Evaluation of Written Inpatient Heart Failure Education to Support Self-Care at Discharge

Evaluate Written Inpatient Heart Failure Education to Support Self-Care after Discharge

ABSTRACT:

Background: The leading cause of hospital readmission is adults with heart failure. Readmission rates in less than thirty days are a key indicator of inadequate health care and as a consequence, the Hospital Readmissions Reduction program requires the Center for Medicare Services to reduce reimbursement rates and fine hospitals with excess thirty day readmission rates for patients diagnosed with heart failure. Research supports that patient education provided at the appropriate literacy level related to self-care: to include medication knowledge, access to healthcare and symptom exacerbation recognition, decreases thirty-day readmission rates for adults with heart failure. The current American College of Cardiology /American Heart Association (ACC/AHA) evidence based guidelines for the care of heart failure patients support education related to self-care as outlined above. The recommended literacy level for patient education is a 4th to 5th grade reading level.

Purpose: The purpose of this project was to evaluate written heart failure inpatient education materials from a hospital and revise to the appropriate literacy level for the target population and to align with the ACC/AHA standards. The secondary purpose is to evaluate the current standard of care for inpatient heart failure education and make evidence based practice recommendations.

Project: The project was conducted at a 581 bed not-for-profit community hospital with magnet status in the cardiology department. Written inpatient heart failure education was compared to current literature and ACC/AHA standards for patient education.  A manual Fry scale was completed for literacy evaluation of all written heart failure patient education to ensure efficacy. A stop light system for self-care and symptom management was used in the new written education, revised at a fourth grade literacy level. In addition, the revised written instructions were translated to Spanish. A system distribution gap identified that unit specificity impeded efficient nurse led patient education. Collaborative meetings with vested cohorts at the hospital were attended by the DNP student to attain approval during the formulation of new written education. Cost, document length, literacy level, language, and ACC self-care guidelines were used when the Heart Failure Committee, cardiologists, and practice improvement committees debated the editorial recommendations to the new inpatient education as suggested by the DNP student.

           English and Spanish versions of the revised written materials, praised by the patient advocate committee for applications to improve lifestyles of patients with heart failure, were distributed to all units. The evidence-based revisions shortened the length of the written document, saving the institution an estimated $8,880 a year. EMR was revised with a text box for nurses to document patient’s personalized self-care goals related to the color of their day as stated in the new patient education booklets.