Date of Award

5-6-2016

Degree Type

Evidence-Based Project Report

Degree Name

Doctor of Nursing Practice (DNP)

Department

Nursing

First Advisor

Theresa A. Kessler

Abstract

Heart Failure (HF) is a chronic progressive disease affecting over 5 million individuals with an expected increase in incidence as the population ages (Yehle & Plake, 2010). The costs associated with managing HF continue to increase and the Centers for Medicare and Medicaid Services (CMS) have attempted to identify ways to improve patient management of HF to reduce the revolving door of hospital readmissions and decrease expenditures. According to 2006 data, as many as one fourth of the Medicare beneficiaries discharged from acute care to skilled nursing facilities (SNF) were readmitted to the hospital within 30 days and the majority of these readmissions were unplanned (Mor, Intrator, Feng, & Grabowski, 2010). The role of nursing homes has changed from tertiary care settings to post-acute care facilities providing skilled nursing services (Mor et al., 2010). The purpose of the Evidence Based Practice (EBP) project was to determine if the implementation of a standardized education intervention to patients admitted to a SNF with a primary or secondary diagnosis of Heart Failure will reduce hospital readmission rates and improve patient knowledge. The theoretical framework used to guide this EBP project was the Situation-specific Theory of Heart Failure Self-care, and the Stetler model was used to implement the project. The Knowledge Acquisition Questionnaire (KAQ), developed by London Health Sciences Center, was used to measure patient and caregiver knowledge pre and post educational intervention. Staff members were also provided HF specific education and were given a questionnaire adapted from the KAQ to measure pre and post education knowledge. Paired-samples t-tests were conducted to analyze mean pre-test (M = 12.1; SD = 2.07) and post-test (M = 11.7; SD = 2.58) scores and did not show a statistically significant change in knowledge (t(9) = .524, p > .05). Hospital readmission rates were also compared to readmission rates for the same time period the prior year. The intervention group had a 0% hospital readmission rate compared to a 20% readmission rate for the comparison group. The results of this EBP indicate that incorporation of evidence-based interventions can reduce readmissions to the hospital.

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