Dear Editor:
Authors Sharon Vincent and Karen Mutsch discuss the increased incidence of heart failure in Americans ,and that by improving self management will promote better outcomes. They provide several interventions to assist in enhancing self management of heart failure patients in “Recognizing Heart Failure Symptoms Can Improve Patient Self-Management” in Volume 10, Issue 10. These interventions include identifying the patient’s why for nonadherence to self management, increasing patient knowledge, weight and dietary recommendations, using motivation to help patients adhere to compliance, and encouraging daily activities. Vincent and Mutsch put a lot of emphasises on educating the patient so they can better self manage themselves. When is this teaching and recommendations being provided to these patients? Upon discharge home from the hospital or the visit they make to their provider? Most people do not retain information on the first go round, and need information repeated over and over to truly use the information they are taught. Yet heart failure patients in a time of stress are expected to return home with self management skills, and be knowledgeable enough to know when to alert their nurse or provider of exacerbating symptoms.
Realizing that patients will be overwhelmed with information to assist in self management of heart failure my home health agency received a grant to set patients up with an in home cardiac monitoring device. This telehealth device takes daily weights, heart rate, oxygen saturation level, blood pressure ,and asks pertinent questions regarding patient symptoms at the time. This information is telephonically sent to a monitoring cardiac nurse. This nurse then evaluates the readings. If the results are abnormal they will call the patient’s home health nurse to alert him/her the patient may be potentially exacerbating, or the cardiac nurse may call the physician directly if no home health nurse is involved with this patient. The home health or cardiac nurse will speak with the physician regarding the abnormal symptoms to help provide the patient with interventions to prevent hospitalization. Telehealth device alerts the cardiac nurse of exacerbating symptom, provides daily trend log that assist the nurse and physician to determine the best plan action for the patient, and education. By the telehealth device repeating daily questions such as “Are you short of breath today?”, “ Are your ankles more swollen than usual?”, “Have you taken your medication today?” this helps to enforce the education regarding symptoms that a patient may experience if they heart failure is exacerbating, and provides a medication reminder. During the home health visit or the call from the cardiac nurse the patient will also get another opportunity to receive reinforcement of education on self management skills, and a chance to ask questions regarding their disease process.
By just providing patients with education and recommendations for changes in patients daily lives is not going to be enough to decrease patient readmittance into the hospital. Most of these high risk, heart failure patients live at home, and need some sort of daily assessment to prevent re-admittance into the hospital. With a combination of using cardiac telehealth along with repeated education and recommendations for changes in patients daily lives will help assist patients in improving their self management skills. Thus, hopefully decreasing hospital readmissions.
Sincerely,
Robin C. RN
