Who in this day and age - with synced online calendars and instant reminders right to your mobile device or email - can stick to their schedule without looking it up? If you fear leaving your smartphone on the kitchen counter, or forgetting to update the family calendar on the refrigerator, imagine waking up in the hospital with a left ventricular assist device (LVAD). The device brings with it myriad hourly, daily and weekly tasks that must be completed before discharge, and just as necessary a routine once you return home. Remembering to drop off dry-cleaning is nothing compared to keeping track of physical therapy appointments, daily medications, dressing changes, and even daily weights and meals.
"Once a patient gets an LVAD, it's a life-changing experience for them," said Marian Toronka, RN, MedStar Washington Hospital Center, Washington, DC. "We had to come up with a way to help them remember what it is they need to do on a daily basis."
On MedStar Washington Hospital Center's 4D Congestive Heart Failure unit, healthcare professionals got together to find a way to combat their patients' planner, calendar and to-do list withdrawals and help them navigate their complex plans of care. They developed a device board management plan, what the unit's nursing director Taryn Hogan, MSN, BS, RN, likens to a patient day planner - just what the doctor ordered.
KEEPING TRACK: Marian Toronka, RN and George Ruiz, MD, update their LVAD patient's device management board to reflect his daily activities.
"To get these high-intensity, high-needs patients through the hospital experience and home safely, we need to have a collaborative relationship with them on a day-to-day, hourly basis," said George Ruiz, MD, director of the pulmonary hypertension unit and part of the advanced heart failure team. "[The board] actively engaged them in reaching these goals and reaching a partnership with the nurses."
Nurses started noticing their patients' difficulties after a hospital promotion campaign led to an increase in LVAD patients on the unit. Patients struggled to understand their overall plans of care and expressed frustration with the seemingly muddled array of daily, even hourly, goals.
"We talk a lot about overall what you need to accomplish after you have an LVAD before you go home, but a lot of that is communicated verbally throughout your stay," Hogan said. "It's not necessarily something that the patient can look at."
Caregivers soon realized those verbal reminders needed to be more visible, since patients might be missing their colorful checklists and crowded calendars. One complex patient, juggling not only the LVAD post-procedure recovery but also short-term memory loss from a stroke, solidified the unit's hunch that visual aid was going to be the key.
"We realized that putting the information up on the wall - we did it first with a large piece of poster board - was something that we could constantly refer back to and helped us keep her focused on the tasks that we needed to get done," said Ruiz. "We realized the power of visual representation with that case. It made a huge amount of difference for the patients when they could see on a regular basis what the goals were."
The patient care board, like that weekend checklist on your counter, helps patients stay involved by visually organizing activities and outlining recovery milestones. Starting with just one or two boards, the team uses a combination of pre-printed magnets and dry-erase markers to customize the board for each patient with the key activities they have to accomplish.
"The more information you give a patient the better, regardless of what it is that you are doing," Hogan said. "This provides another level of information about their care, so patients have a tendency to be happy and comfortable when they know ahead of time what is happening."
Engagement & Accountability
The unit has been adding boards periodically as the hospital budget allows. So far, everyone is thrilled with the new care plan - nurses and patients alike. It gives the patients a recovery calendar that helps them remain engaged in the healing process. Its checklist format creates a sense of accomplishment for reaching daily and weekly milestones.
"It helps them build a routine not only in the hospital; even when they go home they have that visual in their mind," Toronka said. "It helps them remember ... because that will prevent them from coming back in the hospital by doing what they are supposed to be doing."
Although the board was generated with the patient in mind, it has helped the nursing staff in ways they never imagined. If you appreciate your pre-programmed calendar reminders, imagine the benefits of having patient care plans organized in the same way - nurses are communicating better than ever with both their patients and each other.
"Having the board in the room serves as a reminder not only to the patient, but to you," Toronka said. "That way you know this is what I have to do for this patient; this is still what needs to be done. It helps you, as a nurse, make sure that what the patient needs gets done."
"It also creates accountability," Ruiz added. "The patients can hold themselves accountable, the nurses can hold the patients accountable, the patient can hold the nurse accountable, I can hold everyone accountable."
While the majority of patients love the board, Hogan noted a few situations where the board hasn't been as successful. Patients who don't scribble reminders on their calendar or never create that weekend checklist sometimes remain detached from the device management program when in the hospital, and as colorful and interactive as the board can be, it sometimes confuses easily disoriented patients.
Luckily, the nurses are there to ensure everyone has the best possible care, and those that do not do well with the board are not reliant on it. But more often than not, the board has been a huge success.
"Every patient that I have dealt with loved it," Toronka said. "It helps them feel like we are a team and we will work together."
Rebecca Hepp is assistant editor at ADVANCE.