Use of an assessment tool to facilitate evidence based management of home health heart failure patients
Mullins, Lovetta Maureen.
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Heart failure (HF) is a costly and debilitating disease that impacts the quality of life of not only the patients who suffer from its effects but also the ones who care for them. Home health is a post-acute care service that has the potential to impact the effects heart failure has on patients, their caregivers, and the healthcare system. Evidence-based management of home health HF patients improves self-care and decreases readmission and admission rates. Currently no standardized HF needs assessment tools exist for use in the target home health agency. Visiting clinicians need a tool to identify patient/caregiver self-care deficits in order to appropriately provide education and interventions. The purpose of this project is to utilize an existing guideline to create a HF needs assessment tool. This tool was implemented by home health clinicians when admitting a HF patient to services. The design of the tool was guided by the literature reviewed and customized to the home health setting. Age, gender, and race were included on the tool to capture basic demographic information. Other data consisted of differentiating HF type, class, and whether it is the patient's primary or secondary diagnosis. The tool was then divided into different assessment areas: Daily weight practices; Patient/caregiver's knowledge of reporting a weight gain; Guidelines for recommended medications; Knowledge of sodium intake; Knowledge of food labels; Past/present smoking; and Patient/caregiver's independence with identifying signs and symptoms of worsening heart failure. Fifteen females and fifteen males were assessed with the heart failure tool. The results showed that the majority of patients with any class or type of heart failure were not meeting the recommended guidelines. The reasons identified for not meeting the guidelines consisted of knowledge deficit, functional limitations, forgetfulness, lack of equipment, and refused. Many of the medication guidelines were not met due to the drug not being ordered. It is recommended that interventions be designed to address each assessment area and an evaluation tool be implemented to determine if the intervention made a difference. Information gathered should be stored electronically for quality improvement initiatives.