Date of Award

Winter 12-5-2016

Degree Type

Final Project

Degree Name

DNP Doctor of Nursing Practice

Department

Nursing

Advisor

Mary Ellen Roberts, DNP

Committee Member

Kristi Stinson, Ph.D

Committee Member

Chirag Shah, MD

Abstract

The purpose of this project was to implement an APN-led COPD discharge education program to decrease 30-day readmission rates. This Doctorate of Nursing (DNP) project combined strategies obtained in the literature search and blended these into a cutting-edge and state-of-the-art discharge education program at a major medical center. The significance of chronic obstructive pulmonary disease (COPD) readmission rates include financial implications, a large number of Medicare patients who return to the hospital within 30 days, poor quality of patient care, and poorly coordinated discharge processes. An APN-led transitional care COPD education discharge plan was implemented on the pulmonary floor at a major medical center in New Jersey. Consented patients admitted to OMC pulmonary floor and who received their pulmonary care from Pulmonary & Allergy Associates (PAA) were asked to participate in this quality initiative. This quality initiative was conducted on 18 patients with COPD from October 2015 to January 2016. Patients included in this quality initiative received 1-hour; face-to-face visits by me, three days a week during the 12-week program and totaled 15 hours per week. The primary project outcomes were decreased 30-day readmission rates during the 12-week program.

Secondary project outcomes were the implementation of patient discharge education including the following: 7-day pulmonary follow-up; signs and symptoms which require an emergency pulmonary visit; importance of influenza and pneumococcal vaccination; proper inhaler technique utilizing the 10-second breath hold with “teach back” method; importance of physical activity and pulmonary rehabilitation (PR); home oxygen needs; home nebulizer needs; importance of proper nutrition; assessment of anxiety, depression, and gastrointestinal reflux (GERD); and assessment for the safest discharge location based on the patient’s risk for readmission. The clinical significance of this initiative is a suitable approach to decrease 30-day

readmission rates resulting in improved quality of care, a multidisciplinary transition of care approach to the patient with COPD, decreased financial burdens for this medical center, and implementation of pulmonary evidence based guidelines.

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