Review of teaching helps patients remain compliant
One call is all it takes!
With the length of hospital stays for many procedures steadily on the decline, it’s impossible to teach patients all they need to know before discharge. That was the dilemma staff faced with patients who had cardiac interventions at Fairview-University Medical Center in Minneapolis.
"From the moment they come into the hospital, we teach them and teach them, but they only remember about 20% of the information," says Paula Varhol, RN, cardiology aftercare coordinator at the medical center.
Therefore, hospital administration decided to try a new strategy and complete the teaching with follow-up telephone calls after discharge. Now staff teach the patient survival skills during the hospital stay, create a plan for self-care to reduce the patient’s risk of a second heart attack, and provide a packet of written information for patients to review at home. After discharge, Varhol calls the patient at certain intervals to reinforce teaching, help the patient solve compliance problems, and provide the patient with any new information he or she needs.
Before initiating the program, the hospital created a database with the aid of a consultant. It was designed according to Varhol’s specifications and cost approximately $3,000 to develop. The database helps her track each cardiac patient.
When she enters the patient’s name into the computer, the patient’s demographics appear on the screen. The second page on the database has the patient’s medical history such as diagnosis, tests, and procedures; risk factors; and the diet the patient is to follow. The third page has a list of the patient’s medications and the telephone numbers for his or her primary care physician, cardiologist, and surgeon. The last page can be used as a script during the follow-up phone calls. It has a list of issues to discuss such as diet, exercise, smoking cessation, and other medical problems the patient has.
Varhol learns which patients have had cardiac interventions and will therefore participate in the program during the interdisciplinary daily rounds at the hospital. At that time, she writes down patients’ names and visits them before they are discharged. During the visit, she introduces herself and makes sure the patient has been given all the materials he or she needs. For example, if the patient is a smoker, Varhol makes sure smoking cessation pamphlets are in the packet of written materials.
The phone calls begin 48 to 72 hours postdischarge. Each phone call is made with a specific agenda and can last from 10 to 15 minutes to an hour depending on what problems patients might be having. They include:
1. The first phone call is referred to as a "survival call." Frequently, the patient is not sleeping well and doesn’t have an appetite.
"We want them to know they are surviving and they are feeling the same way everyone else feels after heart surgery," says Varhol.
Varhol asks about the patient’s incision and whether he or she has scheduled a follow-up appointment with the doctor and had prescriptions filled.
2. The second call is made one week after the first. During this call, Varhol begins discussing diet choices and makes sure the patient has begun the exercise program the cardiac rehab center designed for him or her. Many times people are fearful of exercise, so she encourages them to get started.
3. The third call is made one month after discharge and, for the first time, truly focuses on educating the patient. Varhol reviews the patient’s medications to make sure he or she understands why they were prescribed. She discusses the patient’s exercise program and dietary changes. All patients have the written information, and she asks them to pull it out and review it with her.
4. The fourth call is made two months after discharge. By this time, most people are back to their normal routine, so Varhol is able to make sure they are not falling back into old habits. Basically, Varhol discusses their plans for modifying their risk factors.
For example, if they are back at work, she asks what they are eating for lunch and reminds them that even at fast food restaurants such as McDonald’s they can make the right food choices. If they need help, Varhol mails information on how to select low-fat items in restaurants.
She goes over their exercise routine to make sure they are exercising regularly at their target heart rate.
5. The last call is made six months after discharge. At this stage, people feel great, so they quit exercising, fall off their low-fat diet, and often begin smoking again.
"This call is to get them back on track," Varhol says.
She reviews their self-care plan, mails them information such as low-fat cookbooks, and refers them to a class if they need additional help.
Once the telephone follow-up ends, patients are encouraged to call Varhol if they need help.
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