I work in Home Health, and my agency has demonstrated lower than average outcomes in the care of ct's with pulmonary conditions, this is measured by the OASIS before data, and at discharge, looking at dyspnea. Granted there may be some subjectivity in the answering of questions, but I am taking on the project to improve our outcomes. We also have a very high rate of re-hospitalization for CHF. I will add that we have a very high population of inner-city, and medicaid ct's, with a fairly large rate of non-compliance. And subjectivity can be corrected if we are assessing pt's in a similar way.
I need input from you guys on several issues.
1) Research is the start, I need to know, esp you HH nurses, if anyone out there has found a good pathway, caremap, or disease management program, that you feel has been effective for you. I know there is a great clinical guideline for asthma from NIH/AHCPR, but is there another place I can find this kind of evidence-based for a COPD management guideline? Anyone out there doing disease management for COPD? I have a very solid cardiac background so I am good with the CHF, there is a ton of info available on CHF, but not a lot of "standards" published, that I know of, for COPD. I did asthma disease management, so I am very well-versed in monitoring peak flows, preparing action plans, the meds, etc... Can this be applied to COPD? It seems that much of it is easily adaptable. What about smoking cessation? Is anyone out there incorporating that? Where do you refer ct's for that?
2) I know the nurses are busy. I will probably have only 1 hour to present the plan for COPD and one hour for CHF, in the form of mandatory (groan) inservices. Rather than focusing on getting the OASIS filled out correctly, I think my time is best spent sharing and education what the evidence-based info is, like a mini-hemodynamics for CHF, some of our nurses have no ICU/CCU background and very little hospital experience, and I think they may not truly understand the difference between a beta-blocker and an ace-i, etc... I would like to spend time teaching them a little advanced physiology and assessment techniques, then apply it to their assessments & questions we need to answer. The education is needed so that we are all doing a consistent assessment. My question is, do you think this is the right approach given the time constraint? Or should I just review the care maps I will develop? I was thinking I could supplement the program by having a poster-a-week display with something eye-catching, and interesting to reinforce what we have done, or a case presentation a week, Hey! That's an idea, what about a few case studies? But, how they can particpate effectively w/o the education? Maybe I can hand out the case studies and give individual feedback after they turn them in? And base the posters on items that multiple people got incorrect???? I don't want to insult the nurses in any way, God knows they have enough on their plates, and I want them to feel I am giving them best bang for their buck (or hour.)
Thanks for your input!!