Making the Case: Teach Back Method for CHF Patients

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Making the Case: Teach Back Method for CHF Patients

Introduction

CHF stands for congestive heart failure. This comes about when less blood than normal is pumped by the heart, leading to excess fluids accumulation in the body. This excess fluid causes congestion in the lungs due to leakage, and can result to swelling of the feet (Albert et al., 2007).

Background Information

The number of Americans affected by heart failure is close to six million, and the number of diagnosis of CHF is approximately 670,000 as per the current statistics. It is basically among the major causes of hospitalizations for people over the age of sixty-five. CHF has also resulted to loss of lives in very many cases. 15 billion dollars is the amount that Medicare spends on re-hospitalizations, where about 17 billion dollars was the total estimated cost in 2004. There are also readmissions, which put lots of strain to patients as well as hospitals. Repeated and frequent hospitalizations are required by CHF patients, because of insufficient correlation of care. Due to a large number of hospitalizations, the yearly national financial Medicare burden is 38 billion dollars, and this is the biggest single Medicare amount. Heart failure causes the heart not to pump enough nutrients and oxygen to the body and due to this, salts and fluids are retained in the body by the kidney. If these fluids become excess, they result to swelling of feet, arms, legs and even the ankles (Boren et al., 2009).

Model for Evidence Based Practice

Some measures have been taken to curb the rising cases of heart failure, and some of them include providing education to people over the age of 50 with the need to have tests conducted on them, and provision of medicines and quality healthcare services. These and other services have been provided by governments and other institutions or organizations all over the globe, in an effort to improve health care provision. Readmissions occur differently in different hospitals, and this proves that some hospitals have better medical care than others. A hospital with fewer medical readmissions proves that it caters for its patients better, compared to the one with many readmissions. These issues of readmissions can be resolved in a very simple manner, where education should be provided to patients. This is just through simple communication between doctors and their patients, and patients should be clearly instructed on how to take their medicines and also how to make appointment follow ups. This greatly reduces readmissions in hospitals because many patients have the knowledge of taking proper care of themselves in their homes (Hagenhoff et al., 1994).

Several measures have been taken to counter attack cases of heart failures. Formal education is being provided to people both young and old, on how to live healthy lives and prevent themselves from heart attacks. Media houses are also providing home videos to reach to as many people as possible. There is also the management of hospitals, where close follow-ups are being done on patients on how they are given medications after they leave the hospitals. Hospitals have employed more doctors to make sure that all patients are catered for in the right way. Sufficient medicines and medical equipments have also been provided to hospitals to improve treatment and prevent readmissions (Kommuri, Johnson, & Koelling, 2012).

PICO Question: Does teach back education method on HF management decrease readmissions in the HF patient population?

What causes CHF? Congestive heart failures are caused by several factors. Heart muscle weakening is one of the causes of the heart failures, and this occurs because of hypertension for long time periods or after a heart attack. Consumption of large amounts of liquor also causes the heart muscles to weaken, resulting to heart failures. Cardiomyopathy is the condition whereby the cause of weakness cannot be determined, and this is because heart muscle weakening is mostly caused by infections. Abnormality in heart valve functioning also causes CHF. Opening and closing of heart valves makes sure that the flow of blood is in the intended direction, and a condition called stenosis prevents blood from flowing normally, and can eventually result to heart failures (Krumholz et al., 2002).

What is patient education, and what is its significance? Patient education is the knowledge passed to patients or non patients to prevent spread or occurrence of illnesses and also on how to curb them. Patient education is very useful, and this has been proven by many researchers. Patient education seeks to acquire many goals such as knowledge of the time to call medical practitioners, how to conduct follow up assessments, how to eat balanced diets, and also the signs and symptoms of CHF. It provides information on social support and interactions to prevent cases of stress and depressions. It provides information on self monitoring and how to take care of oneself, for example, measuring ones weight daily, management of fluids and measuring ankle circumference and diet. Education on management of medication after being discharged is also provided together with how to conduct follow-up assessments (Stromberg, 2005).

What causes readmissions of patients to hospitals? Readmissions are caused by several factors. One of them is insufficient provision of information on medicines and after-care information by medical practitioners. If a patient goes home without fully comprehending how he/she is supposed to take the prescribed medicines, a readmission is likely to occur. Care related information such as taking balanced diets and managing fluids should also be addressed. Another cause of readmission is lack of cooperation by the patients. This is whereby, patients knowingly fail to follow doctors prescriptions and instructions, for instance, patients diagnosed with CHF are advised not to take alcohol, but others do not heed to that advice, and end up being readmitted to hospital. Insufficient care provision by family members may also cause readmissions. This mainly affects the elderly, who are too old to take care of themselves, and have to rely on close family members. Some family members may be very busy and forget to give them their medicines, resulting to readmissions. Errors in hospitals may also cause readmissions, for instance, when a patient is given wrong medicines or inadequate doses (VanSuch et al., 2006).

Synthesis/Overview of Evidence

Teach back education is very crucial when it comes to reducing cases of readmissions. A research conducted by Oregon Health and Science University showed that readmission rates were reduced by eleven percent over a period of 18 months. This institution treats about 200,000 patients per year, and is based in Portland. Just like any other hospital, this hospital received readmissions within 7 days of discharging, and hence a need to address this issue. Staff and medical practitioners developed ways to get to the root-causes of this issue and later on, they came to realize that patients did not fully comprehend the instructions given after discharge. To solve these issues, they sought approval to use better heart failure management materials from North Carolina University. Patients were provided with education, with the help of a literacy expert. For full comprehension, teach back method was used with the patients. Here, patients were asked to explain treatment plans in their own ways and as a result, readmissions of patients with heart failure came down by 11 percent over a period of 18 months (Veroff et al., 2012).

Three Best Strategies

One effective strategy for reducing readmissions is telemonitoring. This is the use of technology to immediately monitor patients after being discharged, and it involves communication between patients and their nurses. Transmission of data to cater for the patients is done on a daily basis. After analyzing 11 RCTs and about 2710 patients followed up through telemonitoring, it was observed that the method led to a reduction of readmissions for heart failure patients (Wang et al., 2011).

Another strategy is outpatient caring. Heart failure patients regularly require self care because it is a chronic condition. This strategy was found to reduce the rate of readmissions by a significant percentage, and this was after a review of 19 RCTs. It was found out that early follow ups after a patient was discharged were very crucial in reducing readmissions. The third strategy is the usual care, which involves providing sufficient and comprehensive services to patients upon admission, and also following up on their progress. It was found out that hospitals that had few readmissions provided better medical care than the other hospitals. All these strategies have been found to be very crucial in reducing readmissions of heart failure patients by different percentages. This conclusion was drawn after conducting researches in different hospitals (White et al., 2013).

Conclusion

Congestive heart failure is a very serious condition and can have fatal consequences on the patients. However, this condition can be prevented, and also it can be treated. A student having knowledge about the disease is in a better position to prevent it as well as help those suffering from it to prevent it successfully (Vreeland, Rea, & Montgomery, 2011).

References

Albert, N.M., Fonarow, G.C., Abraham, W. T., Chiswell, K., Stough, W.G., Gheorghiade, M., & Young, J. B. (2007). Predictors of delivery of hospital-based heart failure education: A report from OPTIMIZE-HF. Journal of Cardiac Failure, 13, 189-198.

Boren, S. A., Wakefield, B.J., Gunlock, T.L., & Wakefield, D. S. (2009). Heart failure self-management education: A systematic review of the evidence. International Journal Evidenced Based Healthcare, 7, 159-158.

Hagenhoff, B. D., Feutz, C., Conn, V. S., Sagehorn, K. K., & Moranville-Hunziker, M. (1994). Patient education needs as reported by congestive heart failure patients and their nurses. Journal of Advanced Nursing, 19, 685-690.

Kommuri, N. V., Johnson, M.L., & Koelling, T. M. (2012). Relationship between improvements in heart failure patient disease specific knowledge and clinical events as a part of a randomized controlled trial. Patient Education and Counseling, 86, 233-238.

Krumholz, H. M., Amatruda, J., Smith, G. L., Mattera, J. A., Roumans, S. A., Radford, M. J., & Vaccarino, V. (2002). Randomized trial of an education and support intervention to prevent readmission of patients with heart failure. Journal of the American College of Cardiology, 39, 83-89.

Stromberg, A. (2005). The crucial role of patient education in heart failure. The European Journal of Heart Failure, 7, 363-369.

VanSuch, M., Naessens, J. M., Stroebel, R. J., Huddleston, J. M., & Williams, A. R. (2006). Effect of discharge instructions on readmission of hospitalized patients with heart failure: Do all of the Joint Commissions on Accreditation of healthcare organizations heart failure core measures reflect better care? Quality Safety Health Care, 15, 414-417.

Veroff, D. R., Sullivan, L. A., Shoptaw, E. J., Venator, B., Ochoa-Arvelo, T., Baxter, J. R., & Wennberg, D. (2012). Improving self- care for heart failure seniors: The impact of video and written education with decision aids. Population Health Management, 15, 37-44.

Vreeland, D. G., Rea, R. E., & Montgomery, L. L. (2011). A review of the literature on heart failure discharge instructions. Critical Care Nursing Quarterly, 34, 235- 245.

Wang, S., Lin, L., Lee, C., & Wu, S. (2011). Effectiveness of a self care program in improving symptom distress and quality of life in congestive heart failure patients: A preliminary study. Journal of Nursing Research, 19, 257-265.

White, M., Garbez, R., Carroll, M., Brinker, E., & Howie-Esquibel, J. (2013). Is teach- back associated with knowledge retention and hospital readmissions in hospitalized heart failure patients? Journal of Cardiovascular Nursing, 28, 137- 146.

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