Sometimes, the muscle beating in our chests simple stops. While clinicians get usually restart the heart, patients have to revamp their lives to prevent further issues.
A program that is unique to the area and joins together the expertise of staff at Kent Hospital and The VNA of Care New England is now offering help to patients who suffer from congestive heart failure (CHF) and seek treatment at Kent. Aptly called The Heart Failure Program, this creates a match between patients’ individual care needs and the care setting to best teach and empower them to successfully manage their heart health at home.
The Heart Failure Program gathers a specialty care team that includes the admitting hospitalist and inpatient nurses from Kent, a cardiac care manager, and the patient’s primary care provider with a home care team from the VNA that consists of a nurse practitioner, home health nurse, telemonitoring nurse, and staff from other disciplines (physical, occupational and speech therapy, nutrition and social work) as needed.
“These team members all play critical roles in successfully transitioning the patient and his or her caregiver(s) from one care setting to the next,” explains Linda Zabbo, RN, the heart failure and telemonitoring coordinator.
Transitional care begins while the patient is still in the hospital as clinicians gather information to craft a home care plan and introduce the Program’s Heart Failure Zone Tool. This tool – consisting of green zone (all-clear), yellow zone (caution) and red zone (emergency) – forms the basis for ongoing interactions between the patient, caregiver and clinicians.
“The process is that all care providers begin their assessment by asking, ‘Can you tell me what zone you are in today?’” Zabbo says.
The goal of The Heart Failure Program is to teach patients to successfully self-manage their heart disease at home, while still seeing their cardiologist for regular appointments.
Patients are guided through the transition from telemonitoring to self-management of vital statistics using a Heart Failure Kit that consists of a digital scale, blood pressure cuff and a journal. Once onsite telemonitoring equipment is removed from the patient’s home, he or she phones in key results to the telemonitoring nurse daily and writes them in the journal to present during visits to the primary care physician and/or cardiologist.
Clinicians also teach the patient the importance of a healthy diet and regular exercise program in improving and maintaining heart health. Caregivers are included in the planning and education as much as possible.
For more information on the Heart Failure Program, call the VNA of Care New England at (401) 737-6050