Enhancing Knowledge and InterProfessional care for Heart Failure (EKWIP-HF) in long-term care: a pilot study

George A Heckman,Andrew Costa,Veronique M Boscart,Karen Harkness,Kelsey Huson,John P Hirdes,Paul Stolee,Robert S Mckelvie

doi:10.1186/s40814-017-0153-8

Abstract

BackgroundHeart failure (HF) affects 20% of long-term care (LTC) residents and is associated with significant morbidity, acute care visits, and mortality. Barriers to HF management are staff knowledge gaps and ineffective interprofessional (IP) communication. This pilot study assessed the acceptability, feasibility, and impact of an intervention to (1) improve HF knowledge; (2) improve IP communication; and (3) integrate improved knowledge and communication processes into work routines.MethodsThe intervention provides multimodal IP education about HF in LTC, including specialist-supported bedside teaching. It was piloted on single units in two facilities. A mixed-methods repeated-measures approach was used to collect qualitative and quantitative process and outcome data at baseline and 6 months post-intervention.ResultsResults were similar at both sites. Participants developed optimized IP communication to promote HF care. Results indicate a perceived increase in staff confidence and self-efficacy, strengthened assessment and clinical proficiency skills, and more effective IP collaboration. Staff deemed the intervention useful and feasible.ConclusionsThis pilot study suggests that a novel intervention in which HF-specific knowledge is applied by LTC staff to improve IP collaboration in their own work place is acceptable and feasible and has a favourable preliminary impact on staff knowledge and IP communication.

Highlights

Heart failure (HF) affects 20% of long-term care (LTC) residents and is associated with significant morbidity, acute care visits, and mortality
Care delivered in an interprofessional (IP) chronic disease management framework has been shown to be highly effective at reducing acute care use and mortality among community-dwelling seniors with HF [9,10,11]
Program description EKWIP-HF has five phases (Table 1) sequenced based on our prior work emphasizing the importance to first address HF knowledge and IP communication among front-line staff, including Personal Support Workers (PSW), Registered Practical Nurses (RPNs), and Registered Nurses (RNs); physicians were excluded from the first three phases [33]

Summary

Introduction

Heart failure (HF) affects 20% of long-term care (LTC) residents and is associated with significant morbidity, acute care visits, and mortality. HF affects 20% of long-term care (LTC) residents, in whom it is associated with significant morbidity and mortality, and accounts for a sizeable share of unplanned transfers to acute care hospitals [3,4,5]. Such transfers could potentially be avoided, and resident quality of life optimized, if effective HF care processes were in place in LTC homes [6,7,8]. A few studies have shown that guideline-based HF management interventions in LTC can improve care quality and prevent hospitalization, though these were not designed with full stakeholder engagement nor directly

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