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Home > CME > Courses
Interdisciplinary Reflections in Geriatric Care of the Heart Failure Patient

Presented by the University of Alabama School of Medicine
Division of Continuing Medical Education

Release Date: September 7, 2012
Expiration Date: September 7, 2015

Target Audience
Objectives
Source
CME Participation
Accreditation & Credit

Introduction
Case
Case Question #1
References

TARGET AUDIENCE:
Primary care physicians, nurses, social workers, physical therapists, occupational therapists, dentists, and dieticians.

OBJECTIVES:
Upon completion of this CME activity, participants should be able to:
  • Describe key components of interdisciplinary discharge planning.
  • Assess therapeutic interventions for a patient with heart failure with reduced ejection fraction.
  • Perform medication reconciliation.
  • Discuss evidence-based methods for patient education that may improve patient outcomes.
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SOURCE:
FACULTY:

AUTHORS:

Lori Lioce, DNP, FNP-BC, NP-C
Clinical Assistant Professor, University of Alabama at Huntsville

Paula A. Thompson, MS, PharmD, BCPS
Associate Professor, Samford University

Idena R. Beckwith, DNP, APRN, CNS
Assistant Professor, University of North Alabama

Charnetta Gadling-Cole, MSW, PhD
Assistant Professor, University of Alabama at Birmingham

Robert Kynerd, MD
Associate Professor, University of Alabama at Birmingham

EDITORS:

Patricia Sawyer, PhD
Associate Professor

Kathleen T. Foley, PhD, OTR\L
Assistant Professor

David Morris, PT, PhD
Associate Professor

Angela Rothrock, PhD
Assistant Professor

Natalie Baker, DNP, CRNP
Assistant professor

Lillian Mitchell, DDS
Assistant Professor

MANAGING EDITOR:

Channing R. Ford, MPA, MA

University of Alabama at Birmingham
Birmingham, AL

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DISCLOSURE:

The authors and editors have no relevant financial relationships related to the content of this activity to disclose.

There is no commercial support for this activity.

Because of the nature of preliminary studies, some products mentioned are unlabeled and investigational. Dosages, indications, and methods of use of drugs mentioned in this publication may reflect the experience of the authors, clinical literature, or other resources. Therefore, please see the full prescribing information before using any licensed product mentioned.


CME PARTICIPATION:

Effective July 1, 2011, enduring materials are required to provide an assessment of the learner that measures achievement of the educational purpose and/or objectives of the activity. For our online enduring materials, the UAB Division of CME has begun implementing a post-test questionnaire (5 content-related questions). Upon completion of the course, you will be directed to the post-test questionnaire. To receive your CME certificate, you must score a minimum of 80% on the post-test.

Medicine, Nursing, Dentistry and Occupational Therapy:
To participate in this online course for CME and CEU credit, please review the objectives before beginning the program. Complete the course and the self-assessment test before September 7, 2015 to receive CME credit. Your certificate will then be available online. This process should take approximately 1 hour.

Social Work and Dietetics:
To receive credit for continuing education for this module, please review the objectives before beginning the program. Complete the course and the self-assessment module before September 7, 2015 to receive credit. Your certificate will be emailed to you within one month of completion. This process should take approximately 1 hour.

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ACCREDITATION:

The University of Alabama School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The University of Alabama School of Medicine designates this enduring material for a maximum of 1 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

The boards of nursing in many states, including Alabama, recognize Category 1 continuing medical education courses as acceptable activities for the renewal of license to practice nursing.

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DISCLAIMER:
Dosages, indications, and methods of use of any drug referred to in this publication may reflect the clinical experience of the authors, clinical literature, or other clinical resources. Therefore, please see the full prescribing information before using any product mentioned. UAB is an equal opportunity/affirmative action institution.
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INTRODUCTION:

In today’s economic climate, attempts are being made to correct the runaway cost of the American medical system and reduce the errors which appear to commonly occur. It has been noted that some discharge diagnoses are more commonly encountered, and that one in particular, heart failure (HF), is common in patients rehospitalized in under 30 days[1].

Principles have been developed to reduce health care errors that occur during transitions in care[2]. Most studies have focused on transfers where hospitals are involved[3,4], but the same general principles should apply to skilled nursing facilities (SNF). In 2010, almost 1.7 million Medicare fee-for-service beneficiaries (4.3 %) used SNF one or more times[5]. In 2009, looking at the first 100 days after admission to a SNF, about 26% of the beneficiaries transitioned to the community while 14.2% were rehospitalized for one or more of five potentially preventable diagnoses, the most common one of which was heart failure[5].

For patients with HF, interdisciplinary discharge planning (IDP) can improve patient outcomes[6]. The following case explores the role of IDP in transitioning a HF patient from a SNF to home.

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CASE:

Mr. B. is a 75-year-old married African American male who was admitted to the hospital with shortness of breath, fatigue, and confusion. His examination confirmed evidence of congestion demonstrated by rales (crackles) in the bases of his lungs, dependent peripheral edema (swelling in his legs), and jugular venous distention (swelling in the large vein in his neck). An echocardiogram performed in the hospital demonstrated left ventricular enlargement with a reduced ejection fraction of 32 % (percent of blood in the chamber which can be pumped forward, normal being 55% to 70%). Mr. B’s condition was stabilized in the hospital but he was not felt able to return home safely at this time, so he is transferred to a nursing home for further medical and rehabilitative care.

At admission to the SNF, Mrs. B is asked to bring her husband’s home medicines in for review. She is also interviewed along with Mr. B about knowledge of his medical condition, recommended treatments, and their ability and willingness to follow recommendations:

Interdisciplinary Team Member Client Status
Physician Mr. B. has HF with a reduced ejection fraction, which practice guidelines indicate respond to beta-blockers and angiotension-converting enzyme (ACE) inhibitors. In addition, the congestion he is experiencing suggests a need for loop diuretics to offload excess fluid (HFSA, 2010)
Nurse Mr. B knows who he is and where he is, but is confused as to time and situation. Mrs. B, his primary caregiver, is capable of assisting with his home care, but is unsure as to the nature of his problem or the appropriate treatment.
Social Work Mr. B lives in a one-story house which he owns with his wife. A daughter lives nearby and can also assist with care. Mr. B is a high school graduate who retired from government service and is currently insured through Medicare with a supplement for medicines.
Physical Therapist Mr. B is able to ambulate but tires easily, is unsteady when walking and is at increased risk of falling. He can perform Activities of Daily Living (AOLs)
Dietician Mr. B should be placed on a diet that will restrict his sodium intake to 3 grams a day and his fluid intake to 2 liters a day.
Pharmacist Review of home medications and hospital discharge medications indicate that Mr. B was on a beta-blocker and an ACE inhibitor at home and these were continued in the hospital. He was started on a loop diuretic and digoxin in the hospital and there were continued at discharge. In addition, he was on an eye drop which is used for glaucoma at home, but this was not on his discharge medications from the hospital.

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Question 1 of 8

1. Interdisciplinary discharge planning is most effective when it occurs:

A. at admission
B. midway through the institutional stay

C. within 24 hours of discharge
D. within 24 hours of the patient reaching the discharge location


 

 
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