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USE OF INTERACTIVE VOICE RESPONSE TECHNOLOGY (IVR) TO IMPROVE COMPLIANCE WITH DYSGLYCEMIA BEST PRACTICE GUIDELINES (BPGS)
Abstracts
This case study will review the results of a percutaneous coronary intervention (PCI) for a forty year old female presenting with a STEMI and the events that lead to a subsequent PCI and emergent surgical revascularization. Following Coronary Artery Bypass Grafting this patient continues in cardiogenic shock supported by intra-aortic balloon therapy and then on to further left ventricular support via Impella 5.0. Following two weeks of intensive medical therapy; including LVAD repositioning, daily hemodialysis and consideration for transplantation, a difficult decision is made. With her husband and two school-age children at the bedside our forty year old patient is removed from life support. This case study will provide an overview of the pharmacological and mechanical therapies available to support those with cardiogenic shock. We will explore the impact of inherent vascular genetics on the outcome of both interventional and surgical revascularization. In conclusion a review of the current literature on end of life care for acute cardiovascular insults will be discussed. N041 HOME VISITS BY A CARDIAC NURSE CLINICIAN AND PATIENTS DIAGNOSED WITH HEART FAILURE J Krzyczkowski,1 S Wong,2 M MacKay,2 J Baumbusch2 1
Lions Gate Hospital Vancouver Coastal Health, North Vancouver, BC 2 University of British Colombia, Vancouver, BC
Heart failure (HF) is a debilitating syndrome affecting thousands of Canadians every year. It is one of the leading causes of death in Canada, and has been found to be the leading cause of readmission to hospital in the United States. A home visit by a cardiac nurse has previously been shown to reduce heart failure readmissions to hospital in the United Kingdom and Australia, yet little is known whether this intervention is effective in Canada. Purpose: We report whether there is a relationship between home visits by a cardiac nurse clinician and 30-day heart failure readmission rates in the adult population. Study design: A retrospective chart review with a sample of 300 patients who were hospitalized with a “most responsible diagnosis of heart failure.” Between 2011 and 2013, 150 patients were referred to the home visit program and seen at home by the cardiac nurse clinician. An equivalent number in the comparison group received usual care, from 2009 to 2011. Intervention: A program overseeing the care of cardiac patients diagnosed with: myocardial infarction, unstable angina, heart failure, aortic valve replacement, coronary artery bypass grafting, mitral valve replacement. Prior to 2011, the intervention program did not treat patients who suffered from heart failure. Meleis’ Transition Theory informed and guided the study, and Wagner’s Chronic Care Model guided the intervention. The main outcome measure is 30-day hospital readmissions for heart failure. The findings will be presented, with discussion of the implications for post-discharge support and program planning for heart failure patients.
S327
N042 REDUCING CONFUSION M Rodger Toronto General, Toronto, ON
Delirium is a relatively common complication following cardiac surgery. The incidence of delirium after cardiac surgery ranges from 5e50% in the literature. Delirium has been shown to be associated with a longer and more costly hospital course and higher likelihood of death within 6 months (Deiner and Silverstein, 2009). Identifying patients at high risk for delirium and promoting interventions to prevent delirium are essential components of nursing care. This presentation will describe the delirium preventative strategies as well as the delirium intervention protocols implemented by our cardiovascular program. It will include the nonpharmacologic and pharmacologic interventions our program utilizes to prevent and treat delirium.
N043 USE OF INTERACTIVE VOICE RESPONSE TECHNOLOGY (IVR) TO IMPROVE COMPLIANCE WITH DYSGLYCEMIA BEST PRACTICE GUIDELINES (BPGS) K Twyman, S Goge, A Arnaout, S Struthers, H Sherrard, B Quinlan University of Ottawa Heart Institute, Ottawa, ON
The increasing burden of prediabetes and diabetes is evident in today’s society. People living with this chronic condition require ongoing self-care management and support. Data from the United States indicate that 28% of cardiovascular expenditures are attributed to diabetes. Our cardiac centre with an annual rate of 6000 admissions is committed to understanding, treating and preventing heart disease. At any given point, sixty percent of our population has dysglycemia. Given the high risk nature of heart disease and dysglycemia, it is essential that safe and cost effective interventions be developed. The purpose of this study is to determine whether the use of IVR technology improves adherence to BPGs for dysglycemia management in a cardiac population. All patients with an HbA1c of 6% or greater are included in an IVR follow up call, post hospital discharge. Patients are contacted at Week 1, 3, 6 and 9 months intervals up to one year. At each interval, the patient will be asked questions focused on the adherence to BPGs. These questions are structured to elicit yes/no responses and will typically last 5 e 8 minutes. Problematic responses are flagged and a diabetes nurse educator contacts the patient to intervene. Preliminary findings suggest that the use of IVR technology improves adherence to BPGs for glycemia management at a minimal cost. Implementation of this study has led to improved patient outcomes and adherence to guidelines while reducing adverse events. Future implications would be to disseminate the use of this technology to other health care institutions.
This case study will review the results of a percutaneous coronary intervention (PCI) for a forty year old female presenting with a STEMI and the events that lead to a subsequent PCI and emergent surgical revascularization. Following Coronary Artery Bypass Grafting this patient continues in cardiogenic shock supported by intra-aortic balloon therapy and then on to further left ventricular support via Impella 5.0. Following two weeks of intensive medical therapy; including LVAD repositioning, daily hemodialysis and consideration for transplantation, a difficult decision is made. With her husband and two school-age children at the bedside our forty year old patient is removed from life support. This case study will provide an overview of the pharmacological and mechanical therapies available to support those with cardiogenic shock. We will explore the impact of inherent vascular genetics on the outcome of both interventional and surgical revascularization. In conclusion a review of the current literature on end of life care for acute cardiovascular insults will be discussed. N041 HOME VISITS BY A CARDIAC NURSE CLINICIAN AND PATIENTS DIAGNOSED WITH HEART FAILURE J Krzyczkowski,1 S Wong,2 M MacKay,2 J Baumbusch2 1
Lions Gate Hospital Vancouver Coastal Health, North Vancouver, BC 2 University of British Colombia, Vancouver, BC
Heart failure (HF) is a debilitating syndrome affecting thousands of Canadians every year. It is one of the leading causes of death in Canada, and has been found to be the leading cause of readmission to hospital in the United States. A home visit by a cardiac nurse has previously been shown to reduce heart failure readmissions to hospital in the United Kingdom and Australia, yet little is known whether this intervention is effective in Canada. Purpose: We report whether there is a relationship between home visits by a cardiac nurse clinician and 30-day heart failure readmission rates in the adult population. Study design: A retrospective chart review with a sample of 300 patients who were hospitalized with a “most responsible diagnosis of heart failure.” Between 2011 and 2013, 150 patients were referred to the home visit program and seen at home by the cardiac nurse clinician. An equivalent number in the comparison group received usual care, from 2009 to 2011. Intervention: A program overseeing the care of cardiac patients diagnosed with: myocardial infarction, unstable angina, heart failure, aortic valve replacement, coronary artery bypass grafting, mitral valve replacement. Prior to 2011, the intervention program did not treat patients who suffered from heart failure. Meleis’ Transition Theory informed and guided the study, and Wagner’s Chronic Care Model guided the intervention. The main outcome measure is 30-day hospital readmissions for heart failure. The findings will be presented, with discussion of the implications for post-discharge support and program planning for heart failure patients.
S327
N042 REDUCING CONFUSION M Rodger Toronto General, Toronto, ON
Delirium is a relatively common complication following cardiac surgery. The incidence of delirium after cardiac surgery ranges from 5e50% in the literature. Delirium has been shown to be associated with a longer and more costly hospital course and higher likelihood of death within 6 months (Deiner and Silverstein, 2009). Identifying patients at high risk for delirium and promoting interventions to prevent delirium are essential components of nursing care. This presentation will describe the delirium preventative strategies as well as the delirium intervention protocols implemented by our cardiovascular program. It will include the nonpharmacologic and pharmacologic interventions our program utilizes to prevent and treat delirium.
N043 USE OF INTERACTIVE VOICE RESPONSE TECHNOLOGY (IVR) TO IMPROVE COMPLIANCE WITH DYSGLYCEMIA BEST PRACTICE GUIDELINES (BPGS) K Twyman, S Goge, A Arnaout, S Struthers, H Sherrard, B Quinlan University of Ottawa Heart Institute, Ottawa, ON
The increasing burden of prediabetes and diabetes is evident in today’s society. People living with this chronic condition require ongoing self-care management and support. Data from the United States indicate that 28% of cardiovascular expenditures are attributed to diabetes. Our cardiac centre with an annual rate of 6000 admissions is committed to understanding, treating and preventing heart disease. At any given point, sixty percent of our population has dysglycemia. Given the high risk nature of heart disease and dysglycemia, it is essential that safe and cost effective interventions be developed. The purpose of this study is to determine whether the use of IVR technology improves adherence to BPGs for dysglycemia management in a cardiac population. All patients with an HbA1c of 6% or greater are included in an IVR follow up call, post hospital discharge. Patients are contacted at Week 1, 3, 6 and 9 months intervals up to one year. At each interval, the patient will be asked questions focused on the adherence to BPGs. These questions are structured to elicit yes/no responses and will typically last 5 e 8 minutes. Problematic responses are flagged and a diabetes nurse educator contacts the patient to intervene. Preliminary findings suggest that the use of IVR technology improves adherence to BPGs for glycemia management at a minimal cost. Implementation of this study has led to improved patient outcomes and adherence to guidelines while reducing adverse events. Future implications would be to disseminate the use of this technology to other health care institutions.