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Improving heart failure disease management in skilled nursing facilities: lessons learned
Mary A Dolansky1, Jeanne A Hitch, Ileana L Piña
1Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA.
Clinical Nursing Research
|April 23, 2013
Summary
Implementing heart failure (HF) management in skilled nursing facilities (SNFs) showed variable adherence. Key facilitators included champions and coaches, while staff turnover and culture posed barriers to improving SNF care.
Area of Science:
- Gerontology
- Healthcare Management
- Quality Improvement
Background:
- Skilled nursing facilities (SNFs) face challenges in managing patients with heart failure (HF).
- Effective implementation of evidence-based protocols is crucial for improving patient outcomes in SNFs.
Purpose of the Study:
- To design and evaluate an improvement project for implementing HF management protocols in four SNFs.
- To assess the impact of an implementation coach on protocol adherence.
Main Methods:
- Utilized Kotter's Change Management principles to guide the implementation process.
- Employed weekly and monthly audits to monitor compliance with eight key HF management protocol aspects.
- Collected contextual factors through field notes and implemented an intervention group with an implementation coach.
Main Results:
- Adherence to HF management protocols varied significantly, ranging from 17% to 82%.
- Facilitators included dedicated staff champions, the presence of an implementation coach, and active physician involvement.
- Barriers identified were high staff turnover and a hierarchical organizational culture.
Conclusions:
- Opportunities exist to integrate HF management protocols to enhance the quality of care provided in SNFs.
- Implementation strategies should address staff turnover and cultural hierarchies to improve protocol adherence.
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