Documentation, assessment add up to improvement
Raising dyspnea scores requires education
Increasing the percentage of patients who show improvement in dyspnea from the 2005 baseline score of 57.6% to 73% in November 2007 earned a certificate of achievement from the Oklahoma Foundation for Medical Quality (OFMQ) for Sequoyah Memorial Homecare-Home Health in Sallisaw, OK.
The higher score was the result of a performance improvement effort that focused on dyspnea, according to Penny Martin, RN, director of home health for the agency. "We developed a plan of action and used tools from OFMQ to help us improve our care of patients with dyspnea," she says.
One of the first steps taken was formal training on how to score the OASIS items related to shortness of breath, says Martin. "We realized that we were not always getting a good baseline during the initial assessment so we held training classes to make sure everyone assessed shortness of breath the same way," she says.
Consistency is also important when teaching patients, points out Bonnie Dixon, RN, BSN, director of Dunn Memorial Hospital Home Care in Bedford, IN. Dixon's agency improved its rates for improvement in dyspnea from a baseline of 49.44% to 63.07% in the first year the agency tackled dyspnea as a performance improvement project. The rates have fluctuated some since the first year of the program but remain around the national average of 61%, she adds.
"I've learned that just by starting a performance improvement project and talking about a specific issue, you raise awareness and see some improvement," admits Dixon. The real challenge is putting tools into place to keep staff members aware of the ongoing importance of activities such as teaching, she says. "We reviewed literature and tools that are available from different sources and selected best care behaviors to implement in our agency," she says.
"We developed a dyspnea teaching packet and we developed a care pathway for dyspnea," says Dixon. By standardizing the teaching and the clinical decisions, all staff members were able to make sure that nothing was overlooked, she says.
"We also saw a need for a smoking cessation program," says Dixon. Her patients live in rural areas in southern Indiana, and are farmers and foundry workers, she says. "There are a lot of smokers and ex-smokers so we have a lot of patients with lung cancer and chronic obstructive pulmonary diseases," she says.
The teaching packet contains information on dyspnea and tips on how to minimize shortness of breath, says Dixon. "We have tips such as elevate the head of the bed, avoid crunching the stomach, use a fan to blow air directly at the face to minimize hunger for air, use oxygen if necessary, and stop to rest before activities that increase shortness of breath," she says.
Increasing the percentage of patients who show improvement in dyspnea from the 2005 baseline score of 57.6% to 73% in November 2007 earned a certificate of achievement from the Oklahoma Foundation for Medical Quality (OFMQ) for Sequoyah Memorial Homecare-Home Health in Sallisaw, OK.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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