As a registered nurse on a medical-surgical unit, I see quite a few re-admissions for congestive heart failure (CHF). You might be seeing this, too—these patients come in with a small amount of edema, or they can be fluid overloaded up to 50+ pounds.
My first questions are, “Have you been weighing every day, and did you notify your primary care physician (PCP) that your weight was up significantly?” The answer is usually, “No one told me to weigh every day—just to do it when I thought about it.”
Watching the readmissions and the complete noncompliance with instructions (when given) had me thinking that there must be something that could and should be done for these patients.
I feel patients can take better care of themselves when they can understand their disease, and I think they need a visual to see how their weights are trending. I understand the clinic downloads some of this information for them, but the patient does not have a hands-on "view" of their own to visualize their weight change.
So, I decided to purchase pocket calendars for our CHF patients so they would have a portable vehicle to record their weight and show the trends and timeframe of weight gain to their PCP. Unfortunately, I hit a roadblock with my organization and wasn’t cleared to provide these to patients. However, I know that the calendar idea would not have worked alone! It must be accompanied by teaching the patient to understand and use the calendar, and it must be able to make an impactful statement to the benefits of this kind of teaching utilized by the patients and generate positive outcomes.
I believe that if nurses can share these tips with CHF patients, together we can reduce readmissions for CHF and have patients better informed with better overall outcomes:
- Weigh daily.
- Record that weight.
- Trend that weight. Is it going up, down, or remaining the same?
- If the weight is up, evaluate your diet. Did you have too much salt? Or did you skip a fluid pill or a day of weighing?
- Take your calendar to your PCP appointments.
- Show your PCP the recorded progress in your daily weights. They will have a better Idea of how to model your treatment because of the information you provide.
- With a clearer idea of how your weight affects your heart health and feelings, you, as the patient, tend to be more proactive and a proponent and advocate for your own health.
The largest problem with this is that it cannot just be done, right? A committee must approve it, and a subcommittee would have to decide if this is beneficial and if this will cost the organization a lot of money. But to that I say, if readmissions for CHF are reduced, doesn’t that leave hospital beds open to others who may need them more?
I sure think it is worth a try. I’ve been working on this idea for a little over three years, and though it has been challenging at times, I can’t help but think about the patients that could have been helped by this process. Every February, when more focus is designated on cardiovascular health because it is American Heart Month, I am reinvigorated to continue my mission. Even if I have to hear “no” a million times, just one “yes” could make the difference between life or death for my CHF patients.
Judith Allyn McCormack, BSN, RN, CMSRN, is a registered nurse and a member of Sigma’s Alpha Xi Chapter.