Nurse Practitioner-Managed Follow-up of Cariac Surgery

The purpose of this study was to determine if patients with Heart Failure (HF) who received telephone enhanced disease management led by an Advanced Practice Nurse (APN) would experience fewer HF related hospital admissions and have improved quality of life. The challenges of heart failure are

This study is aimed at reviewing the literature to find evidence-based interventions that results in a decrease in CHF readmission rates. Elderly, African American, and low socioeconomic status patients have the highest risk for hospital readmission. (Joynt, Orav, and Jah, 2011). Interventions being examined include: screening for individuals at high risk for readmission, administering beta blockers to receive the maximum therapeutic effect, and implementing effective educational programs to improve patient compliance.

Post-discharge follow-up visit remains a critical factor in ensuring that patients continue to do well after they leave the hospital. The success of the team was measured based on data collected after 6 months of revamping the discharge clinic and implementing a phone call system to patients. They had been given a choice of a phone call for discharge follow up or to come in within 7-14 days and be evaluated post discharge.

The following databases were reviewed for this systemic review: CINAHL Plus, MEDLINE, ERIC and Cochrance. The following journals were reviewed and information obtained for this systemic review: Nursing Times, Journal of Gerontological Nursing and The American Journal of Nursing. The following expert organizations were reviewed: World Health Organization (WHO) and Centers for Medicare and Medicaid Services (CMS). This systematic review was conducted by searching for “Effective discharge planning; does it decrease hospital readmission rates?”. The search was further limited by information that was published within the last five years and in the United States.

Lastly, a study by Stanik-Hutt, J., et al. (2013) provides data showing APRNs improve quality of the healthcare system. This study validates what many of the aforementioned studies have already revealed. Furthermore, clinical nurse specialists (CNS) were found to reduce the length of time a patient was in the hospital setting; patients cared for in the primary care setting had the same outcomes as MDs in regards to blood pressure, glucose and

A large study (10,911 patients) showed that APRNs demonstrated equal or better outcomes than physician groups for physiologic measures, patient satisfaction and cost. The study concluded that there were no significant differences in primary care provided by APRNs vs physicians; and actually in some parameters APRNs care was superior. While studies are needed to assess longer term outcomes, these data suggest that the APRNs workforce is well-positioned to provide safe and effective primary care (Swan, Ferguson, Chang, Larson, & Smaldone,

Literature suggests that nurses may not be knowledgeable in self-management by patients with heart failure. Sterne and her colleagues (2014) conducted a study to assess nurse’s knowledge of heart failure by reviewing test scores and evaluating the 30-day readmission rate for patients with heart failure before and after the educational program. The conclusion of this study was that the nurses gained knowledge from the program and the 30-day readmission rate for patients with heart failure decreased (Sterne et al., 2014). Educating providers will have a positive impact of patient

The role of a doctor of nursing practice professional is to transform evidence-based practice into direct patient care. As the chair of the research shared governance at Eastside Medical Center, I had the opportunity to work with a DNP professional, which enabled me to gain significant insight on the challenges and demands of providing evidence-based and cost–effective care to patients. My most important experience involves a research project on 30-day readmission rates for patients with CHF. I was able to assess unit-based core measures, obtain evidence-based research findings, and facilitate the integration of evidence-based practice that transforms nursing care at the bedside and improves patients’ outcomes. As a future DNP, I intend to lead evidence-based practice that increases the efficiency and level of care for

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

Postoperative care is the care a patient receives after a surgical procedure. The type of

For patients with existing symptoms of heart disease, the nurses role may include helping to identify risk factors and lifestyle habits that have led to the disease, as well as obtaining and documenting vital signs and diagnostic tests used to determine the extent of the disease. Education on identification of significant symptoms and the proper subsequent actions will play a major role in the patient’s ability to advocate for themselves and help them determine when it is necessary to seek care. Nursing responsibilities in caring for a patient already experiencing chronic heart failure, like the one being discussed in this review, include specialized cardiac monitoring, monitoring of vital signs and major organ function, post-procedure care, assessment and care of surgical incisions, administration of medications, managing patient anxiety and compliance, and patient education. Discharge is perhaps the most critical educational opportunity for nurses dealing with HF patients. The level of patient self care and symptom recognition and management after discharge is a significant factor relating to the prevalence of readmittance to the hospital and death in HF patients (Barnason, Zimmerman, and Young, 2011). Barnason, Zimmerman and Young (2011) reveal that one of the factors affecting the compliance with self care actions by heart failure patients is the amount of nurse directed

To contain the cost experienced by hospitals with HF readmissions, evidence based practice must be applied to avoid reduction penalties by CMS. Evidence base practice shows implementing effective outpatient measures have reduced HF readmissions by 14% to 87% (McClintock et al., 2014). These outpatient measures include case management, early follow-up care, heart failure clinics, cardiac rehabilitation, medication reconciliation regimen, mailing & telecommunications home health and targeting caregiver burden (McClintock et al., 2014). Subsequently, prior to discharge it is the responsibility of the nurse to advocate for the patient. Effective teaching and patient reinforcement of information is important to avoid readmissions of any time

One of the most frightening medical diagnoses a patient can receive from a physician is a malfunctioning heart, a diagnosis that will eventually lead to death if correction of the issue is not attempted. The heart supplies the entire body with oxygenated blood in addition to requiring its own supply of oxygen rich blood. This is why coronary arteries are vital to the hearts ability to pump. A final option to correcting non-patent coronary arteries is a surgical procedure, coronary artery bypass grafting (CABG). Every year approximately 450,000 patients have CABG surgery in the United States (Mullen-Fortino & O 'Brien, 2008). Based on continuing healthcare trends, more and more people each year are having coronary artery issues causing the need for CABG surgery to rise. Also patient demographics are changing, they are older, sicker, coronary artery blockage / damage is more extensive, and likely have a decrease in functioning of the hearts ventricles (Sidebotham, McKee, Gillham & Levy, 2007). The nursing profession not only has a critical role in caring for these patients, but also in teaching and educating them before and after the procedure. Education and teaching has been implemented into evidence-based practice for years to facilitate better patient outcomes. The goal of this literature

The results from this study can change how nurses and other health care professionals approach mobilization. Early ambulation is cost-effective, can decrease the risk of postoperative complications to patients and can decrease the hospital stay of these patients (King, 2012). Although there is great importance in early ambulation, nurses need to be aware of the barriers that prevent ambulation and need to work around them or remove the barriers all together. I believe that research is a big part of a nurse’s scope of practice because they are always reading and discovering new interventions that they can apply in the health care setting. To promote the use of evidence based knowledge, the results of the study done by Haines et al. (2013) shows

The model is guided and standardized by the Perioperative Nursing Data Set (PNDS) consisting of a variation of elements such as nursing diagnosis, interventions, and outcomes (King and Sapnas, 2007) assisting nurses to utilize evidence-based practice in providing, safe, efficient patient care. The primary goal is to optimize the patient’s surgical outcome using evidence-based best practice measures in order to provide safe and effective patient care (See Appendix A).