Public Reporting Of Discharge Planning And Rates Of Readmissions

Discuss about the Public Reporting Of Discharge Planning And Rates Of Readmissions.

Congestive cardiac failure (CCF) is a condition, which happens when the heart is no longer able to pump blood in the body because of weakened muscles. The leading cause of this disease is coronary artery infection.  In addition, hypertension, obesity and diabetes cause this disease.  This disease mostly affects the elderly. It is a leading cause for hospital admissions for people above the age of 65.Care management in acute CCF i s mostly done by a heart specialist, nurses and the caregivers of the patient. The care management revolves around issues, which include the patient while at home or while in admission in the hospital. Nursing care and management is an approach geared at creating a team to focus on patients and assist the patients and their relative, friend and caregivers in the management of the conditions the patient is facing. It involves coordinating activities, which are required in managing of the illness. Acute CCF requires this approach because it is a chronic illness and can be very traumatizing for the patients without information of the disease.

The period the patient is in the hospital is an ideal time when the hospital staff can educate the patient and the family about CFF monitoring and management. Patients should be introduced to the concepts of self-care. They should learn to monitor their condition and recognize monumental changes and be reporting the changes to the assigned personnel. According to … Ponikowski, & Voors, 2016 (p.48), there is need to carefully evaluate contributing factors of CFF among the patients. If identified these causative agents should are to be dealt with urgently.  These are conditions such as acute coronary syndrome, acute pulmonary embolism and hypertension. With the identification of these underlying causes, the risks posed by having severe CCF are mitigated. To limit the possibilities of misunderstanding between the heart management teams and the patients, the healthcare systems ought to provide written materials about the education supporting the verbal education.

Teaching by word of mouth faces substantial drawbacks such as the limited capacity of the patients to retain new information because of the illness condition. This education primarily on CFF, and thus it should form the basis for continued education and support for the patient (Riley, 2015). The families of the patients should take the initiatives a chance to ask a question and seek clarifications about the disease. It is also vital to inform the patients that the CFF is a an incurable disorder but its management practices such as taking the prescribed medication consistently and curbing physical activities that could increase fluid overload in the body such as foods with sodium guarantees a healthy lifestyle. Moreover, weighing themselves on a constant basis to check fluids overload and informing the doctors of any changes can save lives (Farrell & Tomoaia-Cotisel, et.al 2015 (p.15).

Patient Education

According to previous empirical studies, patients with CCF have recorded high mortality rates after hospital discharge. Despite the care available, approximately 14% of the patients still die, Howlett & Morrin, 2010 (p.139). Notably, age and fragility of the patients’ culminate to such adverse health complications. During hospital admissions, patients must undergo palliative and supportive measure programs. They involve actions such as pain relief, discussions about future care and planning of place to die. By discussing the end of life because of the illness, there are marked improvements in the quality of life of the patients because of the relief and clarity on the patient's life. Some may even choose where to die.

Discharge planning: Patient management in hospitals cannot solely lean on the hemodynamic monitoring. Discharge planning involves the hospital management teams and the patient. There should be a clear and precise plan for the patient to follow being discharged from the hospital. Jha & Orav, et.al 2009, observes that the patients who are not able to follow medications or adhere to recommendations of the management team are readmitted again. There is thus need to plan what happens after the patients are discharged and reduce the risk of them being re admitted again. It is thus necessary to keep following up the patients in the first one to two weeks after discharge. In fact, discharge planning should start once the patient is stable in hospital. Discussions amongst the patient, heart specialist teams and the patient's family should form a discussion where possible.  The family should be included in it taking care of the patient. As Bauer, et.al 2009, highlighted, the patients are in old age and are mostly frail the family should look after them. They should also be part of the team for self-care involving the patient to look for any symptoms, which may need the attention of the doctors. They also need additional supportive community resources after discharge. Thus, when preparing for discharge, preparations ought to align and streamline earlier for the patient and family familiarization and acquainted with the medication needed and support required.

There should be effective planning for the discharge of patients of CCF. Effective planning reduces the chances of readmission in the hospital. Jha & Orav, et.al 2009, observes that lack of planning about the status of the patient after being discharged increases the likelihood of the patient being re admitted again. It is very essential for the management team to involve the close family and the patient in planning for discharge. They should also be told of the symptoms, which they should look out. They should link the discharge planners with the patients' relatives of community-based care and provide mechanisms to follow to keep monitoring the patient.  For older people who have lost touch with caregivers of the family, the community organizations should link up with the patient to help in essential services such as support groups, counseling and monitoring of the health. Since patients from CCF are at readmission again after discharge, the hospitals should provide personnel to follow up on the discharged patients and keep a record of their performance.

End Of Life Care Contextual Framework

Ultimately, there should be a standardized form of manual for use by the hospital for educating all hospitals in the country for use by the patients. It will ensure uniformity in the information given to patients about the disease, also will a standardized form it will be easier to identify gaps in it and inclusion of additional information. Antonicelli, et. el 2008, Notes that there should be programs in the media. There should be efforts to help in raising the concerns about the disease by promoting healthy lifestyles. For the already affected, there should be education about management of the condition.  The decision rationale ought to revolve around a central body its availability simplified to all patients. Hospitals should ensure they talk to patients about the possibility of death from the acute CCF, although hard it will assist the patients in facing reality before them and then they can make decisions involving their life. By providing such information, the patients may opt to reach out to friends and relatives, and overall it will cause the patient to feel at peace.  

There is a research gap on the care and management of discharge planning. Much research has mainly focused on it generally, but there are not researches based on the people suffering from CFF, given their unique circumstances such as being elderly and most detached from their families, researches should be carried out highlight the challenges the care and management team face when planning discharge for such people (Goodlin, 2009). Actually, research strengthens the evidence base of an end of life planning. There are no significant studies in practice.

Creation of planning discharge teams specifically for CCF patients with a heart specialist, they should plan on how to prevent the patient from readmission again. According to Howlett & Morrin, 2010 (p.139) healthcare providers ought to ensure consistent visiting the patients in the first until the third week after discharge to check on their conditions. Moreover, healthcare centers must avail brochures for use by all hospitals towards educating the public and the patients suffering from CCF. The materials must originate from one common source to ensure uniformity of the knowledge about the disease. Furthermore, to maintain proper healing and post-discharge care, the hiring of professionals to talk to patients about the possibility of death from the disease must cater for emotional, physical, and social nurturing. Specially, the professionals ought to have great interpersonal and expertise skills to handle the acute CCF patients (Riley, 2015). Ultimately, the introduction of the end of life care services should include all hospitals and awareness campaigns and programs to all patients suffering from acute CCF.

Recommendations

Congestive cardiac failure (CCF) is a condition that happens to the heart when it is no longer pumping blood throughout the body efficiently because of weakened heart muscles. this disease not only affects the heart but other body organs resulting into breathing difficulties, a limited working of kidneys and accumulation of fluids in different tissues of the body. Coronary artery disease is the leading cause of this condition although, although the heart valve disease, hypertension, obesity, unhealthy eating, smoking, diabetes, heart attack and lack of physical activities can cause it.  Sahle et al.  (p. 32) argue that CCF is most common among the elderly in Australia. It is the leading cause of hospital admissions for the person aged over 65 years and its prevalence increases as age increases. In the population above the age of 75, it has affected 10% of them.

An affected person may show no symptoms although the most commonly reported are coughing, shortness or severe shortness of breath, swelling of legs, gaining of weight, muscular fatigue, abdominal swelling. The condition can be tested through a variety of tests such as X-ray, blood tests and lung functioning tests. Riley (2015, p.23) states that there are various treatment drugs for this condition such as diuretics- they remove the excess fluids, use of inhibitors; which help open the blood vessels, drugs to lower the blood pressure and limit retaining of sodium in the body. In addition, addressing of the underlying disease such as blood pressure is paramount. In fact, can be supplemented by lifestyle changes such as having heart-healthy diets, reducing the use of fats and cholesterol in one food, reducing the amount of salt taken and by ensuring one has a body weight deemed to be healthy.

Conclusion

In conclusion acute CCF is a disease which has lasting effects of the patients. It mainly affects the elderly people above the age of 65. It is very vital if it is detected earlier in order as studies have shown that majority of the cases of hospital admission are preventable. The three key issues which should be addressed by the care and management team include patient education. It should be done while the patient is in hospital, end of life care; the patients should be made aware of the possibility of death as a result of the disease and discharge planning. There should be plans put in place for the patient to follow when finally discharged.

Antonicelli, R., Testarmata, P., Spazzafumo, L., Gagliardi, C., Bilo, G., Valentini, M., Olivieri, F. and Parati, G., 2008. Impact of telemonitoring at home on the management of elderly patients with congestive heart failure. Journal of telemedicine and telecare, 14(6), pp.300-305.

Bauer, M., Fitzgerald, L., Haesler, E. and Manfrin, M., 2009. Hospital discharge planning for frail older people and their family. Are we delivering best practice? A review of the evidence. Journal of clinical nursing, 18(18), pp.2539-2546.

Farrell, T., Tomoaia-Cotisel, A., Scammon, D., Day, J., Day, R. and Magill, M., 2015. ‘Care management: Implications for medical practice, health policy, and health services research’. AHRQ Publication, (15-0018).

Goodlin, S.J., 2009. ‘End-of-life care in heart failure’. Current cardiology reports, 11(3),  pp.184-191.

Howlett, J., Morrin, L., Fortin, M., Heckman, G., Strachan, P.H., Suskin, N., Shamian, J.,  Lewanczuk, R. and Arthur, H.M., 2010. ‘End-of-life planning in heart failure: it should be the end of the beginning’. Canadian Journal of Cardiology, 26(3), pp.135-141..

Jha, A.K., Orav, E.J. and Epstein, A.M., 2009. Public reporting of discharge planning and rates of  readmissions. New England Journal of Medicine, 361(27), pp.2637-2645.

Ponikowski, P., Voors, A.A., Anker, S.D., Bueno, H., Cleland, J.G., Coats, A.J., Falk, V., González?Juanatey, J.R., Harjola, V.P., Jankowska, E.A. and Jessup, M., 2016. 2016 ESC

Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. European journal of heart failure, 18(8), pp.891-975.

Riley, J., 2015. The Key Roles for the Nurse in Acute Heart Failure Management. Cardiac failure review, 1(2), p.123.

Sahle, B.W., Owen, A.J., Mutowo, M.P., Krum, H. and Reid, C.M., 2016. ‘Prevalence of  heart failure in Australia: a systematic review’. BMC cardiovascular disorders, 16(1), p.32.