The Link between Cardiac Recommendations and Nursing Interventions at Discharge
A 2005 study designed to evaluate the efficacy of the recommendations released in 2004 by the American College of Cardiologists and the American Heart Association to improve clinical outcomes of heart failure patients found one-third of the patients in a preselected group did not receive discharge instructions. And except for the use of ACE inhibitors, there was not a strong predictive link between the ACC/AHA recommendations and re-hospitalization or mortality. Another 2005 study, “Discharge Education Improves Clinical Outcomes in Patients with Chronic Heart Failure,” published in Circulation, demonstrated that patients with systolic heart failure who received a one-on-one session with a cardiac nurse educator at the time of discharge had a 35 percent lower rehospitalization rate.
The ACC/AHA study, “Association between Performance Measures and Clinical Outcomes of Patients Hospitalized with Heart Failure,” published in the January 2007 volume of the Journal of the American Medical Association, examined the data on re-hospitalization and mortality 60-90 days post discharge of patients initially admitted for heart failure. The five ACC/AHA recommendations to improve the quality of care include the use of cardiac medication and diagnostic evaluation; two directly concern nursing practice.
The first calls for discharge instructions that include dietary, daily weight, and activity instruction, as well as medication direction, follow-up appointments, and what to do if the condition worsens. The second recommendation calls for offering smoking-cessation information. The patients were preselected from a group admitted for heart failure at 91 US hospitals.
So why don’t discharge instructions, if done, fail to show the same result? Written discharge instructions may not be an adequate substitute for a personal patient-targeted information session; the fact that discharge instructions were not documented in the chart does not necessarily mean that they were not done. In addition, the instructions may have been done but in a manner that was less than satisfactory. The benefit of 60-90 days of smoking cessation may not yet be evident, or more active encouragement during that period may be needed.
Congestive heart failure is the leading cause of hospitalization in people over 65. It is estimated that it causes approximately one million admissions to US hospitals each year at a direct or indirect cost of $60 billion. These staggering figures challenge us to ensure that the therapies we adopt as standards of care at discharge are effective in improving the clinical outcome of heart failure patients, that they are carried out in a manner that is well documented, and that our competency in doing so is measurable.
Christine Contillo RN, BSN, has worked as a nurse since 1979, and has written extensively for various nursing publications as well as the New York Times.
This article is from workingnurse.com.