Introduction
Chronic Obstructive Pulmonary Disease is a very common lung disease often caused by smoking, fumes, and a polluted environment. Sometimes, genetics can determine a predisposition towards COPD. Although the disease can be treated in many hospitals and the mechanisms for its diagnosis and treatment are well-known, the readmission rate for COPD is over 20% (Raley & Baker, 2016). This creates numerous issues, as it increases the stress and workload on nurses, upsets the patients, and causes additional expenses for treatment.
Change Model Overview
Scope of the EBP
The scope of this EBP is to analyze and come up with solutions to reduce readmission rates in adult COPD patients. Some sources indicate that the problem arises due to poor and insufficient information about the home treatment of the disease after hospital discharge (Nguyen et al., 2015). To solve this, nurses must focus more on patient education. A specific educational discharge plan would help to address this issue.
Stakeholders and Team Member Responsibility
Several stakeholders are to be involved in this EBP. Since the scope of this change is to promote better patient education, there will be two stakeholders involved:
- Discharge Nurse – is responsible for patient discharge and primary patient education provider. This nurse will provide education on how to deal with symptoms of COPD at home without having to rely on hospitalization.
- Home-visiting nurse – will provide assistance and additional patient education at home, if necessary. This nurse will also be tasked with assessing the patient’s health status during regular visits.
Evidence
Summary of Evidence
Prieto-Centurion et al. (2014) conducted a study in order to find out the reasons behind hospital readmissions for COPD patients. They find correlations between readmission rates and discharge education planning and follow-up nursing actions such as home visits and calls. This is supported by Nguyen et al. (2015), who also suggest pulmonary rehabilitation and exercise as viable strategies used in decreasing the number of COPD readmissions. There was no evidence about the success rates of other types of nursing interventions in regard to this particular health problem.
Recommendations Based on Evidence
Based on the information provided above, recommendations for nursing personnel could be split into three stages:
- Patient Education. The patient must be instructed and explained everything about the disease, and the techniques used to manage it. These include medical intake and exercise.
- Making sure the patients understand all the techniques and can repeat them on their own without additional instructions or supervision.
- Making home calls and visit every 2 months. This is to make sure the patient’s condition is well-managed. Additional instructions can be provided via phone or during the visit.
Translation
Action Plan
This study will be conducted for a duration of 1 to 3 months. Evidence shows that readmission is most likely to happen during this time period. During this study, the patients will be extensively educated on these topics (“Chronic obstructive pulmonary disease,” n.d.):
- Self-care: Knowing what drugs to take and when to take them, avoiding smoke, doing breathing exercises, and eating healthy food.
- Staying away from infections.
- Saving energy at home.
- Oxygen supply management.
After the patient leaves hospital care, it will be of paramount importance to make regular house calls in order to ensure that the disease is being well-managed. Additional instructions and information will be provided, if necessary.
At the end of the study, the number of readmissions in the test group could be compared to the overall statistic within the hospital, in order to identify any progress or lack thereof.
Process, Outcomes, Evaluation, and Reporting
The desired outcome for this study is to achieve an overall decrease in readmission rates for COPD. The significance of decrease rates at this point is irrelevant, though if the intervention will not decrease readmission rates by a large margin, it will indicate an error in the proposed intervention plan. As it was mentioned before, the results of the intervention will be compared to the overall hospital statistic and relayed to the key stakeholders, which, in this case, would be senior healthcare managers of the hospital.
Next Steps
Should the results of the intervention lead to a positive outcome and a significant reduction of readmission rates within the test group, it will be possible to repeat the experiment on a larger scale, expanding the intervention methods on the entire hospital. The results could be compared to hospital statistics before the intervention, as well as to the statistics for other hospitals, in order to avoid bias.
Dissemination of Findings
All findings within the organization will be communicated in the form of quantitative research. Should the results of the experiment on a larger scale prove positive, the results would be relayed to the rest of the scientific nursing community through publication in a peer-reviewed journal.
Conclusions
COPD is a relatively common disease with unusually high readmission rates. Readmissions lead to increased stress on the patients, medical professionals, and lead to increased medical spending. Research materials show that there is a correlation between certain nursing interventions and readmission rates. Thorough nursing instructions, pulmonary exercises, and home supervision are likely to reduce the number of COPD readmissions.
References
Chronic obstructive pulmonary disease – adults – discharge. (n.d.). In Medline. Web.
Nguyen, H. Q., Rondinelli, J., Harrington, A., Desai, S., Liu, I., Lee, J. S., & Gould, M. K. (2015). Functional status at discharge and 30-day readmission risk in COPD. Respiratory Medicine, 109(2), 238-246. Web.
Prieto-Centurion, V., Markos, M. A., Ramey, N. I., Gussin, H. A., Nyenhuis, S. M., Joo, M. J.,… Jaffe, H. A. (2014). Interventions to reduce rehospitalizations after chronic obstructive pulmonary disease exacerbations: A systematic review. Annals of the American Thoracic Society, 11(3), 417-424. Web.
Raley, R.M., & Baker, L. (2016). Is there a magic formula for decreasing COPD readmission rates? Respiratory Care, 61(10), 51.