Use dedicated nurses to create teaching plan
Cardiac patients assessed for educational needs
An educational process at Sacred Heart Medical Center in Spokane, WA, ensures that cardiac patients admitted to the hospital receive the appropriate teaching.
To complete the education in a timely manner, a teaching plan is set in place. That plan is communicated to the appropriate people, educational materials are used to reinforce teaching, teamwork is emphasized, and referrals are made to home health and rehabilitation programs when needed.
A small cardiac rehabilitation department is located on the cardiac unit that includes two inpatient floors and an outpatient observation floor. Every morning the patient roster is sent to the cardiac rehabilitation nurses that staff the department. They review the patients' charts to determine why they were admitted and what education should be provided.
"We set the plan for the nursing staff. The nurses do a lot of patient education but we also work with the patients," says Gladys Evans, RN, BSN, CCRN, a cardiac rehabilitation nurse at Sacred Heart Medical Center.
In order to make sure that all patients with heart disease are identified the case management staff on other units alert the cardiac rehabilitation department when they have a patient with primary heart failure, says Evans. In addition, the lab department sends the results from all B-type natriuretic peptide tests so the cardiac rehab nurses can review them and determine if the patient is having pulmonary problems or has congestive heart failure (CHF).
Identifying CHF patients on other units is a priority because heart failure is one of the health care quality initiatives at Sacred Heart Medical Center.
To determine the plan for education the cardiac rehab nurses look at the diagnoses, read through the chart to find out why patients were admitted, pull lab results together, and review family history.
Instruction follows the information provided to patients in a three-ring notebook titled Living with Heart Disease. All cardiac patients receive this notebook when admitted. Staff have a similar notebook that covers what needs to be taught for each particular diagnosis. For example, if the patient had a heart attack, teaching would cover such information as risk factors for heart disease and home exercise guidelines.
The notebook is kept at the patient's bedside and the cardiac rehab nurses, as well as the floor nurses, encourage patients and family members to read and re-read the sections that have been highlighted.
"I sit down with them and say, ‘This is the information I would like you and your family to read. These are the key points that I am going to talk to you about.' I start with general topics and then the next time I see the patient I go a little bit further into that topic," says Evans.
For each topic in the notebook the hospital developed accompanying videos that run eight to 10 minutes. They are shown through the closed-circuit television system. Patients read certain sections of their notebook, watch a video, and discuss the information with a nurse.
If patients have a lot of questions about a particular topic, a specialist is called in for more in-depth teaching. Frequently Evans has a dietitian provide specific information.
"I try to have the patient think about how they typically cook, what they typically eat, what they typically buy for groceries so our dietitian can help them make one or two changes that will make a difference," says Evans.
The health care facility has a computerized clinical documentation system so education can be easily tracked. In addition, discharge instructions are entered in the system as soon as a cardiac rehab nurse evaluates the patient to ensure educational needs will have been met by the time of discharge.
Three times a week a 45-minute discharge class for patients who have had open heart surgery is available for family members and patients to attend. Evans says heart surgery patients often are not well enough to come to the class until they are ready to be discharged. However, she encourages family members to attend as soon as the patient has been transferred out of the cardiac intensive care unit so they can go over the discharge instructions in advance.
"In this way they know how to care for the incision and they know what activity their family member is supposed to do so I think it helps alleviate a lot of anxiety also," says Evans.
It is important to include family members in the education as much as possible so everyone knows the plan of care, she explains.
Part of the discharge process is to refer the patient to an outpatient cardiac rehabilitation program close to where they live. Patients are asked to give their permission for a community program to contact them.
"We let each community program talk with the patients, and they can determine if they can be of service but it is an important link to making sure patients get information they need. Our hospital services quite a few outlying communities," says Evans.
These communities include eastern Washington, northern Idaho, and a portion of Montana and Oregon.
It's important for patients to have a resource especially if they have CHF, says Evans. These patients need to take their medication correctly, follow a low-salt diet, and weigh themselves every day. Often they don't realize that if they gained two to three pounds in a day it is extra fluid and they might have to get medical advice before they are short of breath and must be admitted to a hospital.
The notebooks that patients take home with them also provide a quick point of reference. They help provide that continuum of education should a patient require home health service following discharge, says Evans.
"When patients are in the hospital they are ill and stressed. That is why we repeat information a lot. They may not hear it the first time but each time you talk with them they pick up a little bit more information," says Evans.
Sources
For more information about creating teaching plans for cardiac patients to ensure a safe discharge, contact:
- Gladys Evans, RN, BSN, CCRN, cardiac rehabilitation nurse, Sacred Heart Medical Center, 101 West Eighth Ave, Spokane, WA 99220-4045. Phone: (509) 474-5454. E-mail: [email protected].
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