The implementation of HFSA guidelines, according to the Executive Summary of the recommendations (2010) is able to improve nursing teams` working practices and reduce the number of heart failure cases, as well as the rate of re-admissions. Preventive and disease management, testing and monitoring guidelines need to be developed in order to follow the advance directives and use the evidence-based guidelines. Below the authors would like to detail an implementation plan for applying the guidelines in practice.
The proposed solution for the nursing team’s goal to reduce the number of heart failure cases and reduce patients’ risk is to focus on prevention, risk assessment and patient evaluation/monitoring.
Accordingly, there is a need for setting up a specialist nursing team that would be able to carry out the identification of at-risk patients, develop their assessment and monitoring plans. In order to do so, out of the 30 nurses working in the unit, five would be assigned to take on a course on HFSA assessment guidelines. Based on the recommendation, the nurses would develop a daily, weekly and monthly schedule that would be focused on identifying new cases, assessing risk, monitoring and providing information for patients regarding ways of reducing risks, for example dietary and lifestyle advice, becoming the nursing unit’s “heart failure ambassadors”.
The nursing unit would need the support of the hospital in identifying the most suitable heart failure ambassadors, funding the training and assigning extra responsibilities. The overall weekly commitment of the heart failure specialist nurses would be altogether six hours a week: consisting of data collection, updating knowledge, patient care and administration of preventive and action plans. The training would consist of the studying of heart failure practice guidelines. The HFSA has online training presentations available for health care professionals in PowerPoint format. The competency of the candidates would be checked using a computer-based testing system to be developed by the IT department. The process of learning and knowledge evaluation would take up 10 hours of the nurses’ time and would cost approximately 400 USD.
After the successful testing, the nurses would be assigned a task to collaborate in creating an effective plan according to the guidelines. This would also strengthen their commitment and make them feel responsible. The implementation of the process plan would be monitored by the nursing manager, and weekly reports would be created on interventions, preventive measures and the number of “at-risk” patients identified.
According to the evidence-based guidelines and their effectiveness reported by the HFSA, the number of re-admissions should be reduced significantly within the unit, while preventive measures would also reduce the number of new heart failure cases. The implementation of the project would take six weeks altogether.
During the implementation trial of two weeks, daily meetings would be held in the beginning of the working day and in the end of the shift with the nursing leader in order to determine daily priorities, discuss treatment and prevention plans for individual patients. This is needed in order to help the team develop the best possible approach and practices. After the trial period, weekly reports would be created and discussed during a weekly meeting that would assess data from the unit: including new cases, number of interventions and preventive measures applied. The reports over a month would be assessed and compared to historical data of cases, including the number of heart failures, heart failure related conditions, re-admissions and changes in patients’ conditions. The assessment of patients’ lifestyle at admission is also a task assigned for specialist nurses: these include alcohol intake, smoking and diet. Risk assessment questionnaires would be developed and monitored by the nursing team to identify patient groups at risk.
Outcome Measure. The outcome measures would be developed based on the HFSA Guidelines (2010), including the number of patients identified as being at risk of heart failure, the number of suspected and established cases. The tracking of volume status, blood pressure and symptoms would provide evidence for a change in patient outcomes.
The data collected would be reliable to provide the team with an outcome measure of the process improvement implemented. Data would be collected for evaluation purposes and without the patients’ personal details mentioned, according to data protection guidelines. While the number of admissions would be sensitive to change, their comparison with patient outcomes would be sufficient to monitor efficiency. (see Appendix)
Evaluation Data Collection. Admission data would be collected and compared to discharge data in order to identify the outcome patterns. Targets should be identified during admission for blood pressure reduction, weight, blood sugar, in accordance with the recommendation for patient groups. Different goals and treatment plans would be applied for the elderly, those with cardiovascular disease, obese patients and those with related conditions. Symptoms would also be assessed before and after the treatment. The number of re-admissions would also be monitored on a constant basis in the light of the health and lifestyle advice given to patients, as well as their adherence level to lifestyle recommendations, dietary advice during the follow-up period.
Heart Failure Society Of America (2010) HFSA 2010 Guideline Executive Summary. Journal of Cardiac Failure Vol. 16 No. 6 2010