Chronic Heart Failure Treatment With the Left Ventricular Assist Device The prevalence of chronic heart failure is increasing in the United States due to the increase in the number of older adults and because many people are surviving acute cardiac events and living longer with chronic heart disease. In end-stage heart failure, heart transplant was once the gold standard of treatment and patients had to wait for a matching heart donor. In the past, the left ventricular assist device (LVAD) was a mechanical circulatory support treatment used temporarily for those awaiting heart transplant. However, the LVAD is increasingly becoming the chosen treatment of patients in lieu of heart transplant. Home healthcare nurses and clinicians need to be familiar with LVADs in order to care for patients in end-stage heart failure who are using these devices. This article explains the mechanism, potential complications, and nursing implications of caring for the patient who is using an LVAD.

Hospital-to-Homecare Videoconference Handoff: Improved Communication, Coordination of Care, and Patient/Family Engagement Transitions of care between settings and clinicians are a time of vulnerability for patients, and can result in fragmented care, medication errors, avoidable readmissions, and patient/nurse dissatisfaction. Through the use of technology and a structured face-to-face handoff, the patient and family can be engaged in the transition across settings. The purpose of this project was to determine the feasibility and effectiveness of videoconference handoffs between inpatient, case management, and home care nurses, and the patients/families during transitions of care from hospital to home care. Videoconferences were conducted for 2 months with patients transitioning from two pediatric inpatient units to the hospital-based home care agency. The nurses and patient/family connected through a secure cloud-based videoconferencing platform. Participants discussed the patient's status, safety concerns, ongoing plan of care, what the patient/family could expect at home, and the coordination of equipment/supply needs and postdischarge visits. Videoconference handoffs (n = 10) were found to be feasible and address gaps in communication, coordination of care, and patient/family engagement during transitions from hospital to home care. Postpilot, nurses agreed the videoconference handoffs should continue with minimal modifications.

End-of-Life Care: Redesigning Access Through Leveraging the Institute of Medicine Future of Nursing Recommendations In 2010, the Institute of Medicine published the vision for how to transform healthcare to achieve a more seamless patient-centered, high-quality system of care. Among the recommendations were four specifically focused on leveraging nursing which is the largest group of healthcare workers: (1) Ensure that nurses can practice to the full extent of their education and training, (2) Improve nursing education, (3) Provide opportunities for nurses to assume leadership positions and to serve as full partners in healthcare redesign and improvement efforts, and (4) Improve data collection for workforce planning and policy making. At the Care New England Health Care System's Visiting Nurse Association, located in the state of Rhode Island, we redesigned access to end-of-life care by leveraging these recommendations. An experienced palliative care nurse practitioner (NP) leads the program development to improve care delivered by home healthcare nurses and NP specialists. This program was designed to allow patients to remain in their preferred setting of care—their home—until the end of their life. In the 5 years of this program's existence, it has achieved a yearly impact on community-based palliative care and hospice services. The number of documented advance directives increased by 75%, referrals to palliative care and hospice increased by 300% and the length of time on hospice doubled. In addition, NP home visits became an accepted referral source and improvements in both the quality and satisfaction scores for the home healthcare agency were realized.

Hospital Readmissions in Medicare Home Healthcare: What Are the Leading Risk Indicators? A large sample of all 2011 home healthcare users in traditional Medicare was analyzed to identify the risk indicators at start-of-care that were associated with the highest probability of readmission (N = 597,493). Thirty-five patient characteristics found in Outcome and Assessment Information Set, claims history, or other administrative data were associated with a 30-day readmission risk 30% to 100% above the average in the sample. Most of these characteristics were associated with a 30-day readmission probability of approximately 1 in 5, and several were associated with a readmission probability approaching 1 in 10 during the first 7 days. A majority of the high-risk characteristics were uncommon, and they tended not to occur together, suggesting they can be useful flags for clinicians in prioritizing cases to reduce readmissions. Readmission risk grows most quickly early in the episode of care; typically one-third of the readmissions in the first 30 days occurred by the end of 7 days. High-risk markers at 7 and 30 days were substantially the same, illustrating the importance of the early days at home in influencing the 30-day outcome. A variety of domains and characteristics are represented among the highest-risk markers, suggesting challenges to home healthcare clinicians in maintaining the knowledge and skills needed to address readmission prevention. We suggest possible responses to this problem as strategies to consider, and also discuss implications for assessment practices in home healthcare.

Feasibility Testing of Health Information Technology: Enabled Patient-Reported Outcome Measurement in the Home Health Setting The use of Patient-Reported Outcome Measures (PROMs) to improve patient outcomes, communication, and shared decision-making is of significance to home healthcare. Clinicians have begun to integrate health information technology (HIT) enabled PROM platforms (such as tablets) into routine care to facilitate collection of PROMs. To evaluate the feasibility and suitability of incorporating PROMs into the overall workflow in home healthcare, and integrating data collected with electronic health records (EHRs), we engaged two home healthcare agencies as pilot sites over the course of 4 months. We provided tablets enabled with an app version of the validated Patient-Reported Outcomes Measurement Information System to collect patient data. This was followed by surveys, interviews, and observations on aspects of feasibility, which we analyzed using summary statistics and qualitative analysis. Results show that the implementation of the HIT-enabled PROMs in the home healthcare setting is suitable for workflow, without negatively impacting goals of care. Additionally, the tablets were considered user-friendly by both clinicians and patients. Key to the utility of HIT-enabled PROMs in home healthcare is the integration of the data collected with existing data systems, in order to facilitate quality and improve outcomes, the success of which can depend on EHR platform ownership and the related ability or access to modify EHRs.

Sleep and Sleep Hygiene No abstract available

Fall Recovery and Prevention No abstract available

Despite Technology, Verbal Orders Persist, Read Back Is Not Widespread, and Errors Continue No abstract available

Personal Protective Equipment: Protecting the Eyes No abstract available