HEART FAILURE PATIENT SELF-CARE: AN EVIDENCE-BASED OUTPATIENT MANAGEMENT PROGRAM

Purpose: The purpose of this evidence-based practice project is to incorporate an outpatient self-care management program for heart failure (HF) patients recently discharged from the hospital, to reduce hospital admissions and improve patient self-care.

Background: According to the American Heart Association, there are over 5 million people in the United States with HF and projections suggest its prevalence will increase by 46% through 2030. Heart failure is also the most common cause of hospital admissions in the United States for patients age 65 years and older. Despite health system improvements, national readmission rates remain high at 23%. However, significant evidence exists that HF self-care management programs can improve patient self-care and decrease HF related readmissions. While HF management focuses on ensuring evidence-based therapies are prescribed, providers often fail to assess the patient's and/or caregiver's ability and self-confidence to provide adequate self-care. Current guidelines recommend health professionals provide comprehensive HF education and counseling that is focused on knowledge, skills of management, and self-care behaviors. In the project facility, there was no educational outpatient HF self-care patient management program.

Process: The purpose of this evidence-based project is to increase HF patient self-care knowledge and behavior by 10 % and reduce readmissions at a cardiology clinic in southern California. Brown and Ecoff's Evidence Based Practice Institute Model provides the foundation for the project. All participants discharged from the hospital with the diagnosis of HF were seen in the outpatient HF clinic within 14 days and were evaluated using the validated self-care of heart index questionnaire (SCHFI). One week after their outpatient discharge follow-up, each participant and/or caregiver received an individualized and structured one-hour educational nurse visit, utilizing the teach-back method, focused on improving HF self-care behaviors. Telephone follow-up support calls were made on a weekly basis for 5 weeks to assess self-care, address any barriers, and mitigate worsening symptoms. At the end of the program, self-care behaviors were reevaluated using the SCHFI. A chart review is completed to review readmission rates of participants at 30 and 60 days.

Outcomes: In progress. It is anticipated that self-care scores of participants, using the SCHFI, will increase by 10% at completion of the program and readmission rates will be less than the national average of 23%.

Conclusion: Evidence-based outpatient HF self-care management programs can improve patient self-care knowledge and behaviors resulting in reduced readmission rates. Preliminary findings suggest a program led by an advanced practice nurse supports the need for individualized outpatient management programs designed to support and improve self-care behavior in HF patients