Patients are admitted to skilled nursing facilities for reasons including continued nursing care for chronic illnesses or to complete physical rehabilitation.
Returning to the hospital from these long-term care facilities is generally not the norm. Unfortunately, sometimes a patient’s health declines, requiring hospital stabilization.
“There’s nothing more traumatizing for them than when you have to send them back to the hospital, especially when they go into the emergency rooms,” said Robert Zentz, president and CEO of Fellowship Community, Whitehall Township.
Congestive heart failure is one of these chronic illnesses.
According to the American Heart Association, one in five Americans will develop congestive heart failure, which causes stress on the heart to pump blood throughout the body. Symptoms include swelling in the arms and/or legs, rapid heart rate and/or breathing, fatigue and weakness.
The Centers for Disease Control reports there are 5.7 million adults in the U.S. with congestive heart failure, causing $30.7 billion yearly to cover health care services, medications and missed work time.
“We found that heart failure was the main reason we were sending patients back to the hospital,” said Jennifer Oswald, Fellowship Community director of resident assessment and nurse facilitator.
GOLD SEAL OF APPROVAL
Oswald, Zentz and other members of the Fellowship Community interdisciplinary team of therapists, dietitians and its medical director determined it was best to develop an educational program for staff and patients.
In November, their efforts earned for Fellowship – specifically Fellowship Manor Nursing Care Center – The Joint Commission’s Gold Seal of Approval for heart failure certification. Fellowship Manor is one of only three independent skilled nursing centers in the nation to earn the designation.
The seal is a symbol of quality that reflects an organization’s commitment to providing safe and effective patient care. The Joint Commission is an independent, not-for-profit organization that certifies nearly 21,000 health care organizations and programs in the U.S.
“This was a challenging endeavor that took a whole team effort,” said Donna J. Conley, a Registered Nurse and the chief operating officer at Fellowship Community.
“We initiated our quest to seek the designation in 2014, so we spent a long time and a quite a few hours just preparing for the survey. We investigated what we needed to obtain it.”
Fellowship Community hosted a Joint Commission surveyor in September.
To prepare, Fellowship followed the specific set of criteria provided by the commission, step by step, providing staff education along the way so that nurses, therapists and dietitians could work together to provide bedside education to patients and/or families.
BEST PRACTICE GUIDELINES
Oswald said the program includes following patients across the continuum of care from admission to follow-up at home.
Patients are placed on a low-sodium diet and monitored by a dietitian, and take part in a two-minute and six-minute walking test upon admission and discharge from therapy to determine stamina improvement.
Nursing developed an algorithm comprised of best nursing practice guidelines to use in quickly noticing patient changes that is readily available to reference on medication administration carts. Certified nursing assistants also were educated on early heart-failure signs to enable them to alert their team leader.
ONLY ONE READMISSION
Education also is provided throughout the patient’s stay, and case management follows up after discharge to ensure the patient was seen by the primary care physician to prevent return to the hospital.
Conley said that 34 of the 35 who have taken part in the program have returned home without requiring readmission to the hospital.
“We felt that if we could obtain this program and become a center of excellence of care in congestive heart failure, that we would not only give quality care but also improve the quality of life for residents living with heart failure,” she said.