A Maryland hospital adapted an existing program encouraging lung health to respond to the sudden demands of COVID-19. The program helped reduce COVID-19 readmission rates by two-thirds.

University of Maryland Charles Regional Medical Center (UM CRMC) already was promoting a “Healthy Lungs = Healthy You” campaign when the pandemic hit. The hospital quickly pivoted to using the same educational program and resources to address the pandemic. By spring 2020, the program was fostering pneumonia prevention education and helping patients with COVID-19 infections continue their recovery after discharge.

Originally, the program was focused on patients with congestive heart failure (CHF) and chronic obstructive pulmonary disease (COPD) patients, explains Anne S. Weekley, MHA, BSN, RN, CSSGB, CPHQ, vice president for quality/patient experience at the UM CRMC.

Then, COVID-19 hit, and the quality improvement department realized the “Healthy Lungs = Healthy You” campaign could be adapted to address the emerging threats from the pandemic.

“Just before COVID, we were working to see that every patient in the ED and everywhere else, if they came in with a respiratory illness and didn’t meet criteria to be admitted, they were educated on the use of an incentive spirometer and given one to take home. Our transitional nurse navigators followed up with them,” Weekley says. “COVID comes along and we thought this would be an even better use of this program. We scrambled and put together a bag that had a toothbrush, toothpaste, mouthwash, a thermometer, the incentive spirometer, a pulse oximeter, literature on the pulse oximeter reading, and proning documentation.”

The literature included a color-coded chart to show what the pulse oximeter readings mean, with green indicating good lung health, yellow suggesting more incentive spirometer work is needed, and red indicating the patient should return to the ED.

The literature also explained why oral health is important for these patients and why the oral care products should be used regularly.

Provide to All Testing Positive

The hospital provided those kits to all COVID-19 patients, including those who tested positive but were not admitted.

“We’ve heard from people saying that their mom got this kit when she had COVID. They’ll call the transitional nurse navigator who’s checking on mom to say that now the daughter is using the pulse oximeter and got a new toothbrush, but is there any way she could get a spirometer,” Weekley says. “To hear that it has blossomed in the community like that, with family members embracing the education from that one kit, is very encouraging. They have the number for the nurse navigator. There have been times when relatives of the original patient called with their O2 stats, and we told them to come in to the ED.”

In some cases, the caller would protest he or she had just been to the ED a day or two before. Still, the nurse navigator explained the effects of COVID-19 can escalate rapidly and that the pulse oximeter readings indicated a return visit was warranted.

Without the kits in the community, those patients may have waited too long. UM CRMC is in a rural area and gives out about 100 kits per month. Since beginning the program, the hospital has provided about 700 kits to patients.

Kits Improved Over Time

UM CRMC also added items to the kit as the effects of COVID-19 were better understood. When it became clear blood pressure is an issue with systemic disease, the hospital added a blood pressure monitor to the kit, along with instructions on how to use it. A water cup was added to the kit to encourage patients to drink plain water.

Staff also created a “Healthy Lungs = Healthy You” video series to educate patients on the use of an incentive spirometer, along with the benefits of pursed lip breathing, deep breathing, oral hygiene, and movement. (Learn more here.)

UM CRMC has experienced a significant decrease in COVID-19 readmissions and pneumonia admissions since the beginning of the program.

The readmission rate for COVID-19 patients in February 2020 was about 25%. By December 2020, the rate had fallen to about 7%, according to Weekley. The UM health system has adopted the kit program at other hospitals. The system tracks the address, ethnicity, age, and sex of patients receiving the kits.

Data collection for the program indicates COVID-19 readmissions are highest among African American women between age 40 and 60 years, followed by Hispanic women in the same age group.

For African American men, readmissions were highest in the age 60 to 80 years range. Hispanic men age 40 to 60 years readmission rates mirrored those of Hispanic women of the same age.

Kits Are Expensive

Each kit contains about $130 worth of goods. Starting in March 2020, the cost of the kits has been covered by a grant from the Charles County Health Department and other sources. This has prevented UM CRMC from incurring substantial debt for the kits. The hospital does absorb the cost of printing the educational materials. The biggest challenge in the program has been acquiring the items to include in the kits. During the height of the pandemic, when many medical resources were in short supply, Weekley’s team had to be innovative in finding enough items for the kits.

“For a time, we could not get thermometers, blood pressure [monitors], and pulse oximeters. Some of us with Amazon accounts were ordering as many as we could at a time because even our hospital supplier could not provide them,” Weekley says. “Today, we can get access to pulse oximeters, but thermometers and blood pressure [monitors] are still hard to come by. When we start to run low and our supplier can’t help, we all go back and order from Amazon.”

The hospital also had trouble obtaining enough toothbrushes and toothpaste.

“We had people running out to the dollar stores to buy up all the toothbrushes, almost daily. At the beginning of the pandemic, it was like that. You just couldn’t get certain items,” Weekley says. “Initially, we tried to add little hand sanitizer bottles to the kit, but that quickly became impossible to find anywhere.”

The program will continue after the pandemic ends, Weekley says, shifting focus back to the original CHF and COPD patients. Those patients and all major surgical patients currently receive the kits and education.

“At their pre-op visit, [patients] are educated on the use of the incentive spirometer and pulse ox. Once they go home, they can monitor themselves to prevent pneumonia. Then, [patients] are educated again in the surgery suite before they go back to the OR, just to remind them,” Weekley explains. “When [patients] get up to the floor, they get the same thing, and we use their own pulse ox and their own incentive spirometer to teach them. We remind them to track these things when they get home.”

Transitional nurse navigators call all high-risk patients after discharge to make sure they are using the devices and to assess their pulse oximeter readings.

“It’s a program that we’ve seen produce very good results in our population of COVID patients. We’re seeing the same benefits with other patients who are high risk,” Weekley reports. “It’s definitely something we will continue.” 

SOURCE

  • Anne S. Weekley, MHA, BSN, RN, CSSGB, CPHQ, Vice President Quality/Patient Experience, University of Maryland Charles Regional Medical Center, La Plata, MD. Phone: (301) 609-4325. Email: anne.weekley@umm.edu.