Using a Patient Contract in Heart Failure : Engaging the Patient and Nurse

Purpose:
Heart failure (HF) patients experience significant issues with long-term management of their disease. Literature shows that low-income HF patients in urban settings find exceptional difficulties and have poor quality outcomes. Readmissions rates for HF patients are high and costly.

Significance:
Heart Failure is gaining attention as recent payment structures have changed to highlight the significance of high-use diagnosis. Inpatient care of the heart failure patient has often been disjointed and uncoordinated. Care must be structured to allow for best patient outcome.

Strategy and Implementation:
An inpatient Heart Failure unit's Nurse Practice Council created a planning tool to address HF readmissions, titled the “blue card” (BC). This guides the patient education and care coordination across the continuum. During our Magnet re-designation, the blue card was considered best practice by the surveyors, and an exemplar was requested. The BC includes reminders for HF education, weight tracking, and coordination with the home physician and home pharmacy. Data such as patient weight, education, referrals and readmissions is measured. Finally, the card addresses short and long term goals for the patient. Inpatient HF nurses begin the card and address short term goals while the patient is hospitalized. The BC then follows the patient to home or a skilled facility. Long term goals are set prior to discharge and communicated for continuity of care. The focus on goal setting within the patient contract allows for increased engagement in care and aligned patient goals.

Evaluation:
The innovation quickly became standard practice throughout the health system and was highly utilized in coordinating care. Success was measured by implementation and use of the card. The Heart Failure Program has recently been certified by the Joint Commission as an Advanced Heart Failure site.

Implications for Practice:
Providing a consistent reminder tool for bedside nurses to utilize assists in navigating care and can help improve patient outcomes. Navigation tools such as the blue card can ensure gold-standard education is given consistently throughout a nursing unit.