Transcript Document
THE ROLE OF
THE CARDIAC
NURSE
PRACTITIONER
Sue Sanderson MNSc(NP)
July 2014
Tasmanian Health Organisation - South
WHAT IS A NURSE PRACTITIONER?
• “a Registered Nurse educated and authorised to
function autonomously and collaboratively in an
advanced and extended clinical role. The nurse
practitioner role includes assessment and
management of clients using nursing knowledge and
skills and may include but is not limited to the direct
referral of patients to other health care professionals,
prescribing medications and ordering diagnostic
investigations”.
(ANMC, 2006)
DOMAINS
CLINICAL – pt focus
RESEARCH – evidence base
LEADERSHIP – service development
EDUCATION – professional development
SCOPE OF PRACTICE
Approved formulary – PBS schedules
Specific classes related to area of
practice
Approved pathology and imaging
Clinical supervision for collaborative
practice
NP CHRONIC CARDIAC CARE
Coordinates and manages the nurse-led
cardiac rehabilitation program and secondary
prevention services in THO-S
Programs delivered at RHH and ICC
MODEL OF CARE
♥ Adults with
• Step change in condition
Acute Coronary Syndromes (ACS) including ST Elevation Myocardial
Infarction (STEMI), Non-ST Elevation Myocardial Infarction (NSTEMI)
new onset or increasing angina
revascularisation procedures – Percutaneous Coronary Intervention (PCI),
Coronary Artery Bypass Grafts (CABG)
decompensated heart failure
Chronic stable cardiac condition
Established coronary heart disease
Chronic stable heart failure
♥ High risk primary prevention
CLINICAL DOMAIN
Holistic, comprehensive assessments physical, psychosocial, behavioural
Interventions and management of outcomes
within SoP – diagnostics
Pharmacotherapy – prescribe, up-titrate,
monitor, consult
Referral pathways
HEART FAILURE
Cardiologist/NP – HF clinic
Medication up-titration
Support/home visits
MDT
NP clinic/home monitoring
MDT/cardiologist support
NP/CNS/GP – clinic visit
frequency to be determined
Pts self-managing at home
HEART FAILURE
• IN-PATIENT
Education re salt, fluid restriction, symptom
recognition deterioration
Daily weigh
Medications including up-titration
Activity
Risk factor review
Follow-ups – phone, clinic, home
Social circumstances – support
Resources
HEART FAILURE
OUT-PATIENT - with cardiologist – dual clinic
Ongoing education re salt, fluid restriction, weigh mgt,
risk factors
Clinical assessment – BP, HR, SpO2, weight, JVP, HS,
oedema, symptoms, sleeping patterns, eating patterns,
activity
Adherence to fluid restriction
Medications and concordance, adverse effects
Ongoing titration meds, monitoring renal function
HEART FAILURE
♥ Home monitoring
Patient – weight daily, fluid restriction,
– activity levels
– can report concerns by phone
♥ Tele-monitoring
BP, SpO2, HR, weight
Response to symptom-related questions
To computer for triage daily
CHF QUESTIONS
Are you feeling more short of breath today than a
normal day?
Are your ankles more swollen than usual?
Do you get dizzy when you stand up?
Are you experiencing more chest pain than usual?
Do you feel more short of breath with activity?
Are you more short of breath at rest?
Were you short of breath during the night?
Are you coughing more than usual?
Home monitoring system
• mytelemedic monitor
• Weight scale
• Blood pressure monitor
• Pulse oximeter
Generic telehealth system
Client
completes
interview
Feedback from
clinician
mytelemedic
telehealth
monitor
Secure
Communications
network
Monitoring and Triage
CARDIAC REHABILITATION
SECONDARY PREVENTION
• “a coordinated system of care
necessary to help people with CAD
return to an active and satisfying life …
helps prevent the recurrence of cardiac
events or new cardiovascular
conditions”
National Heart Foundation of Australia, 2010
CARDIAC REHABILITATION
SECONDARY PREVENTION
♥ RHH – post revascularisation procedures – CABG, PCI
- ACS – STEMI, NSTEMI, stable angina
- valve surgery
- heart failure
♥ ICC - ACS – STEMI, NSTEMI, PCI, stable angina
- high risk primary prevention
♥ Exercise and education/information groups
CARDIAC REHABILITATION
SECONDARY PREVENTION
♥ ASSESSMENTS
Pre and post participation (RHH [CRN] and ICC [NP])
6 months post HHP
Random 6 months post RHH program
2yrs post ACS RHH program
♥ Health and well-being check, BP, weight, BMI,
waist circ, random lipid profile, 6MWT, activity
levels, smoking status
♥ Post program referral eg Heartmoves
REFERRAL
♥ Pathways to allied health colleagues as need
identified
♥ To NP – from within hospital via phone or person
by cardiology nurses, colleagues
♥ To CR – hospital. Capacity for GP’s to refer
patients identified at high risk for program at the
ICC