Tasmanian Health Organisation - South

THE ROLE OF THE CARDIAC

NURSE PRACTITIONER

Sue Sanderson MNSc(NP)July 2014

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

practiceApproved pathology and imagingClinical 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 clinicMedication up-titrationSupport/home visitsMDT

NP clinic/home monitoringMDT/cardiologist support

NP/CNS/GP – clinic visit frequency to be determinedPts self-managing at home

HEART FAILURE• IN-PATIENT

Education re salt, fluid restriction, symptom recognition deterioration

Daily weighMedications including up-titrationActivityRisk factor reviewFollow-ups – phone, clinic, home

Social circumstances – support Resources

HEART FAILURE

OUT-PATIENT - with cardiologist – dual clinicOngoing education re salt, fluid restriction, weigh mgt,

risk factorsClinical assessment – BP, HR, SpO2, weight, JVP, HS,

oedema, symptoms, sleeping patterns, eating patterns, activity

Adherence to fluid restrictionMedications and concordance, adverse effectsOngoing titration meds, monitoring renal function

HEART FAILURE

♥ Home monitoringPatient – weight daily, fluid restriction, – activity levels– can report concerns by phone

♥ Tele-monitoringBP, SpO2, HR, weightResponse to symptom-related questionsTo 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

SecureCommunications

network

Monitoring and Triage

Feedback from clinician

mytelemedic telehealthmonitor

Client completes interview

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

♥ ASSESSMENTSPre and post participation (RHH [CRN] and ICC [NP])6 months post HHPRandom 6 months post RHH program2yrs 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