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Welcome to the second on-site edition of the Annual Meeting Gazette. The second day of the 2007 AAHFN Annual Meeting was kicked off by Gladys Campbell's motivational address and was followed by a full day program focused on cutting-edge cardiovascular research and ways to build a foundation for excellence in heart failure care.
In this issue of the gazette, we will not only provide a summary of the motivational address, but will also highlight one session from each of the three tracks offered at this year's annual meeting; Cornerstones of HF, Advanced Aspects of HF and Global Aspects of HF.
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| Motivational Address- Friday, June 29th |
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"Standing on a Firm Foundation: Strength for Today, Bright Hope for Tomorrow"
Gladys M. Campbell, RN, MSN
What a delight- this Gladys Campbell! We wish so much you could have been here to experience this in person!
Gladys started out by bringing us back to our "roots" as nurses. What inspired us to become nurses? And, looking to the future, how do we inspire others?
Gladys set out for us the realities of the culture of our practice settings:
- there is a polictical pecking order
- the boundaries between medical and nursing practice are unclear
- there are MULTIPLE standards and policies and procedures set out for us by various agencies such as CMS, JCAHO, ANA/Magnet status, professional organizations
In America, our foundation is based on rights, freedom and the value of independence. With a great deal of humor, she laid out our current practice dilemma as a nurse - how do we go beyond our culture of "competence" and "obedience" which only gets you to "average" and "boring" in our quest for excellence? Excellence often arises out of touch situations, for example, remember Florence Nightingale? She care for 3000 patients with only 35 nurses and still decreased the mortality rate by 50%. This is also happening today with our military doing so much with so few resources.
Excellence starts out on the road of innovation and curiosity:
- Ask simple questions
- Count, keep track of what works
- Where is progress?
- Be courageous
- Challenge those who do not meet known standards
- Challenge beyond the standards
An important point was that as nurses, a key to excellence is upholding the public trust. We need to remember that our licensure comes not from our institution but is a gift from the trust of the publics and we are accountable - even to the most vulnerable members of our society. Remember the goodness of our practice is grounded from the choices we make - don't be afraid to make ripples!
In closing, some food for thought- "To build a ship is just not plank and nails but the passionate desire for the sea."
Submitted by Sherry Birchem, RN
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| Cornerstones of HF |
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"Putting the Guidelines to Work"
Who are we in 2007?
By Mariell Jessup, MD
Indication and Classes of Evidence: Sorting out the Details. By Cindy Adams, MSN, RN
Prevalence of heart failure is increasing as the population ages. Patients have heart failure with low EF, or heart failure with preserved EF. The guidelines are based on evidence from randomized clinical trials. Real world patients tend to be 50/50 male or female. They are an increased incidence of multiple co-morbidities, such as hypertension, diabetes, atrial fibrillation, and renal insufficiency. They tend to be older, with only 50% having coronary artery disease, with the majority (57%) have preserved EF. 
There is no single diagnostic test for heart failure because it is a clinical diagnosis that is based on a careful medical history, physical exam, and test results.
Optimal heart failure management of the individual includes six principles:
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Define the structural abnormality, what is wrong with the heart. 2D echo cardiogram is "the single most useful diagnostic test" in the evaluation of patients with heart failure.
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Develop skills to assess the functional status, and use them at each patient visit. JVD is the most reliable sign of volume overload.
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Determine important co-morbidities that will impact outcome or compliance. Simple tests and vital signs, such as bun>43, systolic blood pressure<115 mm Hg and creatinine >2.75 can be used as prognostic markers for a 21 % increase in mortality in 3 months post-hospitalization.
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Apply evidence based therapies where feasible, and document reasons for intolerance. AHA stages A to D review goals for pharmacologic and non pharmacologic therapy.
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Know where the evidence is then use medical therapy as appropriate. Some examples are the use of aldosterone antagonists, digoxin, and the addition of ARB's or hydralazine and a nitrate.
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Understand the risk profile of all the patients with an ominous prognosis, such as intolerance to beta-blockers, intolerance to aceI/ARB, recurrent hospitalizations need for inotropes, hyponatremia, and progressive renal insufficiency. Some of these patients may be transplant or ventricular assist device and dates. Palliative care, hospice, may be the final step in management of these patients.
Submitted by: Kathy Galvin, ANP
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| Advanced Aspects of HF |
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"Show Me the Money: Billing and
Reimbursement for the APN"
Cheryl Gregg Fahrenholz, RHIA, CCS-P
Cheryl Gregg Fahrenholz is the President of Preferred Healthcare Solutions and has over twenty years of experience working with physicians and their staff offering specialized assistance in practice management and health care consulting. She is known nationally for her presentations on topics including practice management, efficiencies, coding, documentation, and reimbursement.
Today, Cheryl offered an excellent overview presentation sharing with the audience pearls of wisdom for the advanced practice nurse in both billing in the outpatient setting as well as in-hospital, encompassing many difficult billing circumstances. These circumstances included consultations, admissions, critical care consult time, procedures, and much more.
Cheryl emphasized the steps for success in demonstrating your worth as an advanced practice nurse include determining the practice model in which you provide services whether this is independent, collaborative, or contractual. Knowing your billing model and productivity model is key as well. You need to know that you are getting paid for your visits. Determine your marketing package. You are a provider for your employer and provide revenue to the practice.
Understanding billing and reimbursement is key in demonstrating the value of our role as an advanced practice nurse. Know what you are worth!!
Submitted by: Sherri Delgado, MSN, CRNP
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| Global Aspects of HF |
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"Scientific Session: Research Presentations"
The research abstracts presented at the scientific session were interesting and informative. Full abstracts will be printed in a forthcoming issue of PCVN, but a brief review is provided here.
"Testing the Psychometric Properties of the Medication Adherence Scale in Patients
with Heart Failure"
Jia-Rong Wu, MSN, PhD
Dr. Wu presented results of testing the new tool "medication adherence scale" in 100 patients with heart failure. This tool has scales that measure attitudes, knowledge, and barriers to medication adherence. Multiple analyses were performed to assess the reliability and validity of the tool. Results support use of this simple 18 item survey to assess adherence to medications.
"Psychometric Testing of the MD Anderson Symptom Assessment Inventory-Heart Failure in (MDASI-HF): An Evaluative Instrument for Symptom Identification in Cancer Patients with Concurrent Heart Failure"
Anecita P. Fadol, PhD, RN, FNP
Dr. Fadol presented results of another tool, the MD Anderson Symptom Assessment Inventory in HF (MDASI-HF). This tool has gone through much testing and assesses symptoms that are relevant to the person with both cancer and heart failure. Again reliability and validity was strong in this tool that may be useful.
"The Use and Perceptions of Dietary Supplements Among Patients with Heart Failure"
Xiuzhen Fan, PhD
Dr. Fan presented results of a survey of 73 patients with heart failure to determine the use of dietary supplements that are known to interfere with common cardiac medications. The majority of patient used at least one supplement which could be a multi-vitamin. Many respondents had unrealistic expectations or inaccurate information.
"Dietary Sodium Intervention in
Heart Failure Patients"
Brooke B. Bentley, PhD, RN
Dr. Bentley presented results of a pilot study of a theory based (Theory of Planned Actions) intervention on dietary sodium intake in 17 subjects. The intervention was favorably received by those subjects. The sample was too small to detect significant findings but there were promising trends and this warrants further study.
Submitted by Linda Baas, RN, PhD, ACNP
Facilitator: T.Lennie Ph.D.
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Thank you for reading this issue of the Annual Meeting Gazette Look for tomorrow's issue which will not only highlight the program and events from Saturday, June 30th, but will also announce the 2008 Annual Meeting location!
Sincerely,
AAHFN Annual Meeting Committee
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