The New Hypertension Standards: An Education Challenge

In late November, the American College of Cardiology/American Heart Association (ACC/AHA) made an announcement that could change the way tens of millions of American adults are treated for heart disease. After several years of study, the ACC/AHA announced new guidelines for the definition and treatment of high blood pressure.

Under the new guidelines—the first major revision of hypertension guidelines since 2003—almost half of the adult population in the United States should be treated for high blood pressure, either with lifestyle changes or medication. This new, more aggressive definition was adopted to “account for complications that can occur at lower numbers and to allow for earlier intervention,” according to the ACC.1 Continue reading “The New Hypertension Standards: An Education Challenge”

Helping patients decode pregnancy and parenting in the age of information overload

Written by: Jennifer Lincoln, MD, IBCLC, Board Certified OB/GYN

When a woman finds out she is expecting, it seems everyone she knows becomes a pregnancy and parenting expert: “Don’t eat this. You have to give birth this way.” With information available from friends, families, the internet, books, neighbors, and strangers at the park…how do patients know what to believe? And how can we as medical professionals help them sort it all out, and prevent them from heeding bad advice that has no factual basis?

As an obstetrician, part of my job is combating myths and quickly earning the trust of women I just met in a 15- or 30-minute appointment or during a quick visit to Labor and Delivery triage. How do I present myself as the expert, when I am up against the 24/7 churn of the internet and social media advice? Continue reading “Helping patients decode pregnancy and parenting in the age of information overload”

How to Talk about Cutting Sodium: New Hypertension Guidelines Call to Action

Written by: Karen Collins, MS, RDN, CDN, FAND

To meet the new clinical practice guidelines on hypertension published in November 2017 by the American College of Cardiology (ACC) and American Heart Association (AHA) in collaboration with nine other organizations, health professionals need to be prepared to engage more patients in actively reshaping lifestyle.(1) Whether talking to people with elevated blood pressure or stage 1 hypertension (the new terms replacing “prehypertension”), or those with stage 2 hypertension and already taking multiple medications, part of that engagement involves helping people reduce sodium intake.

The first step to lowering sodium intake is to break through patient misconceptions about where sodium is found in the diet and then explore ways to create a delicious “new normal” way to eat.

The new guideline recommends a daily sodium intake of no more than 1,500 milligrams (mg) per day as ideal.(1) However, this target will require significant changes in many people’s food choices and may not be realistic. The average sodium intake for adults is 3,529 mg/day.(2) Even a target of 2,300 mg/day is exceeded by 97% of men and 81% of women.(3) Continue reading “How to Talk about Cutting Sodium: New Hypertension Guidelines Call to Action”

Bridging NICU Staff Education and Family Support to Improve Neonatal Outcomes

The simple belief that “family-centered care” in the NICU means that the family will be present at the bedside while staff makes decisions and provides care doesn’t go nearly far enough in meeting families’ needs. In the model of the Neonatal Intensive Parenting Unit (Hall, 2017), parents are recognized as partners in their baby’s care and respected members of the care team. Their input is welcomed. Caregivers become coaches and mentors who encourage parents to assume active roles; care and decision-making become collaborative.

Providing this kind of comprehensive family support in the NICU means giving families the emotional support and education they need to fully understand their baby’s condition, development, and care. The goal of this comprehensive support is to help establish and cement parent/baby bonding, which is easily and all too often disrupted when a baby is admitted to the NICU. Facilitating and encouraging this bonding will give both baby and family the greatest chance to enjoy the best possible outcomes.

Providing emotional support to parents while caring for their baby is challenging for many NICU caregivers—and NICU parents are not always satisfied with their attempts. (Weiss, 2010) After all, doctors and nurses don’t receive much, if any, education on how to handle difficult conversations with families, how to recognize signs of serious parental distress, and how to help parents get beyond the anxiety created by the trauma of having a premature or sick newborn. Continue reading “Bridging NICU Staff Education and Family Support to Improve Neonatal Outcomes”

How to easily raise your HCAHPS scores

Patient satisfaction has been garnering an increasing amount of attention, since healthcare began its shift to a value-based, more patient-centric system. In an effort to measure “value” as opposed to volume, the Centers for Medicare and Medicaid Service (CMS) have begun implementing the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys to track the level of satisfaction among recently discharged patients. Patients rate their hospital stay in 27 categories, which range from communication with doctors and nurses to pain management to facility cleanliness and quietness. Based in large part on these scores, hospitals can either lose or gain up to 2% of their Medicare reimbursement payments. This percentage is expected to continue increasing along with the expansion of Medicare (an ACA mandate.) By implementing HCAHPS surveys, along with other qualitative measurement tools, CMS encourages healthcare providers and administrators to go beyond the moral imperative to provide high quality care by withholding reimbursement for subpar patient satisfaction.

There are a number of strategies to improve patient satisfaction scores, most of which emphasize improving practice and hospital environment. This costly method, however, may very well do the opposite. As Brenda E. Sirovich, MD, MS, of the Department of Veterans Affairs Medical Center in Virginia, explains, recent studies infer that efforts to cater to patient satisfaction may be ill guided, because by “implicitly encouraging health care providers to honor requests for (or to explicitly offer) discretionary health care services, such efforts may lead to overutilization, higher costs, and worse outcomes.”[1]

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Supporting Families and Staff with Palliative and Bereavement Care in the NICU

No one ever expects that when they become pregnant, their baby may not be born alive or may pass away after birth. And yet this is the reality for an unfortunate number of new parents every year. Many of these babies—whether they are born extremely prematurely, or with birth defects or other significant life-limiting conditions—come through the neonatal intensive care unit (NICU). As such, all who provide care in the NICU need to be prepared to provide sensitive and caring emotional support to parents who find themselves in this difficult situation of neonatal death and infant loss.

NICU Palliative care involves transitioning a baby from life-saving interventions to providing “comfort care,” understanding that when it is offered, any interventions that might once have been considered “life-saving” would not change the ultimate outcome in favor of survival. Comfort care consists of providing warmth, enteral nutrition (only if desired by parents), pain medication, and simple interventions such as nasal cannula oxygen if it is thought it would make the baby less distressed. Most importantly, comfort care involves intimate contact and unrestricted holding between parents and their baby, as well as time with extended family, which is not usually possible to the same degree when baby is undergoing intensive care. The emphasis is on the family’s quality of life during their time spent together.

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Better caregiver education means better patient care: how to successfully leverage the CARE Act

As value-based care initiatives slowly shift the focus of the business of healthcare from “transactions” to sustainable health processes, regulatory bodies have been issuing guidelines at a frenzied pace. Growing research on caregiver influence on patient compliance and legislation have physician and healthcare vendors looking for ways to reach these new stakeholders. To maximize the impact of care post-discharge, 30 states have elected to take part in the CARE Act (Caregiver Advise, Record, Enable), which requires providers to 1) record the family caregiver’s name on the patient’s medical record, 2) inform the family caregiver when the patient is to be discharged, and 3) provide the family caregiver an education on the medical tasks to be performed on the patient at home.  

Approximately 93 million US adults provide over $522 billion worth of caregiving every day, which often involves complex tasks such as wound cleaning, administering medication, and operating feeding tubes, not to mention emotional support and care. They are key stakeholders in the new, value-based healthcare landscape, with real influence on population health (70% of family caregivers spend between 10 and 40 hours a week performing medical tasks), and require a set of tools and systems to support patient outcomes. This growing body of research and data is leading healthcare industry experts to look for tools that would allow for a more holistic approach to patient care, taking socio-economic backgrounds, community support systems, and caregiving options into account, alleviating the heavy burden and potentially dangerous knowledge gaps that many caregivers contend with.

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How we can help doctors and hospitals feel confident with “breast is best”

Written by Jennifer Lincoln, MD, IBCLC

The term “breast is best” sums up exactly what leading medical organizations such as the American Academy of Pediatrics (AAP) and the American College of Obstetricians and Gynecologists (ACOG) believe: babies who receive breast milk as opposed to formula reap substantial benefits.

An increased focus on breastfeeding, as evidenced by more hospitals becoming certified as Baby-Friendly and the Joint Commission Perinatal Care measure tracking exclusive breastfeeding rates in newborn babies, means that the word is getting out about the importance of breast milk.

The Baby-Friendly Hospital Initiative (BFHI) was launched in 1991, with the goal of educating maternity staff in hospitals to better support breastfeeding for their moms and babies. This program includes intensive education and training for all maternity staff, and it sets forth guidelines that aim to increase breastfeeding initiation and exclusivity while in the hospital.

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Leveraging Expanded Patient Education Libraries to Meet Clinical Initiatives

The modern hospital and healthcare setting offers many challenges for healthcare providers. They are now tasked with meeting patient education initiatives while simultaneously doing more work on the floor. In addition, they are asked to manage staff time constraints, making it harder than ever to effectively engage patients in understanding their condition and then following up to make sure they are complying with care directives. While this might feel daunting, reliable, integrated patient education tools are designed to help providers and their teams meet these challenges.

Customized patient education solutions that can be integrated into the EMR to streamline the clinical workflow, can help ease this patient education burden. The Wellness Network’s suite of customizable patient education products can help you satisfy clinical initiatives, increase education time, and improve the overall quality of care while streamlining workflow for providers, making it easier than ever to provide high quality, consistent, individualized patient education.

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Going full term and avoiding the allure of a scheduled C-section: how to get your patients on board

Written by Jennifer Lincoln, MD, IBCLC

When it comes to delivering babies, there is one thing that everyone can agree on: expecting parents, nurses, obstetricians, midwives, and pediatricians all strive for a healthy mom and a healthy baby.

However, sometimes it can be really hard to wait for that healthy baby. From parents wanting to know exactly when their baby will be born to obstetricians trying to schedule deliveries on the day they are at the hospital in the hopes of increasing patient satisfaction, there are more and more reasons babies are arriving via scheduled inductions or planned C-sections.Going Full Term

While it is certainly true that some babies need to be delivered before their due date, such as for complications related to preeclampsia, growth restriction, or poorly controlled maternal diabetes, more often than not it is completely possible—and in fact, desirable—to play the waiting game when it comes to labor and birth.

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