Transcript THE ROLE OF THE HEART FAILURE SPECIALIST NURSE

THE ROLE OF THE HEART
FAILURE SPECIALIST
NURSE
NHS Grampian Heart Failure
Nurses
November 2008
BACKGROUND TO CHRONIC
HEART FAILURE
“ Chronic Heart Failure (CHF) is a common and
debilitating condition” (Gould 2002, p.189).
 It has been described as the end stage of
cardiac illness, having a worse prognosis than
most cancers (Stewart et al, 2001).
 It affects about 2% of the population with
approximately 63,000 new cases in the UK each
year (British Heart Foundation (BHF), 2008).
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BACKGROUND TO CHRONIC
HEART FAILURE
Prevalence is increasing due to a growing
elderly population and improved medical
treatments. Currently 1.5 - 2% of the
population which equates to
approximately 8000 patients in Grampian.
 Increasing financial burden which
accounts for 2% of the NHS Grampian
budget.
 Associated with poor Quality of Life.
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WHAT ROLE DOES THE
SPECIALIST NURSE PLAY?
Recently published data
from BHF has
shown that a nurse led
service can:
 Provide education and
support to patients and
carers.
 Improve drug
compliance.
 Reduce hospital
admissions.
 Reduce costs to the NHS.
 Increase Quality of Life
CURRENT WORKLOAD
Initially, GP referral of recently discharged
patients with LVSD and complex NYHA III
and IV patients (confirmed on Echo).
 Adjustment of concomitant evidence
based therapy on discussion with medical
colleagues.
 Education of primary care staff.
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PROBLEMS FOR CHF PATIENTS
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Confusion over changes to medication.
Failure to get repeat prescriptions.
Taking non prescribed medications.
Poor concordance.
Difficult to titrate up therapy.
Poor social support.
Depression.
Poor cognitive ability.
PROBLEM AREAS
Delay in GPs receiving hospital discharge
letters.
 Delay in referring to HFSN service.
 Delay in updating prescription changes.
 Added and often intensive workload
associated with up titration of therapy.
 Dose of diuretic requiring to be adjusted
soon after discharge.
 Discrepancies regarding discharge therapy.
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KEY ELEMENTS OF THE HEARTS
FAILURE NURSE ROLE
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Regular follow up and assessment to detect early clinical
deterioration.
Adjustment and optimisation of therapy.
Close monitoring of blood chemistry and rapid access to
results.
Education and advice about heart failure, its treatment
and when to seek help.
Encouraging patients to be actively involved in managing
and monitoring their care.
Providing a link between patients and other healthcare
professionals and services.
Supporting patients and carers with advanced heart
failure.
SUPPORT NEEDED FOR HEART
FAILURE SPECIALIST NURSE.
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Clearly defined job description.
Model of care must suit local environment.
Clear guidelines and care pathways for referral,
admission and discharge.
Clear protocols and guidelines for use of
evidence based drug therapy and good practice.
Support from medical colleagues and
multidisciplinary team.
Access to educational programmes and ongoing
training and development.
NHS GRAMPIAN HEART FAILURE
SPECIALIST NURSES
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Moray
Jan Henderson - Dr Grays Hospital
Mandy Davis - Community
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Aberdeenshire
Audrey Stables – Central
Siobhan Taylor – North
Elizabeth Douglas - South
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Aberdeen City
Roz O’Dwyer
Elaine Lee
FURTHER DEVELOPMENT
Education about CHF and its management
to primary care teams .
 Nurses as supplementary prescribers.
 Palliative approach both for symptom
control and end of life care.
 Regular review of referral system and
workload.
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SUMMARY
Patients with chronic heart failure need
access to individualised care and
monitoring. Given sufficient funding and
support, the recruitment of effective
specialist nurses, and the application of
carefully constructed protocols, a heart
failure service can improve the health
outcome of patients with chronic heart
failure.
ANY QUESTIONS?