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The Institute for
Healthcare Improvement has invited Monmouth Medical Center
to display ‘Initiative
for Care of Heart Failure Patients’ at the 21st Annual
National Forum on Quality Improvement in Healthcare, December
6 to 9, 2009 in Orlando, Florida.
Approximately 5,500 healthcare
professionals attend the forum each year from around the world
and thousands more access the conference via satellite.
Monmouth Medical Center will be represented at the forum by Allan
R. Tunkel, M.D., Ph.D., MACP, chair, Department of Medicine;
Sharon Holden, RDCS, BSN, MPA, Administrative Director, Cardiopulmonary
and Renal Services; and Dhruval Patel, M.D., Internal Medicine
resident.
According to The Institute for Health Care Improvement, the theme
for the 21st National Forum is “Simplify,” which
is not meant to imply that it will be simple to achieve the care
wanted and needed. “It means that the goal, though
enormous is simple: health care that produces health and reduces
suffering at a cost we can afford. This is exactly, precisely
and beautifully, what we want and what we can have.”
Monmouth Medical Center’s initiative is in collaboration
with the Visiting Nurse Association of Central New Jersey and
features telehealth monitoring. The program is designed
to help patients receive treatment at home, improve their quality
of life and reduce risk for a trip to the emergency room or a
rehospitalization.
“Our experience is that patients with CHF are often readmitted
shortly after discharge,” says Dr. Tunkel. National statistics
show that in 2006, 25 percent of patients with CHF were rehospitalized
within 30 days and 45 percent within 90 days. The disease is
hard to manage, says Dr. Tunkel, and small things such as not
adhering to a restricted diet or gaining just a few pounds can
make it worse. “We wanted to decrease people’s chances
of needing to be readmitted,” he explains.
To accomplish this goal, Sharon Holden, administrative director
of cardiopulmonary services at Monmouth, met in November 2007
with staff at VNACJ. The nursing group VNACJ helped set up the
program, which has been used in other parts of the country for
about five years but is relatively new to central New Jersey,
says Judy Fancelli, VNACJ’s director of business initiatives.
The program was introduced in February 2008 after it was explained
to the hospital’s case managers, nurse educators, doctors
and other staff, Holden says. “They all are involved in
treating CHF patients, and we wanted them all to buy in.”
Here’s how it works: As soon as a patient is admitted
with CHF, he or she is followed carefully throughout the hospital
stay by the floor nurses, physicians and a VNACJ liaison stationed
at Monmouth, all of whom have been trained in the program. Planning
for care after discharge begins right away. Patients are given
a CHF education booklet that covers the causes of the illness
and the importance of diet, weight control, medication compliance
and other critical factors. “Teaching starts from day one,” says
Holden.
Before discharge, the VNACJ liaison helps arrange for home care,
if needed. The home care nurse also provides the patient with
a TeleHealth monitor if he or she agrees to use the monitor and
if their condition is appropriate for its use. The program is
optional, but so far most patients have given it a try, Holden
says.
The TeleHealth monitor is easy to use. It’s preprogrammed
and passcode-protected. The patient simply turns it on, enters
a passcode and is greeted with a personalized message: “Good
morning, Mr. John Doe.” It then prompts the patient, with
easy-to-follow instructions to measure blood pressure, pulse
oximetry (the amount of oxygen in the blood), blood sugar and
weight through devices connected directly to the machine. There
are then several yes-or-no questions about important daily changes,
such as ankle swelling (a sign of poor CHF control), tiredness
and compliance with medications.
“Patients take these measurements themselves and put the
numbers in once a day,” says Holden. “It gives them
control over their disease and helps establish their independence.”
For more information about Cardiac Services at Monmouth Medical
Center or a referral to a Monmouth Medical Center physician,
call 1.888.724.7123 or visit mmc.barnabashealth.org.
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