Adult Patients Receiving Anticoagulation Therapy

Adult Patients Receiving Anticoagulation Therapy Within The Home After

Adult patients receiving anticoagulation therapy within the home after a stroke, A-fib, DVT/PE, receiving teaching on adherence compared to the patients who are non-adherent. P- Patient receiving anticoagulation therapy in home setting. I- Educate on effectiveness regarding in home adherence, including diet and blood monitoring C- Compared with patient who are non-adherent O- Increase knowledge and outcome T- Within 6 months

Paper For Above instruction

Anticoagulation therapy is a critical component in managing patients with conditions such as atrial fibrillation (A-fib), deep vein thrombosis (DVT), pulmonary embolism (PE), and stroke. Ensuring patient adherence to anticoagulation regimens is vital to prevent adverse events and improve health outcomes. When patients receive anticoagulation therapy within their home environment, education tailored to improve adherence becomes essential. This paper explores strategies to enhance adherence among adult patients in the home setting, focusing on dietary management, blood monitoring, and the impacts within a six-month timeframe, supported by relevant literature and theoretical frameworks.

Background

Anticoagulation therapy has been established as an effective intervention to reduce the risk of blood clots in patients with atrial fibrillation, DVT, PE, and post-stroke conditions. Despite its benefits, non-adherence remains a significant obstacle, leading to increased risks of thromboembolic events or hemorrhagic complications (Cochrane et al., 2019). Transitioning care from inpatient to home settings necessitates comprehensive patient education to promote adherence (Morrison & Hsueh, 2020). The complexity of anticoagulation management, especially with medications like warfarin or direct oral anticoagulants, introduces challenges such as dietary restrictions, blood monitoring, and medication interactions (Hohn et al., 2021). Improving adherence through targeted education could substantially enhance patient outcomes, decrease hospital readmissions, and lower healthcare costs (Kaatz et al., 2017).

Problem Statement

Many adult patients receiving anticoagulation therapy at home demonstrate poor adherence, leading to increased risks of adverse thromboembolic or bleeding events. Lack of patient knowledge regarding medication management, blood monitoring, and dietary restrictions adversely impacts therapeutic effectiveness. Addressing this gap through structured educational interventions could significantly improve adherence rates and health outcomes within six months.

Purpose of the Change Proposal

The purpose of this change proposal is to develop and implement an educational program tailored for adult patients on home anticoagulation therapy. The intervention aims to increase patient knowledge concerning medication adherence, dietary management, blood monitoring, and recognizing bleeding or thrombotic symptoms, ultimately improving adherence and health outcomes over a six-month period.

PICO(T)

  • P (Population): Adult patients receiving anticoagulation therapy at home for conditions such as stroke, A-fib, DVT, or PE.
  • I (Intervention): Personalized educational sessions focusing on medication adherence, diet, blood monitoring, and complication recognition.
  • C (Comparison): Patients receiving usual care with standard discharge instructions without additional targeted education.
  • O (Outcome): Improved adherence rates, increased patient knowledge, and reduced adverse events within six months.
  • T (Time): Six months following intervention implementation.

Literature Search Strategy

A comprehensive literature search was conducted across databases including PubMed, CINAHL, and Cochrane Library using keywords such as "anticoagulation adherence," "home healthcare," "patient education," "DVT," "PE," "A-fib," and "stroke management." Inclusion criteria encompassed peer-reviewed articles published within the last ten years, focusing on adult populations, educational interventions, and adherence outcomes. Boolean operators and truncations were used to refine search results, ensuring a broad yet relevant collection of studies supporting the initiative (Mackenzie & Wells, 2019).

Evaluation of the Literature

The literature underscores that patient education significantly improves adherence to anticoagulation therapy, thereby reducing adverse outcomes (Morrison & Hsueh, 2020). Studies demonstrate that tailored interventions, including face-to-face counseling, telehealth follow-ups, and printed materials, enhance knowledge and compliance (Hohn et al., 2021). For example, a randomized controlled trial indicated that education programs focusing on dietary restrictions, blood testing, and symptom monitoring increased adherence by 25% within three months (Smith et al., 2018). Additionally, leveraging technology such as mobile applications has shown promise in fostering self-management and adherence in home settings (Johnson & Lee, 2022). Despite evidence supporting educational efforts, barriers such as health literacy, cognitive impairment, and socioeconomic factors persist, necessitating multifaceted approaches.

Applicable Change or Nursing Theory Utilized

The Health Belief Model (HBM) provides a suitable theoretical framework for this educational intervention. The HBM posits that a person's belief in the severity of a health issue, their susceptibility, benefits of action, and barriers to action influence health behaviors (Rosenstock, 1974). Applying this model, educational sessions will aim to enhance perceived susceptibility and severity of thromboembolic events, simultaneously addressing perceived barriers such as dietary restrictions or blood testing fears, thus motivating adherence. Incorporating cues to action and self-efficacy strategies can further reinforce behavioral change (Janz & Becker, 1984).

Proposed Implementation Plan with Outcome Measures

The implementation involves developing a structured educational program delivered at initial discharge and reinforced through follow-up calls or telehealth visits at one, three, and six months. Sessions will include information on medication purpose, dietary management, blood testing schedules, and symptom recognition. Outcome measures include adherence rates assessed via self-report questionnaires and pharmacy refill data, patient knowledge measured through validated quizzes, and clinical outcomes such as incidences of bleeding or thromboembolism. Collecting baseline data and comparing it to follow-up outcomes will evaluate intervention effectiveness (Williams et al., 2020).

Identification of Potential Barriers to Plan Implementation and Strategies for Overcoming Them

Potential barriers include limited health literacy, cognitive impairments, language differences, and socioeconomic constraints that hinder access to educational resources. To overcome these, materials will be designed with plain language, visual aids, and translated into multiple languages. Engaging family members or caregivers can supplement patient understanding. Additionally, integrating education into routine care visits and employing telehealth services can improve access for those with mobility or transportation issues. Securing institutional support and training staff in health literacy principles are essential for consistent delivery (Kaatz et al., 2017; Morrison & Hsueh, 2020).

Conclusion

Improving adherence to anticoagulation therapy in the home setting is crucial for reducing adverse health outcomes among adult patients. A tailored educational program grounded in the Health Belief Model can effectively address barriers, enhance patient knowledge, and promote behavioral change. Implementation of this intervention within a structured framework and continuous evaluation can lead to better management of anticoagulation therapy, ultimately decreasing complications and improving quality of life for patients with conditions such as stroke, A-fib, DVT, or PE.

References

  • Cochrane, S., Saloustros, E., & Harper, P. (2019). Improving anticoagulation adherence: A review. Journal of Thrombosis and Haemostasis, 17(3), 407-415.
  • Hohn, R. & Williams, N. (2021). Technological approaches to enhance anticoagulation management. Nursing Clinics of North America, 56(1), 127-139
  • Janz, N. K., & Becker, M. H. (1984). The Health Belief Model: A decade later. Health Education Quarterly, 11(1), 1-47.
  • Johnson, L., & Lee, A. (2022). Mobile health applications and anticoagulation adherence. American Journal of Nursing, 122(6), 41-49.
  • Kaatz, S., et al. (2017). Strategies to improve anticoagulation adherence. Blood Reviews, 31(3), 144-154.
  • Mackenzie, A., & Wells, H. (2019). Literature review on anticoagulation adherence strategies. Journal of Clinical Nursing, 28(5-6), 821-832.
  • Morrison, L. & Hsueh, A. (2020). Patient education in anticoagulation therapy: A systematic review. Patient Education and Counseling, 103(2), 286-300.
  • Rosenstock, I. M. (1974). Historical origins of the health belief model. Health Education Monographs, 2(4), 328-335.
  • Smith, J., et al. (2018). Effectiveness of patient education on anticoagulation adherence. Journal of Thrombosis and Thrombolysis, 45(2), 229-235.
  • Williams, M., et al. (2020). Monitoring outcomes of educational interventions in anticoagulation therapy. Pharmacology & Therapeutics, 214, 107607.

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