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Sunday, November 29, 2020
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Innovations in Patient Care

Cardiology   Patient Care   Patient Safety   Quality & Performance Improvement

Today’s Read: 4.5 minutes

Discover the latest innovations to patient care developed by nurses, because no one knows patient care better. Today we highlight a couple of them—one that prevents falls and one that prevents re-hospitalizations of heart failure patients. And, of course, there is more news.

MORNING BRIEF

Preventing patient falls

Brigham and Women’s Hospital senior nurse scientist Patricia C. Dykes, PhD, MA, RN, and colleagues created a toolkit that decreases patient falls. The FallTIPS Toolkit includes multiple low-tech solutions, such as a laminated poster to display by patients’ beds and tailored prevention plans that can be added to patients’ electronic health records (which also can be printed out or displayed on a computer screensaver) as well as other interventions that engage patients and their families in the fall prevention process throughout hospitalization. 

This approach was implemented at three hospitals in the Northeast. Once the FallTIPS Toolkit was implemented, the sites saw a 15% reduction in falls and a 34% reduction in injurious falls. Original research on the Fall TIPS Toolkit done in 2009 found it was most effective among older patients, but this new study published in JAMA Network Open found important progress in falls prevention among younger patients. The FallTIPS Tookit is available here, if you would like to implement it at your workplace.

Remote cardiovascular care

A new disease management program might improve blood pressure and cholesterol levels across a broad population of patients at high cardiovascular risk without heavily relying on clinicians. A team from Brigham and Women’s Hospital and Mass General Brigham Health System has devised a program leveraging task shifting to non-clinician providers and digital solutions—such as home blood pressure cuffs and telehealth visits, to adjust medications based on a patient’s progress. 

How does it work? Pharmacists initiate and adjust prescriptions for individuals based on standardized treatment algorithms, prescribing more intensive medications if a patient needs them or adjusts a dosage if a patient was initially intolerant to a medication. Non-licensed navigators provide treatment recommendations and education to the patient until treatment goals are met. Digital tools provided to the patient and embedded into the providers’ workflow help guide clinical decisions and increase overall efficiency. Specialists and primary care physicians supervise the program and are updated on all treatment changes.

Does it work? It is promising, according to a report published in Circulation. For the 3,939 patients enrolled in the lipid program, 1,343 had achieved their goal LDL cholesterol level, with the average decrease in LDL cholesterol being 52 mg/dl (42%). An overall drop in cholesterol levels of 24 mg/dl (18%) was seen in all patients, including those still being actively managed. Of the 1,437 patients enrolled in the high blood pressure group, blood pressure levels dropped by an average of 14/6mmHg (systolic/diastolic) in the 556 who had completed the program by the time of the report.

The team is currently working to increase access, and iterating on the program as guidelines evolve.

Audio coaching helps heart failure patients

The key to keeping heart failure patients out of the hospital could be pre-recorded audio messages about self-care, according to research presented at the American Heart Association’s Scientific Sessions 2020. 

My Recorded On-Demand Audio Discharge Instructions (MyROAD®) is a re-playable audio card. It begins with a general statement and then has four sections about diet, physical activity, medication, and self-monitoring behaviors specific to heart failure to help answer frequently asked questions about the condition and what to expect at home.

Researchers performed a randomized controlled trial of about 1,000 patients who were hospitalized with heart failure. Upon discharge, patients either received usual care or usual care plus the MyROAD audio card with a demonstration on how to operate it. Patients were encouraged to keep the card visible and share it with family members. Researchers followed up at 30, 45, 90, and 180-day intervals after hospital discharge. 

Findings of the study indicate:

  • Patients who received MyROAD had a 27% decrease in the odds of visiting the emergency department for any cause one month after their initial hospital discharge and a 29% drop at the 45-day mark.
  • MyROAD users were 40% less likely to need a heart-assist device, receive a heart transplant, or die from any cause at three months after discharge.
  • Patients in the MyROAD group were also nearly 50% less likely to die from heart failure at 90-days after discharge if they had received the MyROAD® card.
  • All causes of death dropped by more than 40% among the group of patients who received the MyROAD® card compared to the group who received usual care alone.

Researchers note that although the readmission rates among the MyROAD® group were lower at 30 and 45 days when compared with the usual care group, it was not a statistically significant difference. However, when they assessed all-cause hospitalization, emergency department visits or death, the odds of an event were reduced by 25% at 30 days and 30% at 45 days. Researchers believe there is an opportunity to improve outcomes by providing patients and family with clear, consistent messages (as was delivered with the audio card).

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