[madwife2002]

I am doing some research into discharge planning with a focus on CHF, has anybody out there done similar research or implemented a discharge planning protocol for their hospital?

[All_Smiles_RN]

No I have not, but my hospital has a protocol for our CHF discharges. I'm not sure if this is specific to my unit/hospital or if it's a larger initiative, but we have "core measures" we are supposed to follow. Some of the things I can recall involve determining that their EF has been documented within the last 6 months, checking for an ACE Inhibitor in their d/c meds, CHF education booklet, smoking cessation booklet, educating on daily weights... I work for a large teaching hospital and we have similiar policies with MI pts as well. I work night shift so I rarely discharge. When I do, I have to look up the protocol for their type of discharge. ;-)

[steelcityrn]

Yes, I have for HH. Priority is s/s of exacerbation and when to call m.d. and or 911. Then you would have a list of preventative measures such as...avoiding salt, daily am wgt with orders when to notify physician with wgt gain, elevating legs at rest, medication education, tx for common chronic cough, effective breathing techniques ect..ect..

[incublissRN]

Originally Posted by steelcityrn

Yes, I have for HH. Priority is s/s of exacerbation and when to call m.d. and or 911. Then you would have a list of preventative measures such as...avoiding salt, daily am wgt with orders when to notify physician with wgt gain, elevating legs at rest, medication education, tx for common chronic cough, effective breathing techniques ect..ect..

When I would discharge patients with CHF the unit had a paper that we would give the patients that reinforced all of the teaching like steelcityrn mentioned. I would also given them their weight log sheet.

The unit also had daily rounds that lasted about 5 minutes. The primary RN would discuss if the core measures (EF documented, ACEI, beta blocker, etc.) were being met, weight trends, labs, if home health would be needed, if the patient needed placement in an ECF, consult for the heart failure clinic, etc. The rounds involved the discharge planner, clinical nurse specialist, pharmacist, and cardiac rehab nurse. I think they were doing research to see if the rounds would decrease frequent rehospilizations.

[silvergirl]

would you ever let a person with chf refuse a cath on your unit? One ICU nurse did for my dad--didnt get one till next day---got 1800 ml off his bladder immediately. Then took cath out sent him home without having him void first (didnt know that till today when VNA had to come place another cath and again got 1800 ml + out) He wasnt on a cardiac floor or in cardiac hosp (went to another in the city that I dont work at-i am in rehab but we are a big cardiac hosp) they had to have him in ICU to give him nitro IV, and lasix IV but when he only put out 250ml in 10 hours they decided to cath him....ugh...plus I asked 2 xs the first night for SCD/foot pumps "oh that is standard protocol." Really? Cuz when I got there the next day, he still didnt have them but when they saw me ran and grabbed em. The nurse who had admitted him to ICU I heard tell my dad about needing a catheter. "oh no I got an infection last time." "well that is because it probably wasnt sterile when they put it in, they did it wrong." WHAT? you dont tell a pt that--you could do it perfect the germs can climb the tubing! Then she says " well if you dont spill the urinal tonite we will leave it out...." UGH I shoulda said something then and there but my fam thought I was just mad cuz they took him to this hosp, not his reg one.....sorry I had to ask if this goes on on your cardiac floors ( imean scan his bladder! and only 250 out in 10 hours and on lasix....)

[All_Smiles_RN]

Originally Posted by silvergirl

would you ever let a person with chf refuse a cath on your unit? One ICU nurse did for my dad--didnt get one till next day---got 1800 ml off his bladder immediately. Then took cath out sent him home without having him void first (didnt know that till today when VNA had to come place another cath and again got 1800 ml + out) He wasnt on a cardiac floor or in cardiac hosp (went to another in the city that I dont work at-i am in rehab but we are a big cardiac hosp) they had to have him in ICU to give him nitro IV, and lasix IV but when he only put out 250ml in 10 hours they decided to cath him....ugh...plus I asked 2 xs the first night for SCD/foot pumps "oh that is standard protocol." Really? Cuz when I got there the next day, he still didnt have them but when they saw me ran and grabbed em. The nurse who had admitted him to ICU I heard tell my dad about needing a catheter. "oh no I got an infection last time." "well that is because it probably wasnt sterile when they put it in, they did it wrong." WHAT? you dont tell a pt that--you could do it perfect the germs can climb the tubing! Then she says " well if you dont spill the urinal tonite we will leave it out...." UGH I shoulda said something then and there but my fam thought I was just mad cuz they took him to this hosp, not his reg one.....sorry I had to ask if this goes on on your cardiac floors ( imean scan his bladder! and only 250 out in 10 hours and on lasix....)

Pts have the right to refuse a foley or anything else. You can measure output with a urinal. It seems they acted appropriately by convincing him that a foley was needed the next day when his output was not optimal. A bladder scan would have told them what they already knew; that he was retaining. If they were giving him IV nitro, something acute was going on and SCDs were probably not a top priority at that moment. Nursing is hard work and you do the best that you can. You prioritize and make judgment calls. Not everyone is going to agree. I'm glad your dad made it home and I hope he is feeling better.

[experiencedrn]

Yes, the facility I work in has an extensive CHF teaching program that begins on admission and is followed through the stay by all health care team members. At time of DC if the diagnosis is new home follow up is provided as is fu for non compliant patients that are frequent flyers