Implementation of an Advanced Practice Nurse-led Heart Failure Clinic

Implementation of an Advanced Practice Nurse-led Heart Failure Clinic


Name: Amanda Anderson

Rank: Maj

Presenter/Poster: Presentation and Poster

Year: 2019


An evidence based practice (EBP) initiative called Project Re-engineered Discharge (RED) was adopted by the Air Force Medical Service (AFMS) in 2014 to decrease preventable readmissions. Due to difficulties with translation into the practice setting Project RED had little effect on heart failure (HF) specific readmission rates and all-cause readmission rates in the MTF. In particular, the strategies and methods used to implement Project RED interventions were not translated into the MTF’s organizational structure.  Due to little change in HF metrics a Readmissions Working Group was initiated. The structure and culture of the AFMS was not fully considered when implementing Project RED or within the working group. An EBP initiative, when developed and implemented correctly with a comprehensive plan that includes the local culture has shown to be 30% more effective in achieving optimal patient outcomes. This EBP initiative seeks to address HF readmissions utilizing an Advanced Practice Nurse (APN) Led Clinic. In (P) adult HF patients, how does the implementation of an (I) APN led HF clinic as (C) compared to current practice affect (O) outcomes (T) over one year?  The specific aims are: create and implement the APN led HF clinic, decrease the HF-specific readmission rate, and demonstrate the significance of having an EBP initiative implemented through a comprehensive plan. Strategies and methodologies that will be employed to evaluate the APN led HF clinic include comprehensive self-care management education, utilization of the Self Care Heart Failure Index (SCHFI) index v 6.2 tool, follow up appointments within 7 days of discharge, and frequent telephone contact to reinforce patient’s education. A literature search was conducted in the following databases: CINAHL, PubMed, and Cochrane Review. In the literature, these interventions were shown to decrease HF specific readmissions: self-care management techniques along with traditional HF interventions, follow up monitoring by specialty trained staff and access to specialized HF clinics. Correctly deploying this EBP initiative will improve management of HF patients, decrease readmissions, and have secondary impacts such as increased access to care. Additionally, implementation of this best practice will provide guidance on how to successfully deploy an EBP initiative within the AFMS.

4 keywords: Military Medicine, Advanced Practice Nurse, Heart Failure Clinic, EBP