Lab Results And How Follow Up Will Occur

When nursing any patient with heart failure it is important to have an understanding of how the heart should work to understand how it stops working correctly. This knowledge is important as writtler (2006) (cited in Jones) feels that district nurses have little knowledge when it comes to heart failure. Patient, Writler (2006) feels that by understanding how the heart works and how it is damaged we, as district nurses will be able to recognise the signs of heart failure earlier7a?.

Providing patients diagnosed with Congestive Heart Failure effective teaching can eliminate reoccurring hospitalizations. Patients are discharged with CHF and readmitted within 30 days. The information provided will examine the process of enhancing patient knowledge and provide additional resources essential for effective health care management. Research evidence provides data that proves patients who are diagnosed with CHF needs a variety of health care needs during admission and after discharge. The proposal will display an evaluation plan, implementation plan and a dissemination of the

The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) core measures in relation to Heart Failure (HF) was examined using empirical-based nursing research. Findings suggest that lack of understanding by nurses contributes significantly to the privation of core measure implementation. A significant number of Americans suffer from HF, so patient quality of care assessment was necessitated. Identifying factors were: nurse-patient education resulting in follow-up appointments, left ventricular performance or left ventricular systolic (LVS) function, treatment medications, and smoking cessation programs. Nurses provide an important role in the education of patients with HF. The Nurse is integral in providing documentation in relation to LVS. Nurses play an important role in the administration of HF medication. Smoking, a major cause of HF, requires special nursing intervention. Nursing results in improved quality of care if HF core measures are implemented properly. Additionally, Orem’s universal requisites are fundamental in the nursing process.

Each year the number of readmissions of the heart failure patient within 30 days of discharge has grown. The Medicare division in relation with the Affordable Care Act is reducing the amount of money they are willing to pay for readmissions to the hospital. Hospitals are now more than ever looking for ways to reduce the number of readmissions to the hospital for the heart failure patient. The purpose of this paper is take a look at a program designed with to reduce the readmission rates of one hospital to reduce the number of readmission through improved education and follow up of the heart failure patient.

PICOT question: In elderly patient with congestive heart failure, how adequate multidisciplinary education compare with lack of education could reduce hospital readmission rates over a 6-month period? The research questions are: Does multidisciplinary education help elderly patient with CHF to adequately manage the disease at home? Does improve knowledge in the disease could decrease hospital readmissions in CHF patient? The hypothesis states that multidisciplinary approach and proper patient education will decrease readmission rate in elderly patients with CHF. The purpose of the study seeks to articulate the problem of lack of education for older patients with congestive heart failure regarding how to manage

A resident at the time saw that although there is a hearty amount of evidence that illustrates that adhering to heart failure guidelines decreases the rate of mortality and morbidity, nationally there is modest adherence to heart failure practice guidelines. Doctors have voiced a multitude of reasons to this poor participation including but not limited to time constraints in a visit, inertia of patterns in practice, lack of awareness and lack of acceptance are a few. This new web-based tool, the “Smart” Heart failure sheet is designed to help connect previously compartmentalized information. It seeks to link guidelines to their patients’ clinical and laboratory characteristics and systematize adherence to heart failure guidelines. It accomplishes this by uploading pertinent patient-specific data, including laboratory and imaging results, procedure reports and relevant medications. Additionally it also provides tools, such as a flow chart for diuretic dosage and weights. Overall this tool is useful to help physicians identify patients who may benefit from a treatment. From there it provides support tools that alert the physician to a personalized medical treatment. The “Smart” Heart Failure Sheet acts as a registry for scholarly research and also provides educational resources to expand providers’ knowledge, thereby improving patient care (Battaglia,

Rising health care cost and stricter regulations for insurance reimbursement plans have pushed health care leaders to re-evaluate health care services. One focus is reducing hospital readmission rates for chronic disease process (Bos-Touwen et al, 2015). Congestive heart failure is one of the leading causes of hospital readmission (Cubbon et al, 2014). Fifteen million people worldwide have a diagnosis of CHF. In addition, 15-20% of those with the diagnosis of CHF are hospitalized yearly (Sahebi et al, 2015). In 2010, 40 billion dollars was spent on health care needs for CHF patients. Seventy percent of the resources were for hospital services (Siabani, Driscoll, Davidson, and Leeder, 2014). The need for streamline healthcare for CHF patients is imperative to improve overall patient outcomes and reduce the amount of hospital readmission rates.

• What is the role of specialist heart failure nurses in the interdisciplinary team in managing improving outcomes of heart failure patients?

With heart failure, increasing in incidence in the United States, hospital readmission rates are being scrutinized to save money, especially for Medicare beneficiaries. Over 5 million people in the United States are living with heart failure, defined as “a condition in which the heart cannot pump enough blood and oxygen to support other organs in the body” (CDC, 2013). Heart failure affects 2.4% of the United States population with nearly 12% of both women and men 80 years and older having heart failure (Heidenreich, P. A., Albert, N. M., Allen, L. C., Bluemke, D. A., Butler, J., Morrow, G. C., Ikonomidis, J. S., et al., 2013). Heidenreich et al (2013) project that by 2030, heart failure will affect over 8 million Americans, with 2 million of those being ages 80 years and older. Heart failure is one of three conditions to be included in the Centers for Medicare and Medicaid Services (CMS) reimbursements that hospitals are penalized for if the hospital experiences an excess amount of readmissions within 30 days of the initial hospitalization due to the disease.

Congestive Heart Failure (CHF) and Heart Failure (HF) are serious problems in regards to hospital re-admissions especially regarding the sixty-five year old population. Data demonstrates approximately over 670,000 individuals each year are diagnosed with CHF, along with that there are 6 (six) million Americans affected with CHF. Hersh, Masoudi, and Allen (2013) described readmissions of patients with CHF is increasing by 25% within thirty days of discharge from the hospital. This creates a huge impact on the taxpayers and patients due to the increasing percentages being re-admitted into the hospitals (Post discharge Environment Following Heart Failure Hospitalization: Expanding the View of Hospital Re-admission, 2013). The problem is to identify a plan to decrease the CHF/HF hospital re-admissions into the especially regarding the 65 (sixty-five) year olds and older, in spite of efforts from the hospital staff providing guidelines and nursing education regarding CHF/HF signs and symptoms.

The corresponding author, Dr. Hernandez of Duke Clinical Research Institute and Department of Medicine, conducted a study examining the relationship between physician follow-up care and 30-day hospital readmission rates in heart failure patients. Fonarow, Heidenreich, Yancy, Peterson, and Curtis, all doctors in specialized cardiac hospitals, along with researchers, Ms. Greiner and Mr. Hammill, contributed in the undertaking of this study. The intended audiences are clinicians and nurses assisting in the transitional care from hospital to home in heart failure patients. This was a qualitative, observational analysis examining the Medicare claims of physician visits within seven days of hospital discharge and readmission claims within 30 days of discharge. The strengths of this study include the large population of over 30,000 patients and the 225 hospitals, which allow for a more identifiable relationship of variables. A weakness of the study that could affect readmission rates would be the lack of consideration of patients involved in remote health-monitoring programs, a form of follow-up care. Even with this limitation, results prove that patients seen by a physician within seven days of discharge were less likely to be readmitted. This study confirms that nurses and clinicians should design discharge plans that include promptly scheduled appointments with a physician following discharge. Making this appointment for the patient and confirming it with them during their discharge teaching will aid in more compliant follow-up care, and ultimately reduce the risk for readmission.

Compliance takes priority. Julie devised and maintains the emergency room physician log which lists the supervising physician for each day. The thorough charting and initial treatment plans exceed the requirements set by CMS. Physician chart reviews and reports are completed in a timely fashion. She researched the specific criteria for the newly determined coverage requirements for patients with congestive heart failure (CHF) whereby she initiated an easy-to- follow document for physicians to utilize for coverage criteria when a patient has a diagnosis of CHF. She seamlessly transitioned her program’s referrals from the ICD 9 codes to the ICD 10 diagnosis codes for pulmonary and cardiac rehabilitation this past year. In addition, she has the responsibility of tailoring all of the corporate policies and procedures to meet the needs of the program at Fannin Regional Hospital, as well as reviewing and revising these fifty-four policies annually.

During exacerbations of Congestive Heart Failure (CHF), older patients may receive care in multiple settings; often resulting in fragmented care and poorly-executed care transitions. The negative consequences of fragmented care lead to duplication of services; inappropriate or conflicting discharge instructions, medication errors, patient/caregiver anxiety, and increased costs of care. In light of changes in Medicare reimbursement penalizing hospitals with above set limits for heart failure (HF) readmissions, models of care are being evaluated for their effectiveness in satisfying this change as well as reducing fragmented care in this population. This paper reviews the Transitional Care Model created by Dr. Mary Naylor at the

Case Study 2 involves a geriatric patient, Mr. P., who is having difficulty managing his congestive heart failure (CHF) and cardiomyopathy (GCU, 2013). For one to find the best way to help him, one must have an understanding of his disease processes. This paper will briefly describe congestive heart failure and cardiomyopathy. It will look at the nurse’s approach to care and define a treatment plan. The treatment plan will include methods for educating Mr. P. and his wife. Furthermore, a teaching plan will be included with language the patient and the wife will understand.

Management will evaluate the significance of nonconforming work and notify clients in writing within three days of the investigative conclusion. Management will document to the client how the reported test results were affected. The laboratory Corrective Action Report will indicate the name of laboratory personnel who notified the client(s).