Transmission Plan for a Myocardial Infarction Patient

Myocardial Infarction Minimizing Hospital Readmission
Phase 1: EBP for Effective Patient Care Transition
Donald, an acute myocardial infarction (MI) patient, has undergone angioplasty, a procedure in which a catheter is inserted into clogged arteries in a patient’s heart to widen them and improve blood flow. To supplement the angioplasty, Donald has had cardiac stents placed to prop the affected arteries open and reduce their risk of narrowing again. Studies have shown that several complications could result from angioplasty procedures and the insertion of stents as in Donald’s case. The most common complications include bleeding or vascular complications (6 percent of patients), acute renal failure (5 percent of patients), and stroke (0.3 percent of patients) (Dunlay et al., 2012). A study analyzing readmission rates among MI patients in Minnesota found that bleeding was the most common complication after angioplasty, affecting 6 percent of patients (Dunlay et al., 2012). The most common form of bleeding was bleeding at the catheter access site, which was shown to affect 62.7 percent of patients. 37.4 percent of patients report complications associated with groin hematoma, gastrointestinal bleeding and bleeding from other sites (Dunlay et al., 2012). At times, the bleeding is just a bruise, but other times, the bleeding may be serious enough to require surgical procedures or a transfusion.
To minimize the risk of side effects related to cardiac catheterization, the nurse plans to educate the patient on the potential side effects of the same and what they could do to minimize the risk. This includes availing information sheets explaining the symptoms of retroperitoneal bleeding and hematoma formation at the groin site as well as methods of preventing the same (dunlay et al., 2012). The nurse will also distribute simplified information sheets teaching the patient how to self-hydrate as a way to minimize the risk of renal failure resulting from cardiac catheterization (Lambert et al., 2017). Since the patient’s extended family is nearby, it would be plausible to include them in the awareness-raising as a way of ensuring that they can adequately distinguish between what is normal and abnormal. It is also prudent that the nurse connects the patient with their primary care provider to facilitate constant monitoring of side effects upon discharge (Lambert et al., 2017). Studies have shown that patient education has significant benefits in reducing the risk of renal complications after angioplasty by 20 percent (Lambert et al., 2017).
Phase 2: EBP for Prevention of Hospital Readmission
Besides the disease-related complications, several non-disease specific factors also influence the risk of readmission. A prominent factor in Donald’s case is that he has not visited his primary care physician for the last 7 months. Given that Donald has been under the observation of a hospitalist during his five days at the hospital, there is a need to involve his primary care physician to ensure sufficient follow-up and post-procedure assessment. According to the Center for Medicare and Medicaid, racial and ethnic minorities are less likely to follow up with a primary care physician or an appropriate specialist after discharge for chronic illness treatment (CMS, n.d.). In this case, the nurse plans to educate the patient, in the simplest terms possible, on the importance of making early follow-ups with their primary care provider (CMS, n.d.). However, the nurse may also need to engage the patient and his family to identify why he has not visited his primary care provider for the past 7 months. This would help the nurse identify whether the problem results from transportation issues, cultural issues, or language barriers. Upon obtaining this information, the nurse will work together with the patient’s PCP to address the problem. For instance, to facilitate transportation to the PCP, the nurse could initiate an informal agreement with both the PCP and community-based non-profits to provide transport services at specified intervals. This form of networking would ensure that the PCP is aware of the patient’s status and can offer constant monitoring for disease progression and potential complications.
Donald’s lifestyle choices are relatively poor and although they are not related directly to MI, they increase the risk of readmission indirectly. First, Donald has untreated hyperlipidemia but his diet still contains considerably large amounts of fats from restaurant and cafeteria foods, as well as fast foods. His daily consumption of coke, coffee, and beer during the weekends, coupled with lack of exercise worsens his untreated obesity and the risk of hypertension from his medical history. The nurse’s first plan to minimize the risk of readmission is to provide simplified educational materials to educate the patient on the need to maintain a healthy diet and undertake proper exercise as a way of slowing down disease progression and minimizing their risk of readmission (Jones et al., 2018). Since Donald and his wife are active participants in the church, the nurse will collaborate with the church leadership to organize awareness-raising and sensitization sessions geared at educating members, including Donald, on the components of healthy diets and the benefits of the same on patients with chronic illness. Participants in these sessions could receive t-shirts and recipe books to guide them on healthy diets. To supplement the educational sessions and reinforce participants’ healthy eating habits, participants could take part in competitions that involve preparing healthy diets and bringing the same to church to share with other participants.
To encourage healthy eating, the nurse could connect the patients with community-based resources that facilitate home-based delivery of fresh groceries from the nearby grocery store located 0.5 miles from their home. Further, since the patient’s family lives nearby, the nurse plans to engage them by supporting them in developing a daily/weekly exercise plan, where members take turns to jog, cycle or attend gym sessions with the patient. This would be preceded by educational sessions geared at educating the extended family on the benefits of exercise and healthy eating to the patient and their effect on their risk of readmission (Lambert et al., 2017). This would help to encourage the patient while ensuring that exercise is centered on their needs.
Phase 3: Hospitalization Prevention Plan
The plan for preventing hospitalization for MI patients involves three levels of prevention: primary prevention strategies, secondary prevention, and tertiary prevention. Primary prevention strategies are early interventions aimed at foiling the disease among high-risk individuals before it begins, while secondary prevention focuses on early detection and halting the progression of asymptomatic disease (Karunathilake & Ganedoda, 2018). Finally, tertiary prevention involves arresting, slowing down, and reversing disease to prevent further deterioration and recurrence of symptoms (Karunathilake & Ganedoda, 2018).
Studies identify high-risk individuals as those presenting with a family history of MI, and those with diabetes, smoking, hyperlipidemia, and hypertension (Borghi & Ambrosioni, 1996). Primary prevention strategies are mainly lifestyle interventions aimed minimizing these risk factors by reducing blood pressure, serum cholesterol, and blood cholesterol (Borghi & Ambrosioni, 1996). One preventive strategy at the primary level could thus involve educating at-risk persons on the risks associated with smoking and connecting them with the tobacco cessation counseling program, which is co-funded by all states to offer support to individuals pursuing smoking cessation. Studies have shown that smoking cessation could reduce the risk of MI by between 50 and 70 percent over a period of five years (Borghi & Ambrosioni, 1996). Another strategy is to educate patients on the components of healthy diets, the importance of exercise, and the risk associated with alcohol consumption. Besides educating patients, the nurse could help the patients reinforce these strategies into their lifestyles by connecting them with community-based programs such as Alcohol Anonymous programs and nutritionists, helping them develop incremental lifestyle goals, and informing them of apps and other community-based programs that they could use to track their weight and order healthy groceries from local stores. This would ensure that participants not only understand the risk that they face, but also play and active role in implementing the strategies for healthy living. Studies have shown that exercise, healthy diets, and low-to-moderate alcohol consumption could reduce the risk of MI by 45, 55, and 35 percent respectively (Borghi & Ambrosioni, 1996).
Prevention strategies at the secondary level focus on halting the progression of asymptomatic disease following an early diagnosis. A crucial intervention strategy at this level is to link the patient with a primary care provider. It is unlikely that patients at this level have a PCP given that they are still asymptomatic. Linking them with a PCP would ensure that risk factors and the progression of disease are constantly monitored (Karunathilake & Ganedoda, 2018). Further, linkage with the PCP would provide avenues for medicinal interventions such as beta blockers and antiplatelet therapy (chiefly aspirin), which help to slow down the progression of the disease. The nurse at the secondary level needs to, if necessary, link patients with programs where they can access statin therapy, a medical program used to manage blood lipids and cholesterol (Karunathilake & Ganedoda, 2018). Lifestyle interventions will also be continued at this stage to supplement the medicinal interventions (Karunathilake & Ganedoda, 2018). Studies estimate that medicinal intervention using beta blockers and antiplatelet drugs reduce the risk of death from MI by 22 percent and 54 percent respectively (Borghi & Ambrosioni, 1996).
Tertiary prevention focuses on increasing the life expectancy of MI patients and helping them manage pain (Karunathilake & Ganedoda, 2018). Prevention strategies at this level include insertion of pacemakers, stents, coronary angioplasty, bypass surgery, and defibrillators (Karunathilake & Ganedoda, 2018). These strategies are to be supplemented with the medicinal interventions (chiefly beta blockers, calcium channel blockers, and Aspirin) and lifestyle interventions identified at the primary and secondary levels (Karunathilake & Ganedoda, 2018). Studies have shown that the long-term administration of beta blockers and antiplatelet drugs reduces the risk of recurrent myocardial infarction by 27 percent and 54 percent respectively (Borghi & Ambrosioni, 1996).
References
Borghi, C., & Ambrosioni, E. (1996). Primary and Secondary Prevention of Myocardial Infarction. Clinical and Experimental Hypertension, 18(3), 547-58.
CMS (n.d.). Guide to Reducing Disparities in Readmissions. Center for Medicare and Medicaid. Retrieved from https://www.cms.gov/About-CMS/Agency-Information/OMH/Downloads/OMH_Readmissions_Guide.pdf
Dunlay, S., Weston, S. A., Killian, J., Bell, R. M., Jaffe, A. S., & Roger, V. L. (2012). Thirty Day Hospital Readmissions Following Acute Myocardial Infarction: A Community Study. Ann Intern Med, 157(1), 11-18.
Jones, R., Arps, K., Davis, D. M., Blumenthal, R. S., & Martin, S. S. (2018). Clinician Guide to the ABCs of Primary and Secondary Prevention of Atherosclerotic Cardiovascular Disease. American College of Cardiology. Retrieved from https://www.acc.org/latest-in-cardiology/articles/2018/03/30/18/34/clinician-guide-to-the-abcs
Karunathilake, S. P., & Ganegoda, G. (2018). Secondary Prevention of Cardiovascular Diseases and Application of Technology for Early Diagnosis. Biomed Research International, doi: org/10.1155/2018/5767864
Lambert, P., Chaisson, K., Horton, S., Petrin, C,…& Brown, J. (2017). Reducing Contrast-Induced Acute Kidney Injury: How Nurses can Improve Patient Safety, a Qualitative Investigation. Critical Care Nursing, 37(1), 13-26.