Home Monitoring Pilot Study Helps Heart Failure Patients Learn Self-Management
Terese McManis, BSN, RN, nurse care coordinator in Aging Adult Services, teaches heart failure patient Earl Shook how to use a portable home monitoring device to take his blood pressure readings each day.
An ongoing home monitoring pilot study extends care into the home for heart failure patients. Launched on January 10, the study is a joint effort between Stanford's Heart Failure Program and Aging Adult Services. The study aims to teach these at-risk patients self-management of their chronic condition, and keep them from being readmitted to the hospital.
"There is abundant evidence in the literature that suggests home monitoring can improve patient outcomes," says Rita Ghatak, PhD, director of Aging Adult Services. "It can improve survival, days out of the hospital, quality of life, and it provides an extra measure of psychosocial support," she says. Tracking daily weights to monitor fluid status is recommended, she adds, and measuring blood pressure, pulse and heart rate regularly can be helpful as medicine doses are titrated or because of other co-morbid conditions.
According to the pilot's lead investigator Dipanjan Banerjee, MD, Stanford has employed a number of interventions to reduce heart failure readmissions over the past three years, but they have all been inpatient, hospital-based interventions such as scheduling follow-up appointments prior to discharge, making discharge phone calls, using teach back to educate patients and reconciling medications before discharge.
"All of these are great but they don't speak to what happens to the patient at home," says Banerjee, director of the Mechanical Circulatory Support Program. "There's a big opportunity to use home monitoring or home-based approaches to improve patient care."
Bringing care home
A day after patients are discharged from the hospital, Nursing & Rehab at Home, a home health agency partner for the study, delivers a digital scale, blood pressure cuff, pulse oximeter and hub station to patients' homes and trains them on using the devices.
"A key focus in heart failure management is prompt symptom recognition and knowing what action to take when early signs of decompensation emerge," says Christine Thompson, RN, clinical nurse specialist for the Heart Failure Program who helped develop the pilot study. "Daily monitoring of vital signs, in addition to assessment of subjective symptoms, is a tool that may particularly benefit some of our high-risk patients."
As part of the pilot, patients also receive a home visit by one of four AAS nurses to ensure that they are using the monitoring equipment correctly, and to reinforce messages about diet, exercise and medications. On more than one occasion, these visits have uncovered a potential health problem that could be addressed immediately.
When Terese McManis, RN, conducted a home visit with patient Earl Shook, she noticed his blood pressure readings were abnormal, with a diastolic number at 110. "We got him in to see his cardiologist the next day," says McManis. His medications were adjusted immediately, bringing his blood pressure back into a normal range within two days.
The pilot study will enroll 30 patients with heart failure from the inpatient and clinic settings, and provide them with home monitoring equipment for 30 days free of charge. To date, the study has enrolled 22 patients. At the end of the 30-day monitoring period, a heart failure nurse conducts a phone survey to evaluate the program's impact on the patient's health and quality of life.
"Heart failure doesn't end when patients leave the hospital," says Angela Bingham, RN, nurse coordinator for the Heart Failure Program. "A big part of managing heart failure is teaching self management for patients with chronic disease. The home monitoring pilot really supports patients doing that."
One such patient is Earl Shook. Newly diagnosed with heart failure and atrial fibrillation last December, Shook spent a week on H1. When he was discharged, he was one of the first patients to be enrolled in the Home Monitoring study. For 30 days, Shook weighed himself daily and measured his blood pressure and oxygen saturation. His readings were automatically transmitted to a central monitoring portal. If he skipped a day, the home health agency would call to remind him. If his vital signs were out of the normal range, the agency would contact the Heart Failure and Aging Adult Services (AAS) nurses to intervene.
For Shook, being sent home after a week in the hospital was unnerving. "When you’re cared for at the hospital by good nurses and doctors, and you're sent out from the hospital, there’s a void," he says. The home monitoring was reassuring. "It let me know there was somebody there still caring for me."
The study also helped him modify his lifestyle. A lifelong chef, Shook has had to learn a "whole new way to cook," he says. "Seeing those numbers every day helped me change my diet, and I do a little more walking with my dog," he says. "It gave me a sense of discipline."