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QIO HHQI Weekly Update :: January 28, 2008   

TIP OF THE WEEK

Patient self-management education

Many times, patient/caregiver education about self-management is the key that makes or breaks disease management programs. The Institute for Healthcare Improvement (IHI) identified typical failures found in patient and caregiver education, which included the following:

  • Assuming the patient is the key learner
  • Poor discharge planning instructions
  • Patient and caregiver confusion about patient self-care instructions and medications
  • Non-adherent patients, resulting in unplanned readmissions

IHI’s 2003 “Transforming Care at the Bedside” project recommended changes included the following:

  • Identify the key learner(s) on admission (e.g., patient, specific caregiver)
  • Redesign patient education process to improve patient and family understanding of self-management
  • Use “Teach Back” during visits and phone calls to assess patient’s and caregivers’ understanding of instructions and self-care.
    • Teach Back: After teaching has occurred, ask patient and/or caregiver to repeat it back.

SELF-MANAGEMENT ACTIVITIES

The Disease Management Best Practice Improvement Package from the Home Health Quality Improvement National Campaign identifies the following patient self-management tasks, and what providers can do to support these tasks.

PATIENT SELF-MANAGEMENT PROVIDER SELF-MANAGEMENT SUPPORT

1. Obtain daily weights at approximately the same time each day:

  • After emptying bladder
  • Before eating or drinking

Obtain weight while wearing about the same amount of clothing each day
  • Instruct patient to obtain a scale if they do not have one. If the patient is indigent, consider providing patient with a scale
  • Instruct patient to report a weight gain of 2-3 lbs. in 24 hours or 3 lbs. in 1 week (or as defined by physician for each particular patient)
  • Utilize telemonitoring, if available, to help establish a daily routine

2. Adhere to physician prescribed sodium restriction (typically 2 gram sodium diet)
  • Demonstrate to patient how to read a food label to identify sources of sodium and actual sodium content
  • Provide patient with a list of foods to avoid
  • Provide patient with a list of seasoning alternatives (Do NOT instruct to use salt substitute unless approved by physician due to high potassium content)

3. Take all medications as prescribed by the doctor
  • Provide patient with appropriate information about the actions, benefits and side effects of medications, while discerning patient’s ability to manage the regimen
  • Complete medication reconciliation (increased knowledge leads to improved medication adherence)

4. Identify changes in condition early and report them to the nurse or physician

Provide patient with disease-specific education by developing an emergency care plan that is reinforced at every visit

Provide patient with a disease-specific tool to help him/her identify which symptoms should be reported and the appropriate action to take

5. Obtain abdominal girth daily
  • Provide patients with a measuring tape to enable them to measure abdominal girth for early identification of fluid retention in the abdomen for diastolic (right-sided) heart failure patients

Sources:

Institute for Healthcare Improvement (IHI). Transforming Care at the Bedside. 2003. http://www.ihi.org/IHI/Programs/StrategicInitiatives/TransformingCareAtTheBedside.htm. Last accessed 1/23/08.

Quality Insights of Pennsylvania. Best Practice Intervention Package – Disease Management. 2008. http://www.homehealthquality.org/hh/hha/interventionpackages/dm.aspx. Last accessed 1/23/08.

 

RESOURCE SPOTLIGHT

Patient Safety Cards
MedQIC.org -- This set of cards can be used to train staff, caregivers, and patients on the basics of home safety. The cards describe common hazards around the patient's home and ways to make the home safer. The message about safety is specific and clear.

 

IN THE NEWS

CMS PROPOSES RATE YEAR 2009 PAYMENT, POLICY CHANGES FOR LONG-TERM CARE HOSPITALS

January 23, 2008 -- CMS -- The Centers for Medicare & Medicaid Services (CMS) issued a proposed payment rule designed to assure that long-term care hospitals (LTCHs) continue to receive appropriate payment for services provided while giving them incentives to provide more efficient care to Medicare beneficiaries. LTCHs are a type of acute care hospital that treats some of Medicare’s most severely ill or medically complex patients. The new policies and payment rates would apply to services provided to individuals who are discharged from these hospitals on or after July 1, 2008. Read more >>

IMMUNIZATION ACTION COUNCIL (IAC) UPDATES STANDING ORDERS PROTOCOLS

January 22, 2008 -- IAC -- IAC recently updated four of its standing orders protocols for administering vaccine to adults and six of its standing orders protocols for administering vaccine to children and teens. Read more >>

NATIONAL LEAGUE FOR NURSING RESEARCH GRANTS PROGRAM ADVANCES THE SCIENCE OF NURSING EDUCATION

January 18, 2008 -- NLN -- The NLN's ongoing grants program supporting nursing education research is one of the few such programs in existence. Funding is available to NLN members to develop, design, and execute research initiatives that will have broad-based significance, be critical to decision-making and policy-setting at institutional and national levels, and help to transform nursing education. Read more >>

 

INDUSTRY EVENTS

Quality Basics for Providers
A national teleconference sponsored by the Process Improvement QIO Support Center.
Tuesday February 12, 2008, 12:00 to 1:30 PM
E-mail piqiosc@waqio.sdps.org for more information.
Space is limited. Register now >>

Upcoming Education from the Ohio Council for Home Care:

 

The Tip of the Week Archive is available on the Ohio KePRO Web Site.