Transcript Life Changers One Patient at a Time

Cardiac Rehab Team
Life Changers...One Patient
At A Time
What is Cardiac Rehabilitation?
A comprehensive exercise, education and behavior
modification program designed to improve the physical
and emotional condition of patients with heart disease.
It’s about...
 learning
 having fun
 exercising
 interacting with patients who have similar challenges
 having a support base
 changing lives
Benefits of Cardiac Rehab Program
• 36 visits – twice a week for 18 weeks
• Two primary components:
1. Makes your heart more fit, helps lower
blood pressure and cholesterol, reduces
stress (recommend walking program)
2. Monitors education. Helps decrease
mortality by 55%.
• Review insurance information and offer
reassurance that assistance is available.
Cardiac Rehab Referrals
• 99% referred by physicians
• If patient is from outlying area (Tifton, Douglas,
etc,) they are referred to a rehab center in their
hometown.
How Do We Acknowledge
Referrals?
Do We Maintain A Current List of Area
Rehab Centers to Assist Patients if They
Live in an Outlying Community?
Providing resources is our responsibility.
Partnerships must be nurtured – Cardiology
Staff
Who is Cardiac Rehab For?
-Terms & Definitions•
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MI (Myocardial Infarction)
PCI (Percutaneous Coronary Intervention)
CABG (Coronary Artery Bypass Graft)
Valve Surgery (Heart valve disease occurs when
your heart's valves do not work the way they should)
Cardiomyopathy (A weakening of the heart muscle or change in
muscle.)
Hypertension (High Blood Pressure)
CAD (Coronary Artery Disease)
Heart Transplant (A heart transplant procedure is considered
when heart failure is so severe that it does not respond to all
other therapies, but the person's health is otherwise good.
Recommendations To Explain Each
Condition
• Develop simple definition of each condition
• Create individual handouts for each term to fit
the specific condition of each patient profile
• Incorporate a visual example/analogy of each
term
Phases of Cardiac Rehab
• Phase I – Inpatient: Beginning of the education
process. Patient begins exercise regimen.
Example: Walking patient down the hallway.
• Phase II – Outpatient: Continuously monitored
exercise, education re-risk factor modification,
support, reassurance and interaction with people
who have similar conditions.
Phases of Cardiac Rehab Cont’d.
• Phase II - The patient will be progressed in
telemetry monitored exercise to achieve increased
muscle strength and endurance. Focus is given to
a different risk factor each week at rehab.
Goal?
To help the patient learn to
make healthy lifestyle
choices!
Phases of Cardiac Rehab Cont’d.
• Phase III - Maintenance:
 Improving exercise, diet and lifestyle choices.
 Exercise Choices: At home, a gym or at
Cardiac Rehab
Benefits of Cardiac Rehab Program:
Provides BP monitoring before and after
exercise and monthly monitored exercise.
Emphasis On Three Keys
• Diet
• Medication
• Exercise
Follow-Up Procedure for Patients to
be Discharged
• One-on-one visit to: Develop rapport, teach
explain and sell Cardiac Rehab Program
benefits...then set-up appointment.
• If patient has been discharged, their chart is
flagged for follow-up. Packet is mailed.
Diversity of Interaction Styles
-Tips and Techniques-
• Be tuned in to patient’s body language and educational
level.
• Strive to be on eye-level with patient (not standing over).
Maintain eye contact.
• Consider using clipboard to support teaching tools.
(Understanding Coronary Artery Procedures, etc.)
• Use analogies: sausage, rubber band, CABG (bypass)
• Use models (example: stent) and explain how the stent
conforms to the shape of an artery and placed in the area
that was narrow to support the artery. Explain
relationship of MRI’s when a stent is in place.
Diversity of Interaction Styles
-Tips and Techniques Cont’d.• Identify and ensure all “primary bases” are covered in
overview:
- Stents
- Enzyme numbers (high or low side)
- Stress test; annual physicals
- Importance of taking medication as prescribed
- Reminder to “not rub the site”
- Diet
- Enlist patient input. Include them in the process/
dialogue. Ask patient how he/she feels before discussing
side effects (denial, depression, fear, anxiety, sleep issues)
Diversity of Interaction Styles
-Tips and Techniques Cont’d.• Identify and ensure all “primary bases” are covered in
overview:
- Review preventative measures and importance of being
aware of symptoms.
- Explain benefits of Cardiac Rehab Program.
- After reviewing patient profile, discuss lifestyle
changes and resources. (Examples: SGMC’s Smoking
Cessation Classes/patches; Refer Diabetic Patients to
SGMC’s Specialty Clinic.
Diversity of Interaction Styles
-Tips and Techniques Cont’d.-
• Identify and ensure all “primary bases” are covered in
overview:
- When reviewing dietary changes (education on
sodium, reading labels, avoiding processed foods
and baked goods) be sure to mention the “name
and title” of the person who will meet with
them to discuss their diet.
- Teaching Tool: Bring a can of processed meat or a
packaged baked good to review the sodium content on
the label with the patient. (May be more suitable for
dietician to use this type of teaching tool.)
Diversity of Interaction Styles
-Tips and Techniques Cont’d.- Strive to set Cardiac Rehab Appointment on-the-spot:
Give time/date options
Verify phone numbers
Print information clear and large on appointment card
Explain purpose of signing paperwork to
authorize making copies of his/her chart
Ensure directions are clear (mention elevator)
- Set the stage for the 15-minute video
Overall Observations
• Each Cardiac Rehab Nurse has their own style
and are highly skilled and knowledgeable
professionals with excellent interpersonal skills.
• Teamwork was demonstrated throughout each
interaction with coworkers.
• Respect for one another, the patient, family
members, Cardiology staff and the Cardiac
Rehab Program was sincerely and consistently
reflected throughout all interactions.
Introductions...Set the Stage
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Knock first
Introduce yourself and give your title
Use patient’s name
If possible, get on “eye-level” with patient
Maintain eye contact
Communicate in simple terms (irregular heart beat vs.
palpitations)
• Be pleasant and give positive gestures
• Acknowledge family members/visitors
Seize All Opportunities to Educate...Use
Education to Prevent Reoccurrence
• Emphasize importance of early warning signs
• Inquire about symptoms (chest pains, swelling, weak,
dizziness, irregular heart beat)
• Inquire if patient has a primary physician and/or urge
him to obtain one.
• Mention health department as resource for blood
pressure check-ups
• Importance of taking medication as prescribed.
• Emphasis on weighing daily (preferably in the
morning). Scales???
• Carrying a stent card for each stent
Key Reminders
• Prepare in advance for patients who do not
speak English (Always have a Spanish Packet
available; Know Patient Rep’s Extension:
#4414; Beeper #1305 for translation; Use
Interpreter in a Box, 1-800-945-7889)
• Explain what the patient can expect...the flow of
people he/she will encounter: Physical
Therapists, Dietary, Social Services and Cardiac
Rehab Specialists, etc.
Questions & Recommendations
• Has the “flow of information presented to each
patent” been identified and covered to ensure
consistency?
• Does Cardiac Rehab appointment card have
directions and phone numbers?
• Are stent card pocket holders available?
• Would it be helpful to have a space for “race”
on referral form?
Questions & Recommendations
• Would a clipboard that has a storage unit be more
beneficial?
• Explore using a “high stool” for C.R. Nurses to
maintain eye-level with patient vs. hovering over the
patient?
• Explore a spiral hardcover educational flip file be used
vs. a pamphlet or booklet?
• Develop a “specialty calendar” to give to cardiac
patients to post in their home bathrooms as a reminder
to weigh daily.
Questions & Recommendations
• Develop a pocket guide to distribute to cardiac
patients to list their medications? (use larger
font)
• Incorporate color tabs to denote “key pages” in
educational material
• Use models/props/analogies...most people are
visual learners and these are effective
reinforcement tools.
• Update all handouts to ensure legibility and
professionalism
Questions & Recommendations
• Consider adding glossary of cardiac terms to
packets
• Revisit website and consider adding 1) “FAQ”
(Frequently Asked Questions) section, 2) A
monthly heart factoid and 3) Credible cardiac
resources (websites) for patients seeking
additional information, i.e. The American Heart
Association: www.AmericanHeart.org
• Update board displaying educational materials
about heart disorders (3rd Floor)
Questions & Recommendations
• Secure testimonies from Phase III Cardiac
Patients. Testimonies are powerful and lend
strong credibility to Cardiac Rehab Program.
• Define term for continuity: Patients or Clients?
• Explain coverage: Medicare, commercial, self
pay, financial forms, etc.
Give Reassurance
“Hearts do Heal”
...however it takes time and a
change in lifestyle!