Cardiology Commons^™

Effect Of Lifestyle Modifications On Blood Pressure And Bmi In Overweight Or Obese Adults With Primary Hypertension, Mariska Vandenbergh

Evidence-Based Practice Project Reports

Hypertension (HTN) and obesity contribute to poor cardiovascular outcomes which can be managed with diet and exercise lifestyle changes. In addition, self-awareness (SA) of eating patterns can be a useful tool to promote adherence to lifestyle changes. The purpose of this project was to determine the effect of lifestyle education, the DASH diet, and tools to increase SA for adult clinic patients who were overweight with hypertension. The REAP and PIH tools were utilized to increase patients’ SA of their diagnosis and current dietary habits. A literature search over five databases was conducted and analyzed thoroughly. National guidelines strongly recommend …

A Randomized Control Trial To Compare Npo Status Against A Specialized Pre-Cardiac Cath Diet, Carri Woods Mba, Msn, Rn, Michelle Wood Msn, Rn-Bc

Nursing Active Studies

The purpose of this research study is to identify best practice for NPO status prior to a cardiac catheterization through a comparative evaluation. This prospective, randomized control study will evaluate current standard of care NPO guidelines and a specialized pre-cardiac catheterization diet in low-medium risk patients undergoing elective cardiac catheterization.

PI: Carri Woods MBA, MSN, RN; Michelle Wood MSN, RN-BC

Contact: [email protected]; [email protected]

Nursing Care Plan For Hypertension, Rebecca Hamlin

Articles, Abstracts, and Reports

No abstract provided.

Implementing A Plan Of Care For Hypertension, Rebecca Hamlin

Articles, Abstracts, and Reports

Introduction: Providers routinely document what the next steps in treatment will be for patients who have elevated blood pressure during their office visit. In order for the plan to implemented, the patient must return to see the provider again and often wait up to 6 months before they return. This results in potentially sustained uncontrolled blood pressure.

A Paramedic Staffed Prehospital Program May Reduce Hospital Readmissions For Heart Failure, Bruce Feldman Do, Christopher J. Greb Nrp, Orlando E. Rivera Rn, Mahek Shah Md, Jennifer Nesfeder, Deborah W. Sundlof Do, Nael Hawwa Md, Alma N. Ohl Crnp, Tara K. Henry-Morrow Emt-P, Jeanne L. Jacoby Md

Department of Emergency Medicine

No abstract provided.

Improving Patient Experience And Education By Leveraging Technology, Cathy Palleschi, Wendy Osgood, Mark Parker, Cecilia Inman, Alicia Russell, Eileen Shanahan, Erin Pappal

Operations Transformation

It is estimated that 65% of the population are visual learners. With that in mind, a team of cardiac nurses in a large academic tertiary hospital developed a quality improvement project to hopefully improve patient engagement as well the patients’ perception that the nurses explained things in a manner that they could understand.

Baseline patient survey scores for the question, “Nurses Explained Things In A Way That I Understand”, were under the 75^thpercentile for a period of 9 months. A root cause analysis was conducted and it demonstrated numerous reasons for this score.

Several countermeasures were instituted to …

Developing An Evidence-Based Discharge Process For Patients On A Cardiac/Renal Acuity-Adaptable Inpatient Unit, Tami Gallagher

Master's Projects

Introduction: Readmissions continue to negatively impact patient outcomes and create a significant financial burden. Regardless of efforts to reduce readmission rates, the cost of readmission continues to increase.

Clinical Problem: All-cause, 30-day readmission rates on a cardiac/renal acuity-adaptable inpatient nursing unit ranged from 11% to 33% from July to December 2018 for patients diagnosed with COPD, AMI, HF, and sepsis. The readmission rate for the organization was 16.2% in September 2018 with a target goal of 14.8%.

Project Aim: To use quality improvement tools and an interdisciplinary team to implement the teach-back method during discharge education and a discharge preparedness …

Navigating A Difficult Transition In Pulmonary Arterial Hypertension: A Clinical Case Study, Tina Hyman, Michael Salinero, Francisco Javier Jimenez-Carcamo, Margarita Pallares, Maribel Matos

Nursing & Health Sciences Research Journal

Over the past 20 years, Pulmonary Arterial Hypertension (PAH) patients and providers have seen an increase in options to treat PAH. Currently, there are choices for the delivery of medications approved to treat patients with PAH where at one point the only option was intravenous (IV) therapy. This case study details the transition from IV Epoprostenol to oral Treprostinil for the treatment of a 53 year old female diagnosed with severe Pulmonary Arterial Hypertension whose quality of life became unbearable by the IV medication delivery route. This patient was a synchronized swimmer in her youth and her passion for water …

Implanting Loop Recorders In A Hospital Unit Versus The Electrophysiology Laboratory: A Retrospective Chart Review, Marie Paule Lafontant, Valerie E. Smith, Nohemi Sadule Rios, Marsha Camille Lambert

Nursing & Health Sciences Research Journal

Introduction: Cardiac arrhythmias and unexplained syncopal episodes remain a challenge for clinicians to diagnose. The recent creation of the smallest Implantable Loop Recorder (ILR) assists in identifying the causes behind cardiac and neurological events. The current study aimed to compare the practice of implanting loop recorders at the bedside in the Cardiac and Vascular Care Unit (CVCU) to implantations in the Electrophysiology Laboratory (EP Lab).

Methods: This study was a retrospective review of electronic medical records. Data abstraction included implantation dates, time of admission and discharge, length of stay (LOS), number of healthcare staff involved, and cost of the procedure. …

Evidence-Based Cardiac Monitoring: A Practice Change, Joseph Paul Urbanski

Doctoral Projects

Background: Overuse of cardiac monitoring (CM) in acute care settings contributes to increased healthcare spending and cost of services for patients. Additionally, inappropriate use of CM can contribute to wastefulness of healthcare resources, increases in hospital staff workloads, and can be improved with best evidence-based practice recommendations. A Midwest acute care hospital lacked an evidence-based, systematic method to define care for patients requiring CM.

Objective: The purpose of the project was to pilot an evidence-based CM change initiative, determine feasibility for sustainment, and propose next steps for adoption of the change initiative across non-emergency department, non-intensive care inpatient CM units …

Health Literacy Screening To Increase Antihypertensive Medication Adherence, Boyann Bonjean

Evidence-Based Practice Project Reports

Hypertension contributes to the risk of developing cardiovascular disease (CVD), stroke, heart attack, and chronic kidney disease (CKD) (Abegaz et al., 2016; Weir, 2014; Whelton et al., 2017). Evidence indicates that 30 to 50% of people who are prescribed antihypertensive medication therapy are nonadherent (Hedna et al., 2015). Non-adherence to antihypertensive medications is a major contributor to hypertension treatment failure (Al Ghurair et al., 2012; Hu, 2016; Whelton et al., 2017). Evidence has shown that low health literacy may impact antihypertensive therapy (Slade, 2017). The purpose of this EBP project was to provide an organizational change by implementing a health …

A Lifestyle Modification Program For Adult Patients With Coronary Artery Disease, Amanda M. Yarbrough

Evidence-Based Practice Project Reports

As a leading cause of death worldwide, coronary artery disease affects people of all races and ethnicities. The foundation for the prevention of secondary fatal cardiac events, such as stroke or myocardial infarction, is lifestyle modification to effectively lower cholesterol levels. Lifestyle change impacts diet, physical activity, smoking habits, vital sign measures, and stress management. The purpose of this evidence-based practice project was to reduce implement a lifestyle intervention to lower LDL-C levels and promote healthier lifestyles. This practice change was developed utilizing Stetler’s Research Utilization model to promote evidence-based practice changes in the clinical setting. Nola Pender’s Health Promotion …

Preoperative Anemia Management In Adult Outpatient Coronary Artery Bypass Graft Surgical Patients To Improve Treatment Of Preoperative Anemia, Katherine Mills

Doctoral Projects

The transfusion of blood products can lead to life-threatening complications after surgery. In addition, blood products are a scarce and expensive resource. Even though anemia in coronary artery bypass surgery patients is currently undertreated, research has shown that the intravenous infusion of iron products, as well as a single dose of erythropoietin-alpha prior to surgery, decreases the amount of blood products used in the perioperative setting. The goal of this pilot project was to increase the number of patients screened for anemia, and if necessary, treated prior to coronary artery bypass graft surgery.

Methods: This was a practice improvement, pilot …

A Nurse Navigator-Driven Program To Increase Palliative Care Referrals For Advanced Heart Failure Patients, Margaret Richter, Linda Desitter, Adam Mizgajski, Deborah Strohecker

Articles, Abstracts, and Reports

No abstract provided.

Rapid 5 Lb Weight Gain Is Not Associated With Readmission In Patients With Heart Failure, Jill Howie-Esquivel, Kathleen Dracup, Mary A. Whooley, Charles Mcculloch, Chengshi Jin, Debra K. Moser, Robyn A. Clark, Michele M. Pelter, Martha J. Biddle, Linda G. Park

Nursing Faculty Publications

Aims Heart failure (HF) patients are taught to identify a rapid 5 lb body‐weight gain for early detection of cardiac decompensation. Few data support this common advice. The study aim was to determine whether a 5 lb weight gain in 1 week and signs and symptoms of HF increased risk for unplanned physician or emergency department (ED) visits or hospital admission in rural HF patients.

Methods and results This was a secondary analysis of a randomized trial. Patients tracked body weight and HF symptoms using diaries. We included patients adherent to daily diaries > 50% over 24 months (N = …

Implementing A Discharge Navigator Reducing 30-Day Readmissions For Heart Failure And Sepsis Populations, Karen Weeks

Doctor of Nursing Practice (DNP) Final Clinical Projects, 2016-2019

A national focus for healthcare reform is preventing hospital readmissions. Thirty-day unplanned hospital readmissions impact patient outcomes and are costly to the healthcare system. This project explored the impact between the discharge navigator and 30-day unplanned readmissions for heart failure and sepsis populations in a 238-bed community hospital located in central Virginia. The primary aim of this discharge navigator project was to reduce 30-day readmissions for the heart failure and sepsis populations to meet the goals of the top quartile for like hospitals and the evaluation of cost avoidance for these readmissions. Heart failure and sepsis populations are high risks …

Frailty In Patients Undergoing Left Ventricular Assist Device Implantation, Candice Falls

Theses and Dissertations--Nursing

Heart failure is a progressive condition that affects over 5.7 million Americans and costs associated with heart failure account for 2-3 % of the national health care budget. The high rates of morbidity and mortality along with increased costs from readmissions associated with advanced heart failure have led to the exploration of advanced treatments such as left ventricular assist devices (LVADs). LVADS have demonstrated morbidity and mortality benefit but cost remains extensive with costs per quality-adjusted years > $400,000. With this in mind, it is important to identify those who are most likely to benefit from an LVAD to avoid unfavorable …

Incidence And Predictor Variables Of Pressure Injuries In Patients Undergoing Ventricular Assist Device And Total Artificial Heart Surgeries: An Eight-Year Retrospective Review, Christopher T. Brindle

Theses and Dissertations

BACKGROUND

Cardiac surgery patients have some of the highest reported incidence and prevalence of pressure injuries (PI). A growing subset of cardiac surgery include patients with end-stage heart failure who undergo ventricular assist device (VAD) or total artificial heart (TAH) surgery. The risk of PI and their natural history of development in this population are unknown and the specific risk factors for PI development remain unexplored.

OBJECTIVES

To perform a systematic review of the literature to identify the incidence and risk factors of PI development in patients undergoing VAD-TAH surgery and thereby inform study design and variables in an eight-year …

Evaluation Of The Effect Of Milner-Fenwick Video-Based Education And Teach-Back On Knowledge Acquisition In Atrial Fibrillation Patients, Melissa Czarapata

DNP Projects

PURPOSE: The purpose of this study was to evaluate if video education impacts knowledge acquisition and health literacy in patients with atrial fibrillation. METHODS: This study employed a descriptive, pretest-posttest single site comparative design. Baseline health literacy was assessed before video education was completed using the Atrial Fibrillation Knowledge scale. Health literacy regarding atrial fibrillation was again assessed for the same participants immediately after video education was completed and again in 7 to 10 days through the use of the Atrial Fibrillation Knowledge scale and teach-back questions. RESULTS: There was no statistical significance found when comparing scores before and after …

Keep The Beat With Heart Failure Education: A Quality Improvement Project, Brenda L. Peterson

Master's Projects and Capstones

Abstract

Problem: Heart failure (HF), also known as congestive heart failure (CHF), is the number one diagnosis-related group (DRG) for people 65 years of age and older in the United States. This disease group is complicated and debilitating, requiring frequent hospitalizations with high mortality rates. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has identified CHF as an area for improvement in hospitals.

Context: This was a quality improvement project for an integrated medical center in the Central Valley, California with over 19,000 HF patients. In 2018, for patients 65 years and older, HF is the third-most admitted DRG …

Examining Symptom Trajectories That Predict Worse Outcomes In Post-Cabg Patients, Ming-Fen Tsai, Shiow-Luan Tsay, Debra K. Moser, Tsuey-Yuan Huang, Feng-Chun Tsai

Nursing Faculty Publications

Background: Coronary artery bypass grafting is one of the most common interventional revascularisation procedures used to treat coronary artery disease worldwide. With a wide variability in postoperative cardiac symptoms, identification of symptom trajectories during the 3-month postoperative recovery period may improve clinicians’ abilities to support symptom recovery.

Aims: To identify distinct trajectories of cardiac symptoms seen over time in a cohort of patients during the 3-month post-coronary artery bypass grafting period, and determine clinical characteristics associated with different symptom trajectories postoperatively.

Methods: A prospective trial used the cardiac symptom survey to determine patient symptoms at baseline prior to surgery, and …

Problems Experienced In The Second And Third Months After Discharge From A Heart Failure-Related Hospitalization, Joan S. Grant, Lucinda J. Graven

Journal of Patient-Centered Research and Reviews

The purpose of this study was to identify high-priority problems experienced by individuals during the second and third month after discharge from an acute care facility for heart failure. This descriptive, exploratory study, an extension of a previous analysis that examined high-priority problems in the first month, comprised 19 participants who were assigned to an intervention group that received a randomized, 12-week-pilot coping partnership (COPE-HF) intervention. A trained research nurse provided the intervention, and participants used a standard list to identify high-priority heart failure-related problems. Quantitative and content data analysis was conducted. While the highest-priority problem continued to be managing …

Trajectory Of Thirst Intensity And Distress From Admission To 4-Week Follow Up At Home In Patients With Heart Failure, Nana Waldréus, Misook L. Chung, Martje H. L. Van Der Wal, Tiny Jaarsma

Nursing Faculty Publications

Background: Patients with heart failure (HF) can suffer from increased thirst intensity and distress. Trajectories of thirst intensity and distress from hospital to home are unclear. The aim of this study was to describe thirst intensity and distress trajectories in patients from the time of hospital admission to 4 weeks after discharge, and describe trajectories of thirst intensity and distress by patients’ characteristics (gender, age, body mass index [BMI], plasma urea, anxiety, and depression).

Patients and methods: In this observational study, data were collected from patients with HF (n=30) at hospital admission, discharge, and at 2 and 4 weeks after …

Effects Of A Phase Ii Cardiac Rehabilitation Program On Patient Depression, Michael R. Legal, Dnp, Msn-Ed, Rn, Ccrn-K

Doctor of Nursing Practice Projects

Background: Screening for depression upon intake and completion of a Phase II cardiac rehabilitation (CR) program may influence the type of interventions implemented by CR staff and reduce depression.

Objectives: We examined patients before and after a Phase II CR program who self-reported as depressed using the CES-D score and also assessed scores by procedure, gender and age. We further identified the types of interventions used for those who were depressed.

Methods: We conducted a pre-post intervention study. Using a convenience sample, data were collected on CES-D scores before and after the program and by type of procedure, gender, and …

Heart Failure Follow Up Phone Calls, Melissa Lampert, Anne Major

Nursing Posters

Increase the number of 72-hour post-discharge follow-up phone calls for patients hospitalized with a primary diagnosis of heart failure.

This is a quality measure required for Joint Commission Heart Failure Certification and also to maintain American Heart Association Gold Plus Status.

Decreasing Unnecessary Pharmacy Cost In The Cath Lab, Scott M. Scepaniak, Kristi Patterson

Nursing Posters

AngioMax is a single dose heparin alternative introduced in 2002 that is used in cardiac patients undergoing percutaneous intervention (PCI). Bivalirudin costs $377 per dose; heparin is less than $15 per dose. Noting practice variations, the Cath Lab set out to eliminate unnecessary pharmacy cost for PCI patients by:

• Using current literature to inform clinical care
• Standardizing practice
• Using data to track and guide implementation

Quantum Confined Peptide Assemblies With Tunable Visible To Near-Infrared Spectral Range, Kai Tao, Zhen Fan, Leming Sun, Pandeeswar Makam, Zhen Tian, Mark Ruegsegger, Shira Shaham-Niv, Derek Hansford, Ruth Aizen, Zui Pan, Scott Galster, Jianjie Ma, Fan Yuan, Mingsu Si, Songnan Qu, Mingjun Zhang, Ehud Gazit, Junbai Li

Faculty & Staff Scholarship

Quantum confined materials have been extensively studied for photoluminescent applica- tions. Due to intrinsic limitations of low biocompatibility and challenging modulation, the utilization of conventional inorganic quantum confined photoluminescent materials in bio- imaging and bio-machine interface faces critical restrictions. Here, we present aromatic cyclo-dipeptides that dimerize into quantum dots, which serve as building blocks to further self-assemble into quantum confined supramolecular structures with diverse morphologies and photoluminescence properties. Especially, the emission can be tuned from the visible region to the near-infrared region (420 nm to 820 nm) by modulating the self-assembly process. Moreover, no obvious cytotoxic effect is observed for …

Impact Of Reducing Transcatheter Aortic Valve Replacement (Tavr) Turnover Time, Diane Rydzy Rn, Victor Mejia, Umer M. Darr

Posters

With increasing financial constraints hospitals must find ways to increase efficiency while maintaining patient safety. Operating rooms function with substantial resources and can be essential in affecting revenue. Turnover time can cause delays, prevent maximum use of resources, and affect patient satisfaction. With increasing TAVR volume, efficient use of the hybrid OR is key to maximizing resources.

Implementing Lean Daily Management System To Improve Cvor First Case On-Time Starts, Haley Borchers, Kelly Fehlhafer, Barbara Mueller, Jessica Nichols, Sarah Talken, Mary Hunter, Kenneth Sam

Posters

No abstract provided.

Decreasing Cardiac Arrests In The Pediatric Intensive Care Unit, Jeremy Affolter, Kathlyn Baharaeen, Mari Hanson, Lisa Laddish, Amy Bohm, Lindsey Bradbury, Megan Mcghee, Anne Leroy, Hannah Cunningham, Michelle Waddell, Tiffany Mullen, Kimberly Lucas, William Douglas, Angel Pope, Marita Thompson, Paul N. Bauer, Erica Molitor-Kirsch, Tara Benton, Laura Miller-Smith

Posters

No abstract provided.