Background Poor adherence to evidence-based medications in heart failure (HF) is a major cause of avoidable hospitalizations, disability, and death. To test the feasibility of improving medication adherence, we performed a randomized proof-of-concept study of a self-management intervention in high-risk patients with HF. Methods Patients with HF who screened positively for poor adherence (<6 Morisky Medication Adherence Scale 8-item) were randomized to either the intervention or attention control group. In the intervention group (n=44), a nurse conducted self-management training prior to discharge that focused on identification of medication goals, facilitation of medication-symptom associations, and use of a symptom-response plan. The attention control group (n=42) received usual care; both groups received follow-up calls at 1 week. However, the content of follow-up calls for the attention control group was unrelated to HF medications or symptoms. General linear mixed models were used to evaluate the magnitude of change in adherence and symptom-related events at 3-, 6-, and 12-month follow-up clinic visits. Efficacy was measured as improved medication adherence using nurse-assessed pill counts at each time point. Results Pooled over all time points, patients in the intervention group were more likely to be adherent to medications compared with patients in the attention control group (odds ratio [OR] 3.92, t=3.51, p=0.0007). Conclusions A nurse-delivered, self-care intervention improved medication adherence in patients with advanced HF. Further work is needed to examine whether this intervention can be sustained to improve clinical outcomes.

Poor education-related discharge preparedness for patients with heart failure is believed to be a major cause of avoidable rehospitalizations. Technology-based applications offer innovative educational approaches that may improve educational readiness for patients in both inpatient and outpatient settings; however, a number of challenges exist when implementing electronic devices in the clinical setting. Implementation challenges include processes for "on-boarding" staff, mediating risks of cross-contamination with patients' device use, and selling the value to staff and health system leaders to secure the investment in software, hardware, and system support infrastructure. Strategies to address these challenges are poorly described in the literature. The purpose of this article is to present a staff development program designed to overcome challenges in implementing an electronic, tablet-based education program for patients with heart failure. (Critical Care Nurse. 2016;36 A lthough many factors contribute to high rates of hospital readmission for patients with heart failure, inadequate educational preparation for discharge is one factor that is largely avoidable and predominantly managed by nurses.1,2 New electronic, tablet-based patient education platforms, designed to address predischarge gaps in education, are increasingly accessible and linked to electronic health records.3,4 Yet, integrating these tools into nursing workflow is challenging. Staff development initiatives to facilitate adoption of electronic tablet-based patient education in the acute care setting are needed.Louise Saladino, RN To illustrate the gravity of the prevalence and high cost of preventable readmissions, the Agency for Healthcare Research and Quality sponsored work to identify contributing factors. Of the 9 million Medicare hospitalizations yearly, 1 in 5 patients is readmitted within 1 month of discharge. 5 The cost of hospital readmissions is estimated to be $26 billion per year, of which $17 billion is considered preventable.5 Notably, inadequate educational preparation was identified as a common contributor to avoidable readmissions and was established as a target for care redesign. [6][7][8] In 2009, providing written instructions and educational materials at discharge became a critical performance measure in the heart failure clinical practice guidelines for the American College of Cardiology and American Heart Association. 9The Joint Commission and the Centers for Medicare and Medicaid Services also require that discharge instructions include information on medications, worsening symptoms, diet, activity, weight monitoring, and follow-up appointments. [10][11][12] Although clinical practice guidelines and regulatory requirements support the need for more effective education before discharge, the challenges of redesigning traditional paper-based educational content and patient education workflow processes in inpatient care settings are substantial.For nurses, classroom education is shifting to include more contemporary, peda...

Objective:We present the design and feasibility testing for the “Digital Drag and Drop Pillbox” (D-3 Pillbox), a skill-based educational approach that engages patients and providers, measures performance, and generates reports of medication management skills.Methods:A single-cohort convenience sample of patients hospitalized with heart failure was taught pill management skills using a tablet-based D-3 Pillbox. Medication reconciliation was conducted, and aptitude, performance (% completed), accuracy (% correct), and feasibility were measured.Results:The mean age of the sample (n = 25) was 59 (36–89) years, 50% were women, 62% were black, 46% were uninsured, 46% had seventh-grade education or lower, and 31% scored very low for health literacy. However, most reported that the D-3 Pillbox was easy to read (78%), easy to repeat-demonstrate (78%), and comfortable to use (tablet weight) (75%). Accurate medication recognition was achieved by discharge in 98%, but only 25% reported having a “good understanding of my responsibilities.”Conclusions:The D-3 Pillbox is a feasible approach for teaching medication management skills and can be used across clinical settings to reinforce skills and medication list accuracy.