews pilot studies, surveys, case studies, and other forms of inquiry. Therefore, I will submit a complete proposal copy to the IRB for review to seek approval.

Again, projects demand financial support. I will lobby support from the institution’s management team such as chief financial officer, human resource manager, and chief nursing officer because they are key decision makers. The success of the project will depend on persuading the leadership that there is a need for such intervention in the institution and it will improve the quality of care to the congestive heart failure (CHF) patients. Apart from the leadership, fellow staff members are also important because they will participate in the program. Therefore, I will have to convince them that the proposed solution will improve their working as well as the quality of care services they provide to patients with CHF. In short, I will have to lobby support from the relevant decision-making authorities and participants in the project to minimize resistance against the project.

Current Deficit

Congestive Heart Failure (CHF) is a common health risk among the aged, and across all ages depending on lifestyle and lineage. As health institutions battle with the high number of CHF patients, the primary challenge is how to minimize the rates of readmission rate within 30-days after discharge. The cost of inpatient hospitalization is on the rise, which makes the reduction of readmission of CHF patients a key quality concern. Notably, the Centers for Medicare and Medicaid Services (CMS) now uses 30-day readmission rates of CHF patients as one of its qualifying factors when allocating funds to health institutions within the United States (Trzeciak, Gaughan, Bosire, & Mazzarelli, 2016). Therefore, hospitals must make it an obligation to minimize 30-day readmission rates of CHF patients and achieve high quality score.

Second, the treatment process for CHF patients can be quite successful. Nevertheless, caregivers cannot guarantee post-discharge safety. Traditionally, discharge of patients with CHF only occurs when caregivers have sufficient evidence that they are well. Post-discharge care is the primary challenge because patients may lack the self-care skills to manage themselves. The same way, family members may have inadequate knowledge about management of CHF. Environmental conditions within the home of CHF patients can also create a barrier for self-care management. For instance, nurses may be willing to conduct follow-ups through telephone support and home monitoring, but that depends on patient’s knowledge of self-care skills.

Within the institution where this project will take place; there is no comprehensive patient education program specifically for CHF patients. Such patients receive health interventions, but their safety becomes an issue after discharge. Due to the limited knowledge on CHF and self-care management, the rate of readmission within 30-days after discharge is overwhelming. Therefore, the project seeks to fill the gap by proposing a comprehensive education program that will assist CHF patients to gain knowledge on their conditions and important self-care behavior. The program will also involve families of patients who may help them enhance post-discharge safety and possible reduce 30-day readmission rates within the health institution.

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Proposed Solution

The project seeks to emphasize the role of patient education in CHF patients and families for purposes of post-discharge self-care survival. Self-care education shifts the perspective care from institutional and disease-based to patient-centered. Self-care education modifies the behavior for self-reliance and comprehensive understanding of CHF. In as much as the institution currently provides education to patients before discharge, it is not specific for CHF patients. Developing a dedicated section within the patient education programs department will improve the quality of education provide to CHF patients just before discharge as a mission to encourage continuous care.

One of the key areas of the proposed education program is to assess the patient background before discharge and personalize learning materials based on their unique characteristics rather considering that all of CHF patients are the same. For instance, self-care education provided to CHF patients with family members around them would be slightly different from that give to CHF patients without close family members to facilitate post-discharge care. Furthermore, the dedicated section will ensure CHF patients spend more time with nurses offering the program and gain more than they do under the current program.

Education will cover aspects such as daily physical exercise strategies of CHF patients after discharge. Walking around the homestead is a natural process of managing CHF that nurses can only emphasize to CHF patients through a comprehensive education program. In a similar vein, nurses can teach patient how to behave in case of emergency and progress monitoring skills after discharge. In case hospital offers home monitoring and structured telephone follow-ups, the education program should improve the communication skills of CHF patients that allow convenient post-discharge remote monitoring process.

In short, the dedicated training program will improve the quality of care for CHF patients admitted to the hospital. It will equip patients with knowledge and skills to enhance their self-care behaviors as well as self-reliance. In other words, the education program will create a foundation for proactive rather than reactive management of CHF patients after discharge. Enhanced self-care behavior will increase the efficiency of nurses during post-discharge follow-ups in that nurses will be directing people who already know and understand self-care strategies for managing CHF.

Rationale for Selecting the Proposed Solution

One of the trends in the provision of health care services is to provide a patient-centered care strategies rather than nurse-centered approach. By equipping CHF patients with adequate self-care education, they can conveniently manage their conditions after discharge thus reducing 30-day readmission frequency. As hospitals face acute shortage of workforce, it becomes difficult to conduct post-discharge follow-ups adequately. The workload on the existing nurses and other health professionals makes the post-discharge follow-ups ineffective even if they are in place. Evidently, equipping CHF patients with adequate self-care knowledge and skills is the modest strategy of reducing readmission rates within 30-days. Providing education on issues such as diet, physical exercises, management of remote monitoring system, and medication enable patients and their families to be almost self-reliant. It saves the time of nurses who manage post-discharge care, promotes continuous care among CHF patients, and improve the quality index score of the institution.

Evidence of Literature Review

Navidian, Yaghoubinia, Ganjali, & Khoshsimaee (2015) evaluated the impact of self-care education on awareness, attitude, and adherence to self-care attributes among patients with CHF. The authors recognize the various self-care skills that patients with CHF should understand given their precarious health condition. Through a quasi-experimental design, the researchers recruited 70 CHF patients for the purpose of the study. Findings indicated that patient education programs improve awareness, attitude, and adherence to self-care behaviors among CHF patients. However, the authors caution that nurses should assess the psychological characteristics of patients before assigning them to the programs. The article provides vital benefits of patient education, that is, awareness, attitude, and adherence to self-care habits. In a similar vein, Adib-Hajbaghery, Maghaminejad, & Abbasi (2013) also identified patient education as one of the key strategies post-discharge continuous care for CHF patients. The article also identifies other strategies such as home visits and telephone calls follow-ups.

Apparently, the two literature emphasize the role of patient education training on self-care in reducing early readmissions. Patient attitude towards CHF management can change positively after gaining comprehensive self-care knowledge. Similarly, patients’ awareness and adherence to the self-care behaviors improves the quality of life after discharge. The studies also show that shifting the perspective of CHF care from nurse-centered to patient-centered is convenient through comprehensive patient education and training. Therefore, I feel the project is necessary to feel the gap at the institution.

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Logistics

The implementation logistics will happen in phases starting with getting the approval of the project from both the IRB and organization’s management team. From the outset, I will collaborate with the institution’s project coordinator to ensure that the I receive support and authority to proceed with the project. The second phase will involve selecting a project team to facilitate a pilot study and later report its findings to the management for full implementation. The teaching of project members on the new education program for CHF patients will happen at this stage. I will lead other project team members selected among the staff to design the research activities, budgets, and start the pilot study.

Before starting the pilot study linked to the project, the third phase will involve communication with other stakeholders such as patients and staff members from the CHF department and patient education department to ensure the project receive support and coordination from relevant sections of the institution. The phase will involve patient recruitment in project – which includes selection, seeking consent, teaching them about the project, and financial support necessary. Also, post-post-discharge evaluation of the progress of patients who participated in the program, and compare the results with the control group will part of this phase. The last phase will involve collecting data from the pilot study, analyze the data, and present findings for full implementation depending on the outcome of the pilot study.

Relevant Resources for Implementation

Educational material such as pamphlets, handouts, posters, PowerPoint presentations will assist in teaching the staff on best practices for patient education and training – specifically for CHF patients. Office space for conducting the CHF patient education program will be needed as well as assessment tools. Importantly, the project will require a substantial financial resource to facilitate operations such as seminars, the motivation for staff participating in the program, and purchase of necessary equipment.