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The quality improvement project examined the impact of nurses' education on heart failure (HF) self-care management principles and use of the teach-back method on readmission in progressive care units. Educational interventions can increase nurses' knowledge of HF self-care management principles, and use of the teach-back method can help ensure patients receive optimal discharge instructions.
Juan Caluyo, Jr.
The Centers for Disease Control and Prevention (2020) reported approximately 6.2 million adults in the United States have heart failure (HF). The American Heart Association (AHA, 2018) estimated the annual cost to treat HF is more than $30.7 billion. Included in the cost are hospital readmissions. Hospitals in the United States readmit more than 20% of patients with HF within 30 days, and as many as 50% within 6 months (O'Connor, 2017). The Centers for Medicare & Medicaid Services (CMS, 2018) Hospital Readmissions Reduction Program developed a 30-day risk standard readmission measure comprised of two criteria: (1) HF-specific readmission attributable to the care received during hospitalization and transition to the outpatient setting with worsening HF signs and symptoms; (2) all-cause readmission, unplanned readmission requiring urgent acute care management for any other reason.
Patients' lack of understanding about HF management is a leading cause of readmission (Ruppar et al., 2016; Ruppar et al., 2015). HF management begins on hospital admission and continues through discharge. It also includes medication adherence, which may be difficult when most patients take at least six medications daily (AHA, 2018). Some patients struggle to understand medications' indications and side effects (Mullings & Sankaranarayanan, 2017). Some patients may discontinue a medication because they did not receive enough information. Patients and family members may not feel comfortable asking questions and tend to hide feelings about the information provided. Thus, the period before discharge is an important time to provide valuable information and reinforce many self-care activities that promote HF management. Registered nurses have an essential role in educating patients in a manner that reduces opportunities for readmission.
Healthcare leaders are taking substantial interest in patient education that promotes collaboration between the patient (and family members) and healthcare team. 'The Institute for Healthcare Improvement (IHI, 2018) and the Agency for Healthcare Research and Quality (2015) recommended using the teach-back method to promote active, clear patient-provider communication across...