MiCMRC Educational Webinar Management of Heart Failure April 25, 2017

Transcription

1 MiCMRC Educational Webinar Management of Heart Failure April 25, 2017

2 MiCMRC Care Management Educational Webinar: Heart Failure Management Expert Presenter: Karen Jackson, RN, MSN Care Manager, Integrated Health Associates

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6 Obtaining a certificate of completion Click on the link and follow the instructions to fill out the evaluation Your certificate will be ed to you as an attachment

7 MANAGING HEART FAILURE Karen Jackson, RN, MSN 4/27/2018 7

8 Objectives What is Heart Failure Why Heart Failure is a Problem Managing Heart Failure Engaging Patients in Self-Management Case Study 4/27/2018 8

9 HEART FAILURE FACTS About 5.7 million adults in the United States have heart failure. One in 9 deaths included heart failure as contributing cause. About half of people who develop heart failure die within 5 years of diagnosis. Heart failure costs the nation an estimated $30.7 billion each year. This total includes the cost of health care services, medications to treat heart failure, and missed days of work. CDC, (2016). Heart Failure Fact Sheet. Retrieved from 4/27/2018 9

10 HEART FAILURE DEFINED Heart failure can occur when there has been some type of damage done to the heart that prevents it from pumping blood adequately, such as hypertension, MI, renal failure, diabetic large and small vessel disease or coronary artery disease. 4/27/

11 Healthy Heart vs. Heart Failure 4/27/

12 TYPES OF HEART FAILURE Systolic HF typically is inability of the left side of the heart to pump blood adequately and is defined primarily by Left Ventricular Ejection Fraction (LVEF) of 40 percent or less. 4/27/

13 TYPES OF HEART FAILURE Diastolic HF typically occurs when there is obstruction or enlargement of the right side of the heart does not allow blood to get into the heart adequately. Diastolic HF is most commonly seen in patients with hypertension, COPD or pulmonary hypertension. 4/27/

14 Worsening Heart Failure Increased shortness of breath Decreased urination Chest pain or heaviness Worsening edema Increased weakness or fatigue Confusion and agitation Increased coughing Weight increase 4/27/

15 PATIENT EDUCATION Daily weight Low NA diet Fluid limit Medications Follow Heart Failure Action Plan 4/27/

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17 Managing Heart Failure to avoid Hospitalization PCP appointments Collaboration with PCP and Cardiologists Homecare involvement Cardiologist appointment Identify barriers 4/27/

18 A Note about Homecare Importance of collaboration with homecare. Understanding homecare services (visit structure, monitoring services offered). 4/27/

19 Impacting Your Patients Collaboration with hospital discharge planners to form an interdisciplinary partnership. 4/27/

20 Benefits of Patient Engagement Patient engagement in chronic disease care is cited as being critical for improved health outcomes and reducing costs. Simmons et al. Genome Medicine 2014, 6:16. Retrieved from 4/27/

21 Patient Engagement Defined Patient takes an active role in his/her health. Patient has knowledge, skills, and confidence to manage health. Patient performs health-promoting behaviors. Simmons et al. Genome Medicine 2014, 6:16. Retrieved from 4/27/

22 Engaging your Patient Understanding the patient experience Patient concerns since discharge Goal Setting Steps to prevent re-hospitalization Care Managers as their partner 4/27/

23 Assessing Patient Engagement Patient Activation Measure Motivational Interviewing Teach-back 4/27/

24 Patient Activation Measure (PAM) Who: Patient Activation Measure PAM reliably predicts future ER visits, hospital admissions and readmissions, medication adherence. What: 10 Questions that provides patient specific level PAM identifies where an individual falls within four different levels of activation. This gives providers and health coaches insight to more effectively support each individual. Where: Over the Phone or Face to Face Encounter When: Initial call & every 3 months Each point increase in PAM score correlates to a 2% decrease in hospitalization and 2% increase in medication adherence. 4/27/

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28 Diet & Nutrition for CHF PAM LEVEL 1: Goal: Understand how Diet Impacts heart health. Explain the link between diet and CHF ~ the heart does not have to work as hard when individual consumes a healthy diet and maintains a healthy weight. Explain what foods to eat more of ~ whole grains, fruits and vegetables, low- or nonfat dairy, skinless poultry and fish, nuts and legumes, etc. Explain what nutrient density means ~ foods that contain the most healthy nutrients and the fewest calories ~ vegetables, fruits, beans, seafood, lean meats, etc. PAM LEVEL 4: Goal: Maintain a heart- heathy diet Maintain ideal calorie intake over time ~ use a diet and activity-tracking tool. Maintain portion control over time ~ at home and in restaurants. Use the American Heart Association as a guide. Try to have at least 3 meatless days, or more, each week ~ instead, choose low-fat, high-protein combined protein dishes like beans & rice, whole grain bread & peanut butter, non-fat yogurt & fresh fruit, low-fat milk & whole-grain cereal, and roasted almonds & low-fat cheese. 4/27/

29 Motivational Interviewing In motivational interviewing collaboration and trust are established to support partnerships. Motivational interviewing promotes change by utilizing 4 basic skills. 4/27/

30 Motivational Interviewing Skills Open-ended questions Affirmations Reflective listening Summary statements 4/27/

31 Principals of Motivational Interviewing Express Empathy Support Self-Efficacy Roll with Resistance Develop Discrepancy 4/27/

32 Spirit of Motivational Interviewing Collaboration Evocation Autonomy 4/27/

33 Teach-Back The teach back process is a systematic manner of educating patients and assuring they understand the information presented. It has been researched (Schillinger; University of North Carolina, Iowa Health Institute) and shown to result in improved patient outcomes. 4/27/

34 Teach-Back Teach-back uses evidence based health literacy intervention that promotes patient engagement. It is a gateway to better communication, better understanding, and shared decision making. 4/27/

35 Goal of Teach-Back The goal of teach-back is to explain medical information clearly so that patient and families understand what you have communicated to them. Teach-back requires patient and family members to explain in their own words what they need to know or do. It is not just repeating what they heard, you ask them to teach it back. 4/27/

36 Teach-Back Validation Teach-back validation requires that the clinician has explained medical information clearly and that patients and/or family members have a clear understanding of what you have told them. Teach-back positively correlates with improved patient adherence and outcomes. 4/27/

37 Is Your Patient Engaged? Ability to preform self care Can they self monitor, perceive and identify changes in function Can they judge the meaning and severity of changes Can they assess options for action to manage changes Can they select and perform appropriate actions 4/27/

38 Noncompliance If your patient is non complaint is it: -Lack of adequate and specific instructions about treatment regimens -Depression 4/27/

39 Palliative Care Ensure patients know the difference between Palliative Care and Hospice Care. Palliative Care Prevents and treats symptoms/side effects of disease. Hospice- Provides supportive care to those in their final phase of terminal illness. 4/27/

40 Hospice Care Hospice Care is about quality of life Services offered- RN- assess and manage symptoms. Home Health Aid- assists with ADL. MSW- EOL planning, journaling life review, helping patient sort out what s important to them. Spiritual Care- whatever this means to the patient. Ancillary services. 4/27/

41 Case Study 77 year old female who lives in an ALF with dx. CHF, COPD, and DM. Good understanding of her DM, counts carbohydrates, fats, and proteins. Fastings are WNL and HgbA1C is less than 7. Former smoker, uses inhalers as instructed. Frequent URIs, had pneumonia and the flu this winter. Daily weights are completed, and maintains FR. Difficulty with Low NA diet. 4/27/

42 Advance Care Planning Get this done! 4/27/

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