Background: Heart Failure (HF) is responsible for more than one million hospitalizations each year with a related cost of thirty billion dollars in the United States alone. Additionally, patients with HF who are hospitalized have a 25% chance of being readmitted within 30 days of discharge. The complexities and challenges of managing HF increase the risk of hospitalization and subsequent readmission to the hospital for patients with a HF diagnosis. Foreground: In the southwest (SW) region of Utah, there is a large elderly, retired and snowbird population. The SW region has one level 2-trauma center hospital with excellent cardiovascular services and the readmission rate at this facility is comparable to the national average. The facility utilizes a HF education program called MAWDS, an acronym for Medication, Activity, Weight, Diet, and Symptoms, documented only once by the registered nurse (RN). EBP Framework: The Iowa Model of Evidence-Based Practice and Merle Mishel’s Theory of Uncertainty in Illness guide the implementation of this clinical improvement project. The Iowa Model promotes the use of research to guide practice change decisions, facilitate problem identification, and development of solutions. The Theory of Uncertainty in Illness recognizes the importance of reducing uncertainty in all patients, especially patients with chronic illness. Methods: The objective of this project was to utilize the multidisciplinary team to provide and document HF education. This change was compared to the current method of HF education. The outcome measure data identified the difference in the number of patient HF education occurrences pre and post implementation. Findings & Results: The literature identifies poor care coordination, incomplete or ineffective discharge planning and education, poor recognition of symptoms, and confusion about medications as factors associated with high rates of hospital readmissions. Thorough multidisciplinary education and effective evaluation of patient understanding is critical to assess the patient’s motivation, ability to manage medications, keep follow-up appointments, participate in self-care, and monitor for signs and symptoms of worsening HF. Conclusion & Recommendations: A multidisciplinary approach to patient education increases the number of occurrences of education and opportunities to assess patient status by multiple disciplines. Multidisciplinary patient HF education is recommended to provide manageable amounts of information to promote patient comprehension.
