Successful Heart Failure Management Nurse/NP Run Clinics

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1 Dagmar Knot RN BScN CCCN Transplant Coordination Team Leader Organ Transplant Center KFSHRC Riyadh, KSA Heart Failure Nurses Role, responsibilities & education Successful Heart Failure Management Nurse/NP Run Clinics 1

2 Health care systems are overstretched and unable to meet the complex needs of HF patients Considerable impact of HF nurses on patients' management HF clinics do not appear to increase costs HF clinics using nurse intervention reduce readmission frequencies and improve quality of care for HF patients Study Name Participants Key findings Blue et al (2001) 165 patients with HF from an acute admission unit Risk reduction 62% for hospital admission for worsening HF in intervention group Stromberg et al (2003) Thompson et al (2005) 106 patients with HF from three hospitals 106 patients with HF from two hospitals 41% reduction in hospital readmission in intervention arm in first three months of trial 22% reduction in admissions nurse-led intervention group Sisk et al (2006) 406 ambulatory care patients with HF Fewer hospitalization and better functioning in nurse management patients 2

3 The level of nursing support is clinic based on the team decision Some clinics prefer the Nurse Practitioner role Others an expert Registered Nurse Others a hybrid of both roles The scope of practice varies between countries/institution Registered nurse can practice with Physician orders NPs can provide a wider scope of care and work independently Rapidly increase in past decade in many countries Health care changes Increase in HF clinics HF nurse work in primary & secondary care settings HF nurses are working in an extended, autonomous nursing role Involvement in clinical research trials Patient & staff education Public awareness & education 3

4 ANP generally requires a master s degree with five years clinical practice in area of specialization Most nurses have a first nursing degree and HF knowledge obtained through practice and courses Post Graduate Certificate in CHF, UK, USA, Canada) Accredited educational program Supervised practical training Support from medical colleagues Nurse aware of the limitations and boundaries Accountable for their practice Protocols increases the scope of practice Supplementary prescribing (NP/ANP) Intended to improve patient care Faster and efficient access to medicines Competent in clinical assessment skills Comprehensive history The monitoring of objective observations Gathering information 4

5 A multidisciplinary approach Individualized care Access to specialist health care professional Patient education and counseling (including family/care givers) Intensive follow up of high risk patients to detect and address clinical problem Evidence-based pharmacological treatment and adherence Application of non-pharmacological strategies Encouraging patients to be actively involve in managing their own care Lynda Blue, J.McMurray. How much responsibility should heart failure nurse take. Eur Heart Failure J 7, 2005; Patient teaching experience Provide HF self-management teaching & support Extensive cardiac experience Advanced cardiac & HF assessment skills Confidence to introduce the end of life planning Safely provide telephone support/advice to patients Basic computer skills 5

6 Healthy diet 2-g Sodium restriction Maintaining ideal body weight Monitoring daily weight Fluid restriction adjusted according to the Na+ level liter per day Medication Monitoring blood pressure Cessation of smoking and ETOH consumption Light aerobic exercise Call list and HF clinic staff What to do when symptoms worsen Follow up visits Multidisciplinary Team Cardiologist: initial evaluation and establishment of treatment plant HF nurses, ANP/NP Pharmacists: medical therapy and drug evaluation Physiotherapists & Occupational Therapist Dieticians Social workers Palliative Care HF nurse/np/anp Responsible for the care of the patient Follow the treatment plan Assessment of functional capacity & quality of life Adjust medication within given limits (follow protocols and guidelines) Education (non-pharmacological management) Psychological support 6

7 GOALS: Reduce Mortality Reduction in hospital Provide highly specialize individualized care Improve quality of life Optimal patient care REQUIRENMENTS: Ongoing commitment of resources Application of clinical practice guidelines Appropriate infrastructure Culture of quality assessment 7

8 Algorithm/Guidelines: Heart Function Clinic, RAH, Edmonton Alberta, 2005 Algorithm/Guidelines: Heart Function Clinic, RAH, Edmonton Alberta,

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10 HEART FUNCTION CLINIC INITIAL LETTER What is the Heart Function Clinic Program? The Heart Function Clinic is an outpatient program to support persons living with congestive heart failure. The goals of the program are to improve quality of life and to prevent and decrease hospital admissions. What is heart failure? Heart failure occurs when the heart muscle weakens and needs to work harder to keep blood flowing through the body. The person with heart failure may have: Fatigue which limits activities. Shortness of breath even with minimal activity. Fluid retention resulting in weight gain, chest congestion and ankle swelling. Waking up breathless at night Who comes to the Heart Function Clinic Program? People who have been diagnosed with heart failure. Patients are referred to our clinic by cardiologists or other physicians. Who will you see at your appointments? At your initial appointment you will meet a nurse, a doctor, if needed you may be seen by a dietician and, a social worker. At follow up appointments you will see a nurse and and/or doctor, the dietician and a social worker as needed. What will happen at the Heart Function Clinic? A day before the appointment you will have your blood work and other test done. Assessment of your heart failure status. Ongoing education, re: salt and fluid restrictions, medications, lifestyle changes recommendations. Measure you weight, BP. Review your medications and encourage you to take them regularly. Arrange for other tests or procedures as needed. PLEASE BRING ALL YOUR MEDICATIONS WITH YOU TO THE CLINIC Please call the clinic to book a follow up appointment if you have been hospitalized. Nurses are also available for consult during office hours (Saturday to Wednesday 8:30am to 3pm) With team approach there is brighter future for heart failure patients 10