The Impact of Nurse Education on Heart Failure Readmissions and Patient Education

2021 ◽  
pp. JDNP-D-19-00076
Author(s):  
Kimberly Mattina ◽  
Beverly W. Dabney ◽  
Mary Linton
Keyword(s):  
Heart Failure ◽  
Educational Intervention ◽  
The United States ◽  
Nurse Education ◽  
Quality Improvement Initiative ◽  
Care Hospital ◽  
Study Results ◽  
Step Down ◽  
The Impact ◽  
Nurse Knowledge

BackgroundHeart failure (HF) has become a national concern, with approximately 5.7 million adults in the United States suffering from this life-altering disease. Improved education of these patients prior to discharge helps patients manage their disease adequately and reduce symptom exacerbations.ObjectiveThis quality improvement initiative aimed to determine the effectiveness of an educational intervention in improving nurses' knowledge of HF discharge teaching and documentation of this education in patient charts.MethodsThis project was conducted at a Magnet-recognized acute care hospital with 39 critical care step-down beds. Twenty-nine nurses employed on the step-down unit participated in the educational intervention. Pre/post nurse knowledge and chart review data were analyzed.ResultsThere was a statistically significant increase in the percentage of patients receiving HF education from unit nurses from preintervention 77.0% (n = 81) to postintervention 96.4% (n = 138) (p < .001). There was also a statistically significant increase in the mean number of days patients were educated from 1.64 to 2.58 days (p < .001). Nurse knowledge also increased from pretest (69.7%) to posttest scores (100%) (p < .001).ConclusionsProviding HF educational opportunities enhanced nurse knowledge and increased their documentation of HF education in patient charts.Implications for NursingNurse educators may use the study results to improve nurse education and practices aimed at reducing HF readmissions.

scholarly journals A study to assess knowledge and skill among doctors about hand hygiene, WHO five moments, personal protective equipment’s and assess the impact of educational intervention, in tertiary care hospital, Al Qassim provenance of Saudi Arabia

2018 ◽  
Vol 5 (9) ◽  
pp. 3796
Author(s):  
Sanjay Kumar Gupta ◽  
Fahd Khaleefah Al Khaleefah ◽  
Ibrahim Saifi Al Harbi ◽  
Sinimol Jabar ◽  
Marilou A. Torre ◽  
...  
Keyword(s):  
Hand Hygiene ◽  
Educational Intervention ◽  
Tertiary Care ◽  
Educational Interventions ◽  
Infection Prevention And Control ◽  
Care Hospital ◽  
Effective Measure ◽  
Knowledge And Skills ◽  
Study Results ◽  
The Impact

Background: Hand hygiene (HH) is now to be considered as one of the most important effective measure of infection control activities. This is because enough scientific evidence suggested the observation that if properly implemented, hand hygiene alone can significantly reduce the risk of cross-transmission of infection in healthcare facilities.Methods: Hospital based educational intervention.Results: The study results showed the overall improvement pre and post educational intervention regarding hand hygiene skills, five moments and donning and doffing of PPE was significantly improved from 56.50% to 94.51%. If we see the knowledge and skills among doctors between department than we found significantly low knowledge and skills among (pre-interventional) doctors of radiology 23.33% followed by orthopedics 42.50%. The post educational interventions improvement in intensive care unit, laboratory, ENT and dental department were near 100% and lowest observed in departments in pediatrics (84%).Conclusions: The study shows that need for the doctors to increase their knowledge and skill related to infection prevention and control practice by assessing their existing knowledge and skills in small groups and according to observations intervention also plan and its improved knowledge and skill significantly.

scholarly journals Impact of Rapid PCR Influenza Testing on the Rate of Inpatient Admissions During Influenza Season at a Tertiary-Care Center

2020 ◽  
Vol 41 (S1) ◽  
pp. s263-s264
Author(s):  
Jordan Polistico ◽  
Avnish Sandhu ◽  
Teena Chopra ◽  
Erin Goldman ◽  
Jennifer LeRose ◽  
...  
Keyword(s):  
Influenza Season ◽  
Care Center ◽  
Tertiary Care ◽  
The United States ◽  
Turnaround Time ◽  
Care Hospital ◽  
Tertiary Care Center ◽  
Pediatric Hospital ◽  
Rapid Pcr ◽  
The Impact

Background: Influenza causes a high burden of disease in the United States, with an estimate of 960,000 hospitalizations in the 2017–2018 flu season. Traditional flu diagnostic polymerase chain reaction (PCR) tests have a longer (24 hours or more) turnaround time that may lead to an increase in unnecessary inpatient admissions during peak influenza season. A new point-of-care rapid PCR assays, Xpert Flu, is an FDA-approved PCR test that has a significant decrease in turnaround time (2 hours). The present study sought to understand the impact of implementing a new Xpert Flu test on the rate of inpatient admissions. Methods: A retrospective study was conducted to compare rates of inpatient admissions in patients tested with traditional flu PCR during the 2017–2018 flu season and the rapid flu PCR during the 2018–2019 flu season in a tertiary-care center in greater Detroit area. The center has 1 pediatric hospital (hospital A) and 3 adult hospitals (hospital B, C, D). Patients with influenza-like illness who presented to all 4 hospitals during 2 consecutive influenza seasons were analyzed. Results: In total, 20,923 patients were tested with either the rapid flu PCR or the traditional flu PCR. Among these, 14,124 patients (67.2%) were discharged from the emergency department and 6,844 (32.7%) were admitted. There was a significant decrease in inpatient admissions in the traditional flu PCR group compared to the rapid flu PCR group across all hospitals (49.56% vs 26.6% respectively; P < .001). As expected, a significant proportion of influenza testing was performed in the pediatric hospital, 10,513 (50.2%). A greater reduction (30% decrease in the rapid flu PCR group compared to the traditional flu PCR group) was observed in inpatient admissions in the pediatric hospital (Table 1) Conclusions: Rapid molecular influenza testing can significantly decrease inpatient admissions in a busy tertiary-care hospital, which can indirectly lead to improved patient quality with easy bed availability and less time spent in a private room with droplet precautions. Last but not the least, this testing method can certainly lead to lower healthcare costs.Funding: NoneDisclosures: None

scholarly journals The Impacts of Discrimination and Filial Caregivers’ Age on Aspects of Physical Health

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 360-360
Author(s):  
Barbara Hodgdon ◽  
Jen Wong
Keyword(s):  
Physical Health ◽  
Family Caregivers ◽  
Family Caregiving ◽  
Chronic Conditions ◽  
The United States ◽  
Life Course Perspective ◽  
Late Adulthood ◽  
Study Results ◽  
The Face ◽  
The Impact

Abstract Filial caregivers (e.g., individuals caring for a parent or parent-in-law) are a part of the growing number of family caregivers in midlife and late adulthood. The responsibilities that filial caregivers navigate in midlife and late adulthood may expose them to multiple types of discrimination that may decrease their physical health, though this relationship has been understudied. As numbers of family caregivers grow, it is important to examine the potential vulnerability of younger and older filial caregivers’ physical health in the context of discrimination. Informed by the life course perspective, this study compares the physical health of younger (aged 34-64) and older (aged 64-74) filial caregivers who experience discrimination. Filial caregivers (N=270; Mage=53; SD=9.37) from the Midlife in the United States (MIDUS-II) Survey reported on demographics, family caregiving, daily discrimination, self-rated physical health, and chronic conditions via questionnaires and phone interviews. Regression analyses showed no differences between younger and older adults’ self-rated physical health or average chronic conditions. However, moderation analyses revealed that younger filial caregivers who experienced greater discrimination reported poorer self-rated physical health than their older counter parts as well as younger and older filial caregivers who experienced less discrimination. Additionally, younger caregivers with greater discrimination exposure exhibited more number of chronic conditions as compared to other caregivers. The study results highlight the impact of the intersection between filial caregivers’ age and discrimination on physical health. Findings have the potential to inform programs that could promote the health of filial caregivers in the face of discrimination.

The Impact of Political System and Culture on Political Advertising

2005 ◽  
Vol 8 (1) ◽  
pp. 23-43 ◽  
Author(s):  
Chun-Sik Kim
Keyword(s):  
House Of Representatives ◽  
Presidential Election ◽  
Political System ◽  
Political Advertising ◽  
The United States ◽  
Election Campaigns ◽  
Daily Newspapers ◽  
Study Results ◽  
The Impact ◽  
The U.S

This study examines the impact of political system and culture on political advertising of the United States, Japan and Korea. The population of this study was defined as all political ads appearing in major daily newspapers during the 1963–1997 presidential election campaigns in the U.S. and Korea, and the House of Representatives' election campaigns in Japan. A total of 695 political newspaper ads were content-analyzed in this study. Results of the study showed that there were differences in types, valences and appeals of political advertising of the U.S., Japan and Korea. Also, discussions based on study results showed mixed and intertwined arguments against or for the expectations for this study.

scholarly journals 566. Reduction of Hospital-Onset Methicillin-Resistant Staphylococcus aureus (MRSA) Bacteremia in an Acute Care Hospital: Impact of Bundles and Universal Decolonization

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S268-S268
Author(s):  
Adriana Jimenez ◽  
Kathleen Sposato ◽  
Alicia de Leon-Sanchez ◽  
Regina Williams ◽  
Reynande Francois ◽  
...  
Keyword(s):  
Hand Hygiene ◽  
Acute Care ◽  
Care Facility ◽  
The United States ◽  
Adult Patients ◽  
Care Hospital ◽  
Icu Patients ◽  
Improvement Project ◽  
Contact Precautions ◽  
The Impact

Abstract Background MRSA is a major concern for hospitalized patients in the United States. Hospital-Onset (HO) MRSA bacteremia is used as a proxy measurement of MRSA healthcare acquisition, exposure, and infection burden. HO MRSA bacteremia standardized infection ratio (SIR) is used by several national agencies as a quality report metric. Our institution had more than expected HO MRSA bacteremia cases despite several interventions. We describe the impact of a bundle of interventions aimed to decrease HO MRSA bacteremia in an acute care facility. Methods This quality improvement project was implemented in a 380-bed community hospital in Miami, FL from January 2015 to March 2019. HO MRSA bacteremia was defined as non-duplicate MRSA isolated from a blood culture collected >3 days after admission. SIR was calculated dividing the number of observed events by the number of predicted events; predicted events were obtained from the NHSN report. During baseline period (Figure1 Phase 1 January 2015–August 2016) all adult patients in the intensive care unit (ICU) were screened for MRSA nasal colonization on admission and weekly thereafter, ICU patients received daily Chlorhexidine (CHG) bathing, and colonized/infected patients with MRSA were placed in contact precautions. In Phase 2 (September 2016–June 2017)daily CHG bathing was switched from 2% wipes to 4% soap foam and expanded to all adult patients; ICU patients also received nasal decolonization with mupirocin. Nasal mupirocin in ICU was replaced with alcohol-based nasal sanitizer for all adult units in July 2017 (Phase 3). In April 2017 we discontinued using contact precautions for MRSA patients; nasal surveillance cultures were discontinued in October 2017. In May 2018 (Phase 4) we introduced alcohol-based wipes for patient hand hygiene at the bedside. SIR were compared by exact binomial test. Results We observed 48 HO MRSA bacteremia cases during the study period. The SIR decreased from 3.66 to 0.97 from baseline to postintervention periods (P = 0.003). The largest decrease in cases and SIR was attained using combined hospital-wide daily CHG bathing, alcohol-based nasal sanitizer, and alcohol wipes for patient hand hygiene during Phase 4 (Table 1). Conclusion Our bundle of interventions for universal decolonization was successful in decreasing HO MRSA bacteremia. Disclosures All authors: No reported disclosures.

scholarly journals Impact of Genetic Ancestry on Outcomes in ECOG-ACRIN-5103

2017 ◽  
pp. 1-9 ◽  
Author(s):  
Bryan P. Schneider ◽  
Fei Shen ◽  
Guanglong Jiang ◽  
Anne O’Neill ◽  
Milan Radovich ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Heart Failure ◽  
Congestive Heart Failure ◽  
The United States ◽  
Genetic Ancestry ◽  
Phase Iii ◽  
European Ancestry ◽  
Induced Hypertension ◽  
The Impact ◽  
Dose Reductions

Purpose Racial disparity in breast cancer outcomes exists between African American and white women in the United States. We have evaluated the impact of genetically determined ancestry on disparity in efficacy and therapy-induced toxicity for patients with breast cancer in the context of a randomized, phase III adjuvant trial. Methods This study compared outcomes between 386 patients of African ancestry (AA) and 2,473 patients of European ancestry (EA) in a randomized, phase III breast cancer trial, ECOG-ACRIN-5103. The primary efficacy end point, invasive disease–free survival (DFS), and clinically significant toxicities were compared, including anthracycline-induced congestive heart failure, taxane-induced peripheral neuropathy (TIPN), and bevacizumab-induced hypertension. Results Overall, AAs had significantly inferior DFS ( P = .002; hazard ratio, 1.5) compared with EAs. This was significant in the estrogen receptor–positive subgroup ( P = .03), with a similar, nonsignificant trend for those who had triple-negative breast cancer ( P = .12). AAs also had significantly more grades 3 to 4 TIPN (odds ratio [OR], 2.9; P = 2.4 × 10−11) and grades 3 to 4 bevacizumab-induced hypertension (OR, 1.6; P = .02), with a trend for more congestive heart failure (OR, 1.8; P = .08). AAs had significantly more dose reductions in paclitaxel ( P = 6.6 × 10−6). In AAs, dose reductions in paclitaxel had a significant negative impact on DFS ( P = .03), whereas in EAs, dose reductions did not have an impact on outcome ( P = .35). Conclusion AAs had inferior DFS, with more clinically important toxicities, in ECOG-ACRIN-5103. The altered risk-to-benefit ratio for adjuvant breast cancer chemotherapy should lead to additional research with the focus on the impact of genetic ancestry on both efficacy and toxicity. Strategies to minimize dose reductions in paclitaxel, especially as the result of TIPN, are warranted for this population.

scholarly journals The Effect of Educational Intervention on Nurses’ Attitudes and Beliefs about Depression in Heart Failure Patients

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
Patricia Lea
Keyword(s):  
Heart Failure ◽  
Educational Intervention ◽  
Positive Influence ◽  
Heart Failure Patients ◽  
Surgical Units ◽  
Treatment Of Depression ◽  
Before And After ◽  
Consistent Assessment ◽  
Effective Diagnosis ◽  
The Impact

Systematic depression screening is feasible, efficient, and well accepted; however the lack of consistent assessment in heart failure inpatients suggests barriers preventing its effective diagnosis and treatment. This pilot study assessed the impact of an educational intervention on nurses’ beliefs about depression and their likelihood of routinely screening heart failure patients. Registered nurses(n=35)from adult medical-surgical units were surveyed before and after an educational intervention to assess their beliefs about depression prevalence and screening in heart failure patients. There was no significant influence on nurses’ beliefs about depression, but the results suggested an increased likelihood that nurses would routinely screen for depression. The moderately significant correlation between beliefs and intent to screen for depression indicates that educational intervention could ultimately have a positive influence on patient outcomes through early detection and treatment of depression in patients with cardiovascular disease; however the observed increase in the intent to screen without a corresponding change in beliefs indicates other influences affecting nurses’ intent to screen heart failure patients for depression.

scholarly journals Forecasting the Impact of Heart Failure in the United States

2013 ◽  
Vol 6 (3) ◽  
pp. 606-619 ◽  
Author(s):  
Paul A. Heidenreich ◽  
Nancy M. Albert ◽  
Larry A. Allen ◽  
David A. Bluemke ◽  
Javed Butler ◽  
...  
Keyword(s):  
United States ◽  
Heart Failure ◽  
The United States ◽  
The Impact

Abstract 1: The Impact of State Medicaid Expansions on Care Quality and Outcomes for Low-Income Patients Hospitalized With Heart Failure

2018 ◽  
Vol 11 (suppl_1) ◽  
Author(s):  
Rishi K Wadhera ◽  
Karen E Joynt Maddox ◽  
Gregg C Fonarow ◽  
Xin Zhao ◽  
Paul A Heidenreich ◽  
...  
Keyword(s):  
Heart Failure ◽  
Hospital Mortality ◽  
Outcome Measures ◽  
Low Income ◽  
Inpatient Care ◽  
The United States ◽  
Care Quality ◽  
National Quality ◽  
Quality And Outcomes ◽  
The Impact

Background: Heart failure (HF) is the leading cause of morbidity and mortality in the United States. Despite considerable advancement in the management of HF, outcomes remain suboptimal, particularly among the uninsured. In 2014, the ACA expanded Medicaid eligibility, and millions of low-income, non-elderly adults gained insurance coverage in 32 states. Little is known about Medicaid expansion’s effect on quality and outcomes of inpatient care for HF. Methods: We used the American Heart Association’s Get With The Guidelines-HF registry to assess changes in inpatient care quality and outcomes among low income, non-elderly patients hospitalized for HF prior to and following Medicaid expansion, in expansion and non-expansion states. Patients were classified as low income if covered by Medicaid, uninsured, or missing insurance. We considered expansion states to be those that implemented expansions in 2014. We constructed piecewise logistic multivariable regression models to track quarterly trends over time of quality and outcome measures in the pre-expansion (1/1/2010-12/31/2013) and post-expansion (1/1/14 - 6/30/17) periods, by state expansion status. Results: The cohort included 58,804 patients hospitalized across 391 sites - 53% were covered by Medicaid, 21.3% uninsured, and 25.6% missing insurance. Among expansion states, defect-free HF care increased significantly during the pre-expansion period (aOR 1.06, 95% CI 1.03-1.08) but did not change after expansion (aOR 0.99, 95% CI 0.97-1.02). Similarly, other quality measures, such as use of aldosterone antagonists, evidence-based beta blockers, and ICD implantation significantly increased prior to expansion, but did not change following expansion (Table). In-hospital mortality rates remained similar during the pre-expansion (aOR 0.99, 95% CI 0.96-1.02) and post-expansion periods (aOR 1.00, 95% CI 0.97-1.03). Trends in quality and outcome measures for non-expansion states are also shown in the table. Conclusion: The ACA Medicaid state expansions were not associated with improvements in quality of care or in-hospital mortality in expansion states among sites participating in a national quality improvement initiative. Future investigation should evaluate the long-term impact of expansion on HF care during the post-discharge period.

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