Improving Cardiac Functional Status Through Self-Care Assessment and Education

Abstract

Problem & Purpose: At a large urban tertiary medical center, the 30-day readmission rate for HF patients who attend the Heart Failure Bridge Clinic (HFBC) post-discharge is 14%. On chart review, 70% of HF clinic patients are NYHA functional class III or IV. Deficits in patient self-care is a root cause responsible for low functional status and hospital readmissions. This quality improvement initiative aimed to implement self-care assessment with the Self-Care in Heart Failure Index (SCHFI) and a nurse-led self-care education program. Methods: All new patients to the HFBC and recent hospital discharges received an invitation to participate in the self-care assessment and education program over 15 weeks. Patients completed the SCHFI on paper or electronically at their first visit to the HFBC and post-education. Self-care education consisted of five 30-minute educational sessions administered by two RNs during nurse-led clinic visits. The standardized curriculum was divided into five sessions: (a) understanding and self-management of heart failure, (b) symptoms, (c) medications, (d) diet, and (e) daily life. Results: 100% of HFC staff received education on SCHFI administration and self-care education (SCE) before implementation. Project team members integrated documentation of SCHFIs and SCE into the electronic health record. The average proportion of eligible patients completing the pre-education SCHFI was 75%. The average score was 76, with a score > 70 indicating adequate self-care. Ten patients completed the first education session; no patients completed five sessions. Conclusion: Findings suggest the SCHFI is a practicable tool for assessing self-care in a transitional HF care setting. There is opportunity to target patients with SCHFI scores < 70 for SCE and address barriers to patient follow-up in the future.