Doctor of Nursing Practice
Post Master's DNP Completion
Year Degree Awarded
Month Degree Awarded
Heart failure (HF), transitional care, 30-day readmission rate, long term-care.
Gabrielle Abelard DNP, PMHNP-BC
DNP Project Chair
Pamela Aselton PhD, MPH, FNP-BC
Background: Heart failure is the leading cause of hospitalization in the United States and accounts for more than one million hospitalizations every year. Readmission within 30 days of discharge is an indicator used for measuring the quality of care for heart failure patient. Methods: The goal of this quality improvement project is to reduce the 30-day readmission rate of heart failure patients 60 years and older in a long-term care setting in Texas by using an evidence-based transitional readiness discharge checklist for heart failure. Interventions included staff education on the key components and on the checklist. A pre- and post-test was given to measure staff learning, and the 30-day readmission rate of patients was provided by the longterm care facility electronic health record. Results: The project followed 18 patients with heart failure and other comorbidities admitted between October 2018 and March 2019. None of the 18 patients were readmitted to the hospital within 30 days for heart failure exacerbation, although two were readmitted for other reasons. The patients continued to be treated in long term care, which reduced the readmission rate from a previous high rate of readmission to the hospital from this facility of 45% to 13%. Staff reported an increased knowledge of heart failure on pre and posttests. Ten licensed staff had pre-test mean score was 82.78, with a post-test score increased to 98.57 indicating greater knowledge of heart failure. Conclusion: Education on discharge readiness checklist of heart failure older adult patients and power-point presentation increased the knowledge of the staff as evidenced by the result of pre- and post-test. A reduction in the 30-day readmission rate was seen in the patients involved in the project.
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