Cardiac care education receives high marks
Care becomes consistent, more efficient
A Minnesota-based home health company made staff education a crucial component of its new cardiac home care program, which focuses on patient compliance and monitoring in the home.
The program’s goals are to reduce cardiology related costs, including reducing the number of inpatient stays and emergency department visits.
"We gear education to a lot of compliance issues, and we believe whoever is entering the home has to be able to relate to specific issues of cardiac patients," says Jody Nurik, RN, vice president of product development for In Home Health Inc. of Minnetonka, MN. In Home Health is a publicly traded company with 43 branches in 15 states, including one in Greensboro, NC, where the program was launched.
"We are starting to gather important initial outcomes baseline data," Nurik says.
"The program is still too new to have collected enough outcomes data, but anecdotal evidence is promising," says Katrina Lane, QI supervisor and former staff education director of In Home Health in Greensboro, NC.
"We had a female patient in her sixties, who was hospitalized three times in a two-month period with congestive heart failure, unstable angina, and hypertension," Lane relates.
Then the branch started the cardiac care program. Through its careful assessment, constant physician contact, and medication management, the staff was able to stabilize her without any repeat emergency room visits and hospitalizations for five months.
"They did a follow-up heart catheterization, and it showed no progression of diseases. She didn’t require any further procedures," Lane adds.
In Home Health’s program consisted of six inservices held for nurses who already had a cardiac background or a strong interest in cardiac care. One inservice was devoted to teaching nurses how to use clinical pathways. Other training programs showed nurses how to use EKGs and cardiac event monitoring in the home.
Home health aides are also trained to care for the cardiac patient in the home.
Lane and Nurik offer the following tips based on their own experiences of how to improve cardiac care educational programs:
• Have nurses teach high-risk patients what to do when they feel chest pains or other symptoms of cardiac disease.
"We provide instruction and reinforcement of their disease process, so when they’re starting to feel symptomatic, they have a better appreciation of what triggers problems," Nurik says.
The patients are told when to call the on-call nurse, physician, and 911 emergency number. Lane says it has helped both the patients and staff. Now that the patients know what to expect with certain symptoms, they are less likely to panic unnecessarily or do the opposite of ignoring problem signs.
"The nurses were worried we would get all these calls from cardiac patients," Lane says. Instead, they discovered that the cardiac care patients rarely call because now they know when it is important to call for help, and they know exactly who to call.
• Teach nurses how to use EKGs and how to use cardiac event monitoring more proficiently.
In Home Health’s cardiac equipment instruction includes classroom work and an in-home demonstration.
In Home Health uses what is called a single-lead cardiac event monitoring. This system is hooked up to the patient, so when the patient has a change in heartbeat, the machinery will record an EKG and transmit it over the telephone to the physician or the home care office.
Another system used is an event monitor that the patient wears for several days. When the patient has chest pains, he or she can press a button, and the equipment will record what happened one to two minutes before and after the pain. It works by continually reading the patient’s heartbeat, but it will not start until the button is pushed by the patient.
"Teaching nurses about monitoring equipment involves an inservice," Lane says.
In Home Health also trains case managers to use the monitoring equipment "in case they should ever need to see a patient who had a cardiac event monitor," she adds.
The company that manufactures the equipment trained Lane on the use of the equipment. As a result, she provides all the necessary training to her staff.
• Obtain patients’ cooperation in staying with the program even when they feel well.
Often cardiac patients will become less diligent at taking their medications and following their diets once they begin to feel better.
In Home Health’s program worked at breaking the trend by providing a seamless management approach that ensures that the patient will learn to stay healthy through lifestyle management, diet, and exercise. Case managers are assigned to work closely with each patient.
Nurik says the clinical pathways guide staff through each patient’s particular condition state and how often that patient should be seeing nurses and therapists. The clinical pathways also give specific goals for teaching and assessing each condition.
One change the Greensboro branch office made to help with this seamless process was to reduce the number of clients handled by each case manager, Lane says.
"We found that our cardiac case managers could not carry as large a load as other case managers because of the complexity of the cases," she explains.
"Many of these patients have multi-system problems, such as cardiac, renal, insulin dependency. They tend to be sicker, i.e., post-op open heart surgery patients coming home within four to five days," Lane adds.
• Teach nurses how to assess patients’ exercise levels, and teach aides about cardiac care nutrition and exercise programs.
In Home Health’s aides are taught to note the number of stairs in a patient’s home and to ask the nurse whether the patient should be taken up and down stairs.
Nurses assess the patient’s kitchen foods by checking the cabinets with the patient to see what they typically eat, Lane says. The nurses teach the patients about dietary changes, such as substituting low-sodium soups for regular types, and the aides assist with the patient’s compliance.
"We had to explain to nurses how to determine a patient’s starting point for exercise," Lane says. The clinical pathways show nurses exactly how many minutes to have a patient walk, how to assess their progress, and when to stop the exercise.
"Some patients’ cardiac status is so severe that they can’t exercise on a regular exercise program, and we have specific guidelines from doctor’s orders about their exercise," Lane adds.
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