Andrew White

Graph showing cases of ARF in Central Australia

Graph showing cases of ARF in Central Australia

Acute Rheumatic Fever

0

5

10

15

20

25

30

35

1995

1996

1997

1998

1999

2000

2001

2002

Year

Nu

mb

er

Recurrence

Diagnosis

What are the implications of this pattern for management (prevention) of RHD

Ten-year follow up of a cohort with rheumatic heart disease (RHD)

Carapetis JR1 Kilburn CJ MacDonald KT Walker AR Currie BJ

METHODS AND RESULTS

Of a cohort of 33 children seen between 1980 and 1984 27 survived until July 1984

Twenty-five of the survivors were followed up for a mean of 106 years to a mean age of

241 years The two deaths during follow-up were both due to RHD Six people

underwent valve replacement surgery all were clinically healthy when last seen

Complications included two thromboembolic events and two episodes of endocarditis

Deterioration of RHD severity was associated with ARF recurrences (relative risk 36

95 CI 17-76) and resolution of RHD was associated with having only mild valve

lesions initially (risk difference 058 95 CI 030 to 086) During follow-up valve lesions

tended either to resolve or to become more complex and severe with a higher proportion

of aortic valve lesions and multiple valve lesions Of seven children with suspected past

ARF excluded from the original cohort because of normal cardiac findings at the time

three developed RHD including one who died due to RHD and two with moderate or

severe valve lesions

Graph showing cases of ARF in Central Australia

Graph showing cases of ARF in Central Australia

Acute Rheumatic Fever

0

5

10

15

20

25

30

35

1995

1996

1997

1998

1999

2000

2001

2002

Year

Nu

mb

er

Recurrence

Diagnosis

What are the implications of this pattern for management (prevention) of RHD

Ten-year follow up of a cohort with rheumatic heart disease (RHD)

Carapetis JR1 Kilburn CJ MacDonald KT Walker AR Currie BJ

METHODS AND RESULTS

Of a cohort of 33 children seen between 1980 and 1984 27 survived until July 1984

Twenty-five of the survivors were followed up for a mean of 106 years to a mean age of

241 years The two deaths during follow-up were both due to RHD Six people

underwent valve replacement surgery all were clinically healthy when last seen

Complications included two thromboembolic events and two episodes of endocarditis

Deterioration of RHD severity was associated with ARF recurrences (relative risk 36

95 CI 17-76) and resolution of RHD was associated with having only mild valve

lesions initially (risk difference 058 95 CI 030 to 086) During follow-up valve lesions

tended either to resolve or to become more complex and severe with a higher proportion

of aortic valve lesions and multiple valve lesions Of seven children with suspected past

ARF excluded from the original cohort because of normal cardiac findings at the time

three developed RHD including one who died due to RHD and two with moderate or

severe valve lesions

Ten-year follow up of a cohort with rheumatic heart disease (RHD)

Carapetis JR1 Kilburn CJ MacDonald KT Walker AR Currie BJ

METHODS AND RESULTS

Of a cohort of 33 children seen between 1980 and 1984 27 survived until July 1984

Twenty-five of the survivors were followed up for a mean of 106 years to a mean age of

241 years The two deaths during follow-up were both due to RHD Six people

underwent valve replacement surgery all were clinically healthy when last seen

Complications included two thromboembolic events and two episodes of endocarditis

Deterioration of RHD severity was associated with ARF recurrences (relative risk 36

95 CI 17-76) and resolution of RHD was associated with having only mild valve

lesions initially (risk difference 058 95 CI 030 to 086) During follow-up valve lesions

tended either to resolve or to become more complex and severe with a higher proportion

of aortic valve lesions and multiple valve lesions Of seven children with suspected past

ARF excluded from the original cohort because of normal cardiac findings at the time

three developed RHD including one who died due to RHD and two with moderate or

severe valve lesions

Pediatr Int 2013 Dec55(6)685-9 doi 101111ped12163 Epub 2013 Sep 20

Rheumatic silent carditis echocardiographic diagnosis and prognosis of long-

term follow up

Pekpak E1 Atalay S Karadeniz C Demir F Tutar E Uccedilar T

(Turkish Study)

METHODS

A total of 156 consecutive patients diagnosed with acute rheumatic fever were

included in the study Patients had either clinical carditis CC or silent carditis SC

RESULTS

Acute rheumatic fever was diagnosed in 156 patients and 103 of these (66) had

carditis The prevalence of SC was 282 among these 103 patients

Follow up gt 1 year

CC SC

Regurg improved 45 15

Regurg resolved 18 30

Heart 2011 7 2018 -2022

Screening study

Follow up of 100 cases after approx 1 year

Worsened in 4

Non progressive in 68

Regressed in 28

Your patient John 14 years old has a history of ARF when 8 You receive a letter after his cardiology review which says rdquoJohnrsquos cardiac echo shows moderate mitral regurgitation On history it appeared that John is not getting any prophylactic penicillin at all The fact that John is totally noncompliant with prophylaxis places him at great riskrdquo What are the issues Do you have any suggestions for management

Secondary prevention should include

bull strategies aimed at improving the delivery of secondary

prophylaxis and patient care

bull the provision of education

bull coordination of available health services

bull advocacy for necessary and appropriateresources

RHD Australia Guidelines

Secondary prophylaxis

Manyemba J Mayosi BM Penicillin for secondary prevention of rheumatic fever Cochrane Database of Systematic Reviews 2002 Issue 3

Secondary prophylaxis

Manyemba J Mayosi BM Penicillin for secondary prevention of rheumatic fever Cochrane Database of Systematic Reviews 2002 Issue 3

bull Biggest factor was availability and acceptability of staff members and belonging to community rather than pain or understanding [Z Harrington 2005]

Secondary Prevention

Audit Townsville RHD paediatric outreach

Townsville Model

bull Nursing led

bull One team is responsible for follow up establishment of

relationships leadership etc

bull Multidisciplinary

bull Indigenous Liaison Officer

bull Allied Health

Townsville Model

bull Focus on the patient

bull (and family)

bull First Needle

bull Use of distraction Occupational therapist

bull Individualised care

bull Needles in hospital until patient is desensitised

bull Then at school or home

Townsville Model

bull Medical Support

bull Cohort into a clinic

bull Continuity

bull STP funded registrar available to review patient see new

patients etc

Townsville

Model

bull Hospital

recognition of the

team

bull Promotion etc

To combat fear and pain Buzzy uses the physiologic pain relief of icy numbing and tingly vibration to block transmission of sharp pain on contact In the same way that rubbing a bumped elbow helps stop the hurt or cool running water soothes a burn Buzzy dulls sharp pain

Buzzy Bee

The Paediatric Outreach Service TTH

Case manages all children lt 16 yrs diagnosed with ARF ampor RHD in the

local district plus children attending boarding schools

AIMS

100 compliance of LA Bicillin prophylaxis using strategies

bullProcedural Interventions to reduce trauma amp anxiety of IMrsquos working closely

with occupational therapist

bull Establish routines amp familiarity for children amp families working

closely with THHS IHWrsquos amp ALOrsquos

bull Provision of ongoing education reinforcement of importance of

ongoing treatment for the long term emphasising the importance of

days at risk (IMI every 21 ndash 28 days)

bullProvision of home amp school outreach visits for older children who are

bicillin desensitised

The Paediatric Outreach Service TTH

AIMS (continued)

Reduce risk of recurrences improve general health and ensure follow up by

bullWorking with families to raise awareness of the importance of improving

personal hygiene standards amp nutritional status

bullCoordinating clinical follow up for regular medical review ECHO

dental checks annual vaccinations amp opportunistic health assessments

bull Maintaining monthly data sharing with ARF amp RHD QLD Registry

bullContacting or refer to other health services when clients move

bullUsing culturally appropriate educational resources supplied by the

ARF amp RHD QLD surveillance amp control program

bullReferring to the ARF amp RHD program district coordinator for clinical

educationin-service updates for paediatric clinicians amp nursing staff

bullNotifying ARF amp RHD coordinator when targeted education intervention is

required for clientfamily (if compliance is poor)

The Paediatric Outreach Service TTH

LONG TERM GOALS

bullEnsure all suspected cases of ARF are reported to NoCS

bullAssist in the accurate diagnosis ARF as per 2012 Guidelines

bullPrevent ARF recurrences

bullMaximise prophylaxis (100) to

- prevent recurrent ARF and progression of RHD and

- allow for resolution of early stages of valvular disease

bullPrevent progression of RHD

bullContinue to achieve 100 prophylaxis compliance

Your patient John 14 years old has a history of ARF when 8 You receive a letter after his cardiology review which says rdquoJohnrsquos cardiac echo shows moderate mitral regurgitation On history it appeared that John is not getting any prophylactic penicillin at all The fact that John is totally noncompliant with prophylaxis places him at great riskrdquo What are the issues Do you have any suggestions for management

Secondary prevention should include

bull strategies aimed at improving the delivery of secondary

prophylaxis and patient care

bull the provision of education

bull coordination of available health services

bull advocacy for necessary and appropriateresources

RHD Australia Guidelines

Secondary prophylaxis

Manyemba J Mayosi BM Penicillin for secondary prevention of rheumatic fever Cochrane Database of Systematic Reviews 2002 Issue 3

Secondary prophylaxis

Manyemba J Mayosi BM Penicillin for secondary prevention of rheumatic fever Cochrane Database of Systematic Reviews 2002 Issue 3

bull Biggest factor was availability and acceptability of staff members and belonging to community rather than pain or understanding [Z Harrington 2005]

Secondary Prevention

Audit Townsville RHD paediatric outreach

Townsville Model

bull Nursing led

bull One team is responsible for follow up establishment of

relationships leadership etc

bull Multidisciplinary

bull Indigenous Liaison Officer

bull Allied Health

Townsville Model

bull Focus on the patient

bull (and family)

bull First Needle

bull Use of distraction Occupational therapist

bull Individualised care

bull Needles in hospital until patient is desensitised

bull Then at school or home

Townsville Model

bull Medical Support

bull Cohort into a clinic

bull Continuity

bull STP funded registrar available to review patient see new

patients etc

Townsville

Model

bull Hospital

recognition of the

team

bull Promotion etc

To combat fear and pain Buzzy uses the physiologic pain relief of icy numbing and tingly vibration to block transmission of sharp pain on contact In the same way that rubbing a bumped elbow helps stop the hurt or cool running water soothes a burn Buzzy dulls sharp pain

Buzzy Bee

The Paediatric Outreach Service TTH

Case manages all children lt 16 yrs diagnosed with ARF ampor RHD in the

local district plus children attending boarding schools

AIMS

100 compliance of LA Bicillin prophylaxis using strategies

bullProcedural Interventions to reduce trauma amp anxiety of IMrsquos working closely

with occupational therapist

bull Establish routines amp familiarity for children amp families working

closely with THHS IHWrsquos amp ALOrsquos

bull Provision of ongoing education reinforcement of importance of

ongoing treatment for the long term emphasising the importance of

days at risk (IMI every 21 ndash 28 days)

bullProvision of home amp school outreach visits for older children who are

bicillin desensitised

The Paediatric Outreach Service TTH

AIMS (continued)

Reduce risk of recurrences improve general health and ensure follow up by

bullWorking with families to raise awareness of the importance of improving

personal hygiene standards amp nutritional status

bullCoordinating clinical follow up for regular medical review ECHO

dental checks annual vaccinations amp opportunistic health assessments

bull Maintaining monthly data sharing with ARF amp RHD QLD Registry

bullContacting or refer to other health services when clients move

bullUsing culturally appropriate educational resources supplied by the

ARF amp RHD QLD surveillance amp control program

bullReferring to the ARF amp RHD program district coordinator for clinical

educationin-service updates for paediatric clinicians amp nursing staff

bullNotifying ARF amp RHD coordinator when targeted education intervention is

required for clientfamily (if compliance is poor)

The Paediatric Outreach Service TTH

LONG TERM GOALS

bullEnsure all suspected cases of ARF are reported to NoCS

bullAssist in the accurate diagnosis ARF as per 2012 Guidelines

bullPrevent ARF recurrences

bullMaximise prophylaxis (100) to

- prevent recurrent ARF and progression of RHD and

- allow for resolution of early stages of valvular disease

bullPrevent progression of RHD

bullContinue to achieve 100 prophylaxis compliance

Secondary prevention should include

bull strategies aimed at improving the delivery of secondary

prophylaxis and patient care

bull the provision of education

bull coordination of available health services

bull advocacy for necessary and appropriateresources

RHD Australia Guidelines

Secondary prophylaxis

Manyemba J Mayosi BM Penicillin for secondary prevention of rheumatic fever Cochrane Database of Systematic Reviews 2002 Issue 3

Secondary prophylaxis

Manyemba J Mayosi BM Penicillin for secondary prevention of rheumatic fever Cochrane Database of Systematic Reviews 2002 Issue 3

bull Biggest factor was availability and acceptability of staff members and belonging to community rather than pain or understanding [Z Harrington 2005]

Secondary Prevention

Audit Townsville RHD paediatric outreach

Townsville Model

bull Nursing led

bull One team is responsible for follow up establishment of

relationships leadership etc

bull Multidisciplinary

bull Indigenous Liaison Officer

bull Allied Health

Townsville Model

bull Focus on the patient

bull (and family)

bull First Needle

bull Use of distraction Occupational therapist

bull Individualised care

bull Needles in hospital until patient is desensitised

bull Then at school or home

Townsville Model

bull Medical Support

bull Cohort into a clinic

bull Continuity

bull STP funded registrar available to review patient see new

patients etc

Townsville

Model

bull Hospital

recognition of the

team

bull Promotion etc

To combat fear and pain Buzzy uses the physiologic pain relief of icy numbing and tingly vibration to block transmission of sharp pain on contact In the same way that rubbing a bumped elbow helps stop the hurt or cool running water soothes a burn Buzzy dulls sharp pain

Buzzy Bee

The Paediatric Outreach Service TTH

Case manages all children lt 16 yrs diagnosed with ARF ampor RHD in the

local district plus children attending boarding schools

AIMS

100 compliance of LA Bicillin prophylaxis using strategies

bullProcedural Interventions to reduce trauma amp anxiety of IMrsquos working closely

with occupational therapist

bull Establish routines amp familiarity for children amp families working

closely with THHS IHWrsquos amp ALOrsquos

bull Provision of ongoing education reinforcement of importance of

ongoing treatment for the long term emphasising the importance of

days at risk (IMI every 21 ndash 28 days)

bullProvision of home amp school outreach visits for older children who are

bicillin desensitised

The Paediatric Outreach Service TTH

AIMS (continued)

Reduce risk of recurrences improve general health and ensure follow up by

bullWorking with families to raise awareness of the importance of improving

personal hygiene standards amp nutritional status

bullCoordinating clinical follow up for regular medical review ECHO

dental checks annual vaccinations amp opportunistic health assessments

bull Maintaining monthly data sharing with ARF amp RHD QLD Registry

bullContacting or refer to other health services when clients move

bullUsing culturally appropriate educational resources supplied by the

ARF amp RHD QLD surveillance amp control program

bullReferring to the ARF amp RHD program district coordinator for clinical

educationin-service updates for paediatric clinicians amp nursing staff

bullNotifying ARF amp RHD coordinator when targeted education intervention is

required for clientfamily (if compliance is poor)

The Paediatric Outreach Service TTH

LONG TERM GOALS

bullEnsure all suspected cases of ARF are reported to NoCS

bullAssist in the accurate diagnosis ARF as per 2012 Guidelines

bullPrevent ARF recurrences

bullMaximise prophylaxis (100) to

- prevent recurrent ARF and progression of RHD and

- allow for resolution of early stages of valvular disease

bullPrevent progression of RHD

bullContinue to achieve 100 prophylaxis compliance

Secondary prophylaxis

Manyemba J Mayosi BM Penicillin for secondary prevention of rheumatic fever Cochrane Database of Systematic Reviews 2002 Issue 3

Secondary prophylaxis

Manyemba J Mayosi BM Penicillin for secondary prevention of rheumatic fever Cochrane Database of Systematic Reviews 2002 Issue 3

bull Biggest factor was availability and acceptability of staff members and belonging to community rather than pain or understanding [Z Harrington 2005]

Secondary Prevention

Audit Townsville RHD paediatric outreach

Townsville Model

bull Nursing led

bull One team is responsible for follow up establishment of

relationships leadership etc

bull Multidisciplinary

bull Indigenous Liaison Officer

bull Allied Health

Townsville Model

bull Focus on the patient

bull (and family)

bull First Needle

bull Use of distraction Occupational therapist

bull Individualised care

bull Needles in hospital until patient is desensitised

bull Then at school or home

Townsville Model

bull Medical Support

bull Cohort into a clinic

bull Continuity

bull STP funded registrar available to review patient see new

patients etc

Townsville

Model

bull Hospital

recognition of the

team

bull Promotion etc

To combat fear and pain Buzzy uses the physiologic pain relief of icy numbing and tingly vibration to block transmission of sharp pain on contact In the same way that rubbing a bumped elbow helps stop the hurt or cool running water soothes a burn Buzzy dulls sharp pain

Buzzy Bee

The Paediatric Outreach Service TTH

Case manages all children lt 16 yrs diagnosed with ARF ampor RHD in the

local district plus children attending boarding schools

AIMS

100 compliance of LA Bicillin prophylaxis using strategies

bullProcedural Interventions to reduce trauma amp anxiety of IMrsquos working closely

with occupational therapist

bull Establish routines amp familiarity for children amp families working

closely with THHS IHWrsquos amp ALOrsquos

bull Provision of ongoing education reinforcement of importance of

ongoing treatment for the long term emphasising the importance of

days at risk (IMI every 21 ndash 28 days)

bullProvision of home amp school outreach visits for older children who are

bicillin desensitised

The Paediatric Outreach Service TTH

AIMS (continued)

Reduce risk of recurrences improve general health and ensure follow up by

bullWorking with families to raise awareness of the importance of improving

personal hygiene standards amp nutritional status

bullCoordinating clinical follow up for regular medical review ECHO

dental checks annual vaccinations amp opportunistic health assessments

bull Maintaining monthly data sharing with ARF amp RHD QLD Registry

bullContacting or refer to other health services when clients move

bullUsing culturally appropriate educational resources supplied by the

ARF amp RHD QLD surveillance amp control program

bullReferring to the ARF amp RHD program district coordinator for clinical

educationin-service updates for paediatric clinicians amp nursing staff

bullNotifying ARF amp RHD coordinator when targeted education intervention is

required for clientfamily (if compliance is poor)

The Paediatric Outreach Service TTH

LONG TERM GOALS

bullEnsure all suspected cases of ARF are reported to NoCS

bullAssist in the accurate diagnosis ARF as per 2012 Guidelines

bullPrevent ARF recurrences

bullMaximise prophylaxis (100) to

- prevent recurrent ARF and progression of RHD and

- allow for resolution of early stages of valvular disease

bullPrevent progression of RHD

bullContinue to achieve 100 prophylaxis compliance

Secondary prophylaxis

Manyemba J Mayosi BM Penicillin for secondary prevention of rheumatic fever Cochrane Database of Systematic Reviews 2002 Issue 3

bull Biggest factor was availability and acceptability of staff members and belonging to community rather than pain or understanding [Z Harrington 2005]

Secondary Prevention

Audit Townsville RHD paediatric outreach

Townsville Model

bull Nursing led

bull One team is responsible for follow up establishment of

relationships leadership etc

bull Multidisciplinary

bull Indigenous Liaison Officer

bull Allied Health

Townsville Model

bull Focus on the patient

bull (and family)

bull First Needle

bull Use of distraction Occupational therapist

bull Individualised care

bull Needles in hospital until patient is desensitised

bull Then at school or home

Townsville Model

bull Medical Support

bull Cohort into a clinic

bull Continuity

bull STP funded registrar available to review patient see new

patients etc

Townsville

Model

bull Hospital

recognition of the

team

bull Promotion etc

To combat fear and pain Buzzy uses the physiologic pain relief of icy numbing and tingly vibration to block transmission of sharp pain on contact In the same way that rubbing a bumped elbow helps stop the hurt or cool running water soothes a burn Buzzy dulls sharp pain

Buzzy Bee

The Paediatric Outreach Service TTH

Case manages all children lt 16 yrs diagnosed with ARF ampor RHD in the

local district plus children attending boarding schools

AIMS

100 compliance of LA Bicillin prophylaxis using strategies

bullProcedural Interventions to reduce trauma amp anxiety of IMrsquos working closely

with occupational therapist

bull Establish routines amp familiarity for children amp families working

closely with THHS IHWrsquos amp ALOrsquos

bull Provision of ongoing education reinforcement of importance of

ongoing treatment for the long term emphasising the importance of

days at risk (IMI every 21 ndash 28 days)

bullProvision of home amp school outreach visits for older children who are

bicillin desensitised

The Paediatric Outreach Service TTH

AIMS (continued)

Reduce risk of recurrences improve general health and ensure follow up by

bullWorking with families to raise awareness of the importance of improving

personal hygiene standards amp nutritional status

bullCoordinating clinical follow up for regular medical review ECHO

dental checks annual vaccinations amp opportunistic health assessments

bull Maintaining monthly data sharing with ARF amp RHD QLD Registry

bullContacting or refer to other health services when clients move

bullUsing culturally appropriate educational resources supplied by the

ARF amp RHD QLD surveillance amp control program

bullReferring to the ARF amp RHD program district coordinator for clinical

educationin-service updates for paediatric clinicians amp nursing staff

bullNotifying ARF amp RHD coordinator when targeted education intervention is

required for clientfamily (if compliance is poor)

The Paediatric Outreach Service TTH

LONG TERM GOALS

bullEnsure all suspected cases of ARF are reported to NoCS

bullAssist in the accurate diagnosis ARF as per 2012 Guidelines

bullPrevent ARF recurrences

bullMaximise prophylaxis (100) to

- prevent recurrent ARF and progression of RHD and

- allow for resolution of early stages of valvular disease

bullPrevent progression of RHD

bullContinue to achieve 100 prophylaxis compliance

bull Biggest factor was availability and acceptability of staff members and belonging to community rather than pain or understanding [Z Harrington 2005]

Secondary Prevention

Audit Townsville RHD paediatric outreach

Townsville Model

bull Nursing led

bull One team is responsible for follow up establishment of

relationships leadership etc

bull Multidisciplinary

bull Indigenous Liaison Officer

bull Allied Health

Townsville Model

bull Focus on the patient

bull (and family)

bull First Needle

bull Use of distraction Occupational therapist

bull Individualised care

bull Needles in hospital until patient is desensitised

bull Then at school or home

Townsville Model

bull Medical Support

bull Cohort into a clinic

bull Continuity

bull STP funded registrar available to review patient see new

patients etc

Townsville

Model

bull Hospital

recognition of the

team

bull Promotion etc

To combat fear and pain Buzzy uses the physiologic pain relief of icy numbing and tingly vibration to block transmission of sharp pain on contact In the same way that rubbing a bumped elbow helps stop the hurt or cool running water soothes a burn Buzzy dulls sharp pain

Buzzy Bee

The Paediatric Outreach Service TTH

Case manages all children lt 16 yrs diagnosed with ARF ampor RHD in the

local district plus children attending boarding schools

AIMS

100 compliance of LA Bicillin prophylaxis using strategies

bullProcedural Interventions to reduce trauma amp anxiety of IMrsquos working closely

with occupational therapist

bull Establish routines amp familiarity for children amp families working

closely with THHS IHWrsquos amp ALOrsquos

bull Provision of ongoing education reinforcement of importance of

ongoing treatment for the long term emphasising the importance of

days at risk (IMI every 21 ndash 28 days)

bullProvision of home amp school outreach visits for older children who are

bicillin desensitised

The Paediatric Outreach Service TTH

AIMS (continued)

Reduce risk of recurrences improve general health and ensure follow up by

bullWorking with families to raise awareness of the importance of improving

personal hygiene standards amp nutritional status

bullCoordinating clinical follow up for regular medical review ECHO

dental checks annual vaccinations amp opportunistic health assessments

bull Maintaining monthly data sharing with ARF amp RHD QLD Registry

bullContacting or refer to other health services when clients move

bullUsing culturally appropriate educational resources supplied by the

ARF amp RHD QLD surveillance amp control program

bullReferring to the ARF amp RHD program district coordinator for clinical

educationin-service updates for paediatric clinicians amp nursing staff

bullNotifying ARF amp RHD coordinator when targeted education intervention is

required for clientfamily (if compliance is poor)

The Paediatric Outreach Service TTH

LONG TERM GOALS

bullEnsure all suspected cases of ARF are reported to NoCS

bullAssist in the accurate diagnosis ARF as per 2012 Guidelines

bullPrevent ARF recurrences

bullMaximise prophylaxis (100) to

- prevent recurrent ARF and progression of RHD and

- allow for resolution of early stages of valvular disease

bullPrevent progression of RHD

bullContinue to achieve 100 prophylaxis compliance

Audit Townsville RHD paediatric outreach

Townsville Model

bull Nursing led

bull One team is responsible for follow up establishment of

relationships leadership etc

bull Multidisciplinary

bull Indigenous Liaison Officer

bull Allied Health

Townsville Model

bull Focus on the patient

bull (and family)

bull First Needle

bull Use of distraction Occupational therapist

bull Individualised care

bull Needles in hospital until patient is desensitised

bull Then at school or home

Townsville Model

bull Medical Support

bull Cohort into a clinic

bull Continuity

bull STP funded registrar available to review patient see new

patients etc

Townsville

Model

bull Hospital

recognition of the

team

bull Promotion etc

To combat fear and pain Buzzy uses the physiologic pain relief of icy numbing and tingly vibration to block transmission of sharp pain on contact In the same way that rubbing a bumped elbow helps stop the hurt or cool running water soothes a burn Buzzy dulls sharp pain

Buzzy Bee

The Paediatric Outreach Service TTH

Case manages all children lt 16 yrs diagnosed with ARF ampor RHD in the

local district plus children attending boarding schools

AIMS

100 compliance of LA Bicillin prophylaxis using strategies

bullProcedural Interventions to reduce trauma amp anxiety of IMrsquos working closely

with occupational therapist

bull Establish routines amp familiarity for children amp families working

closely with THHS IHWrsquos amp ALOrsquos

bull Provision of ongoing education reinforcement of importance of

ongoing treatment for the long term emphasising the importance of

days at risk (IMI every 21 ndash 28 days)

bullProvision of home amp school outreach visits for older children who are

bicillin desensitised

The Paediatric Outreach Service TTH

AIMS (continued)

Reduce risk of recurrences improve general health and ensure follow up by

bullWorking with families to raise awareness of the importance of improving

personal hygiene standards amp nutritional status

bullCoordinating clinical follow up for regular medical review ECHO

dental checks annual vaccinations amp opportunistic health assessments

bull Maintaining monthly data sharing with ARF amp RHD QLD Registry

bullContacting or refer to other health services when clients move

bullUsing culturally appropriate educational resources supplied by the

ARF amp RHD QLD surveillance amp control program

bullReferring to the ARF amp RHD program district coordinator for clinical

educationin-service updates for paediatric clinicians amp nursing staff

bullNotifying ARF amp RHD coordinator when targeted education intervention is

required for clientfamily (if compliance is poor)

The Paediatric Outreach Service TTH

LONG TERM GOALS

bullEnsure all suspected cases of ARF are reported to NoCS

bullAssist in the accurate diagnosis ARF as per 2012 Guidelines

bullPrevent ARF recurrences

bullMaximise prophylaxis (100) to

- prevent recurrent ARF and progression of RHD and

- allow for resolution of early stages of valvular disease

bullPrevent progression of RHD

bullContinue to achieve 100 prophylaxis compliance

Townsville Model

bull Nursing led

bull One team is responsible for follow up establishment of

relationships leadership etc

bull Multidisciplinary

bull Indigenous Liaison Officer

bull Allied Health

Townsville Model

bull Focus on the patient

bull (and family)

bull First Needle

bull Use of distraction Occupational therapist

bull Individualised care

bull Needles in hospital until patient is desensitised

bull Then at school or home

Townsville Model

bull Medical Support

bull Cohort into a clinic

bull Continuity

bull STP funded registrar available to review patient see new

patients etc

Townsville

Model

bull Hospital

recognition of the

team

bull Promotion etc

To combat fear and pain Buzzy uses the physiologic pain relief of icy numbing and tingly vibration to block transmission of sharp pain on contact In the same way that rubbing a bumped elbow helps stop the hurt or cool running water soothes a burn Buzzy dulls sharp pain

Buzzy Bee

The Paediatric Outreach Service TTH

Case manages all children lt 16 yrs diagnosed with ARF ampor RHD in the

local district plus children attending boarding schools

AIMS

100 compliance of LA Bicillin prophylaxis using strategies

bullProcedural Interventions to reduce trauma amp anxiety of IMrsquos working closely

with occupational therapist

bull Establish routines amp familiarity for children amp families working

closely with THHS IHWrsquos amp ALOrsquos

bull Provision of ongoing education reinforcement of importance of

ongoing treatment for the long term emphasising the importance of

days at risk (IMI every 21 ndash 28 days)

bullProvision of home amp school outreach visits for older children who are

bicillin desensitised

The Paediatric Outreach Service TTH

AIMS (continued)

Reduce risk of recurrences improve general health and ensure follow up by

bullWorking with families to raise awareness of the importance of improving

personal hygiene standards amp nutritional status

bullCoordinating clinical follow up for regular medical review ECHO

dental checks annual vaccinations amp opportunistic health assessments

bull Maintaining monthly data sharing with ARF amp RHD QLD Registry

bullContacting or refer to other health services when clients move

bullUsing culturally appropriate educational resources supplied by the

ARF amp RHD QLD surveillance amp control program

bullReferring to the ARF amp RHD program district coordinator for clinical

educationin-service updates for paediatric clinicians amp nursing staff

bullNotifying ARF amp RHD coordinator when targeted education intervention is

required for clientfamily (if compliance is poor)

The Paediatric Outreach Service TTH

LONG TERM GOALS

bullEnsure all suspected cases of ARF are reported to NoCS

bullAssist in the accurate diagnosis ARF as per 2012 Guidelines

bullPrevent ARF recurrences

bullMaximise prophylaxis (100) to

- prevent recurrent ARF and progression of RHD and

- allow for resolution of early stages of valvular disease

bullPrevent progression of RHD

bullContinue to achieve 100 prophylaxis compliance

Townsville Model

bull Focus on the patient

bull (and family)

bull First Needle

bull Use of distraction Occupational therapist

bull Individualised care

bull Needles in hospital until patient is desensitised

bull Then at school or home

Townsville Model

bull Medical Support

bull Cohort into a clinic

bull Continuity

bull STP funded registrar available to review patient see new

patients etc

Townsville

Model

bull Hospital

recognition of the

team

bull Promotion etc

To combat fear and pain Buzzy uses the physiologic pain relief of icy numbing and tingly vibration to block transmission of sharp pain on contact In the same way that rubbing a bumped elbow helps stop the hurt or cool running water soothes a burn Buzzy dulls sharp pain

Buzzy Bee

The Paediatric Outreach Service TTH

Case manages all children lt 16 yrs diagnosed with ARF ampor RHD in the

local district plus children attending boarding schools

AIMS

100 compliance of LA Bicillin prophylaxis using strategies

bullProcedural Interventions to reduce trauma amp anxiety of IMrsquos working closely

with occupational therapist

bull Establish routines amp familiarity for children amp families working

closely with THHS IHWrsquos amp ALOrsquos

bull Provision of ongoing education reinforcement of importance of

ongoing treatment for the long term emphasising the importance of

days at risk (IMI every 21 ndash 28 days)

bullProvision of home amp school outreach visits for older children who are

bicillin desensitised

The Paediatric Outreach Service TTH

AIMS (continued)

Reduce risk of recurrences improve general health and ensure follow up by

bullWorking with families to raise awareness of the importance of improving

personal hygiene standards amp nutritional status

bullCoordinating clinical follow up for regular medical review ECHO

dental checks annual vaccinations amp opportunistic health assessments

bull Maintaining monthly data sharing with ARF amp RHD QLD Registry

bullContacting or refer to other health services when clients move

bullUsing culturally appropriate educational resources supplied by the

ARF amp RHD QLD surveillance amp control program

bullReferring to the ARF amp RHD program district coordinator for clinical

educationin-service updates for paediatric clinicians amp nursing staff

bullNotifying ARF amp RHD coordinator when targeted education intervention is

required for clientfamily (if compliance is poor)

The Paediatric Outreach Service TTH

LONG TERM GOALS

bullEnsure all suspected cases of ARF are reported to NoCS

bullAssist in the accurate diagnosis ARF as per 2012 Guidelines

bullPrevent ARF recurrences

bullMaximise prophylaxis (100) to

- prevent recurrent ARF and progression of RHD and

- allow for resolution of early stages of valvular disease

bullPrevent progression of RHD

bullContinue to achieve 100 prophylaxis compliance

Townsville Model

bull Medical Support

bull Cohort into a clinic

bull Continuity

bull STP funded registrar available to review patient see new

patients etc

Townsville

Model

bull Hospital

recognition of the

team

bull Promotion etc

To combat fear and pain Buzzy uses the physiologic pain relief of icy numbing and tingly vibration to block transmission of sharp pain on contact In the same way that rubbing a bumped elbow helps stop the hurt or cool running water soothes a burn Buzzy dulls sharp pain

Buzzy Bee

The Paediatric Outreach Service TTH

Case manages all children lt 16 yrs diagnosed with ARF ampor RHD in the

local district plus children attending boarding schools

AIMS

100 compliance of LA Bicillin prophylaxis using strategies

bullProcedural Interventions to reduce trauma amp anxiety of IMrsquos working closely

with occupational therapist

bull Establish routines amp familiarity for children amp families working

closely with THHS IHWrsquos amp ALOrsquos

bull Provision of ongoing education reinforcement of importance of

ongoing treatment for the long term emphasising the importance of

days at risk (IMI every 21 ndash 28 days)

bullProvision of home amp school outreach visits for older children who are

bicillin desensitised

The Paediatric Outreach Service TTH

AIMS (continued)

Reduce risk of recurrences improve general health and ensure follow up by

bullWorking with families to raise awareness of the importance of improving

personal hygiene standards amp nutritional status

bullCoordinating clinical follow up for regular medical review ECHO

dental checks annual vaccinations amp opportunistic health assessments

bull Maintaining monthly data sharing with ARF amp RHD QLD Registry

bullContacting or refer to other health services when clients move

bullUsing culturally appropriate educational resources supplied by the

ARF amp RHD QLD surveillance amp control program

bullReferring to the ARF amp RHD program district coordinator for clinical

educationin-service updates for paediatric clinicians amp nursing staff

bullNotifying ARF amp RHD coordinator when targeted education intervention is

required for clientfamily (if compliance is poor)

The Paediatric Outreach Service TTH

LONG TERM GOALS

bullEnsure all suspected cases of ARF are reported to NoCS

bullAssist in the accurate diagnosis ARF as per 2012 Guidelines

bullPrevent ARF recurrences

bullMaximise prophylaxis (100) to

- prevent recurrent ARF and progression of RHD and

- allow for resolution of early stages of valvular disease

bullPrevent progression of RHD

bullContinue to achieve 100 prophylaxis compliance

Townsville

Model

bull Hospital

recognition of the

team

bull Promotion etc

To combat fear and pain Buzzy uses the physiologic pain relief of icy numbing and tingly vibration to block transmission of sharp pain on contact In the same way that rubbing a bumped elbow helps stop the hurt or cool running water soothes a burn Buzzy dulls sharp pain

Buzzy Bee

The Paediatric Outreach Service TTH

Case manages all children lt 16 yrs diagnosed with ARF ampor RHD in the

local district plus children attending boarding schools

AIMS

100 compliance of LA Bicillin prophylaxis using strategies

bullProcedural Interventions to reduce trauma amp anxiety of IMrsquos working closely

with occupational therapist

bull Establish routines amp familiarity for children amp families working

closely with THHS IHWrsquos amp ALOrsquos

bull Provision of ongoing education reinforcement of importance of

ongoing treatment for the long term emphasising the importance of

days at risk (IMI every 21 ndash 28 days)

bullProvision of home amp school outreach visits for older children who are

bicillin desensitised

The Paediatric Outreach Service TTH

AIMS (continued)

Reduce risk of recurrences improve general health and ensure follow up by

bullWorking with families to raise awareness of the importance of improving

personal hygiene standards amp nutritional status

bullCoordinating clinical follow up for regular medical review ECHO

dental checks annual vaccinations amp opportunistic health assessments

bull Maintaining monthly data sharing with ARF amp RHD QLD Registry

bullContacting or refer to other health services when clients move

bullUsing culturally appropriate educational resources supplied by the

ARF amp RHD QLD surveillance amp control program

bullReferring to the ARF amp RHD program district coordinator for clinical

educationin-service updates for paediatric clinicians amp nursing staff

bullNotifying ARF amp RHD coordinator when targeted education intervention is

required for clientfamily (if compliance is poor)

The Paediatric Outreach Service TTH

LONG TERM GOALS

bullEnsure all suspected cases of ARF are reported to NoCS

bullAssist in the accurate diagnosis ARF as per 2012 Guidelines

bullPrevent ARF recurrences

bullMaximise prophylaxis (100) to

- prevent recurrent ARF and progression of RHD and

- allow for resolution of early stages of valvular disease

bullPrevent progression of RHD

bullContinue to achieve 100 prophylaxis compliance

To combat fear and pain Buzzy uses the physiologic pain relief of icy numbing and tingly vibration to block transmission of sharp pain on contact In the same way that rubbing a bumped elbow helps stop the hurt or cool running water soothes a burn Buzzy dulls sharp pain

Buzzy Bee

The Paediatric Outreach Service TTH

Case manages all children lt 16 yrs diagnosed with ARF ampor RHD in the

local district plus children attending boarding schools

AIMS

100 compliance of LA Bicillin prophylaxis using strategies

bullProcedural Interventions to reduce trauma amp anxiety of IMrsquos working closely

with occupational therapist

bull Establish routines amp familiarity for children amp families working

closely with THHS IHWrsquos amp ALOrsquos

bull Provision of ongoing education reinforcement of importance of

ongoing treatment for the long term emphasising the importance of

days at risk (IMI every 21 ndash 28 days)

bullProvision of home amp school outreach visits for older children who are

bicillin desensitised

The Paediatric Outreach Service TTH

AIMS (continued)

Reduce risk of recurrences improve general health and ensure follow up by

bullWorking with families to raise awareness of the importance of improving

personal hygiene standards amp nutritional status

bullCoordinating clinical follow up for regular medical review ECHO

dental checks annual vaccinations amp opportunistic health assessments

bull Maintaining monthly data sharing with ARF amp RHD QLD Registry

bullContacting or refer to other health services when clients move

bullUsing culturally appropriate educational resources supplied by the

ARF amp RHD QLD surveillance amp control program

bullReferring to the ARF amp RHD program district coordinator for clinical

educationin-service updates for paediatric clinicians amp nursing staff

bullNotifying ARF amp RHD coordinator when targeted education intervention is

required for clientfamily (if compliance is poor)

The Paediatric Outreach Service TTH

LONG TERM GOALS

bullEnsure all suspected cases of ARF are reported to NoCS

bullAssist in the accurate diagnosis ARF as per 2012 Guidelines

bullPrevent ARF recurrences

bullMaximise prophylaxis (100) to

- prevent recurrent ARF and progression of RHD and

- allow for resolution of early stages of valvular disease

bullPrevent progression of RHD

bullContinue to achieve 100 prophylaxis compliance

The Paediatric Outreach Service TTH

Case manages all children lt 16 yrs diagnosed with ARF ampor RHD in the

local district plus children attending boarding schools

AIMS

100 compliance of LA Bicillin prophylaxis using strategies

bullProcedural Interventions to reduce trauma amp anxiety of IMrsquos working closely

with occupational therapist

bull Establish routines amp familiarity for children amp families working

closely with THHS IHWrsquos amp ALOrsquos

bull Provision of ongoing education reinforcement of importance of

ongoing treatment for the long term emphasising the importance of

days at risk (IMI every 21 ndash 28 days)

bullProvision of home amp school outreach visits for older children who are

bicillin desensitised

The Paediatric Outreach Service TTH

AIMS (continued)

Reduce risk of recurrences improve general health and ensure follow up by

bullWorking with families to raise awareness of the importance of improving

personal hygiene standards amp nutritional status

bullCoordinating clinical follow up for regular medical review ECHO

dental checks annual vaccinations amp opportunistic health assessments

bull Maintaining monthly data sharing with ARF amp RHD QLD Registry

bullContacting or refer to other health services when clients move

bullUsing culturally appropriate educational resources supplied by the

ARF amp RHD QLD surveillance amp control program

bullReferring to the ARF amp RHD program district coordinator for clinical

educationin-service updates for paediatric clinicians amp nursing staff

bullNotifying ARF amp RHD coordinator when targeted education intervention is

required for clientfamily (if compliance is poor)

The Paediatric Outreach Service TTH

LONG TERM GOALS

bullEnsure all suspected cases of ARF are reported to NoCS

bullAssist in the accurate diagnosis ARF as per 2012 Guidelines

bullPrevent ARF recurrences

bullMaximise prophylaxis (100) to

- prevent recurrent ARF and progression of RHD and

- allow for resolution of early stages of valvular disease

bullPrevent progression of RHD

bullContinue to achieve 100 prophylaxis compliance

The Paediatric Outreach Service TTH

AIMS (continued)

Reduce risk of recurrences improve general health and ensure follow up by

bullWorking with families to raise awareness of the importance of improving

personal hygiene standards amp nutritional status

bullCoordinating clinical follow up for regular medical review ECHO

dental checks annual vaccinations amp opportunistic health assessments

bull Maintaining monthly data sharing with ARF amp RHD QLD Registry

bullContacting or refer to other health services when clients move

bullUsing culturally appropriate educational resources supplied by the

ARF amp RHD QLD surveillance amp control program

bullReferring to the ARF amp RHD program district coordinator for clinical

educationin-service updates for paediatric clinicians amp nursing staff

bullNotifying ARF amp RHD coordinator when targeted education intervention is

required for clientfamily (if compliance is poor)

The Paediatric Outreach Service TTH

LONG TERM GOALS

bullEnsure all suspected cases of ARF are reported to NoCS

bullAssist in the accurate diagnosis ARF as per 2012 Guidelines

bullPrevent ARF recurrences

bullMaximise prophylaxis (100) to

- prevent recurrent ARF and progression of RHD and

- allow for resolution of early stages of valvular disease

bullPrevent progression of RHD

bullContinue to achieve 100 prophylaxis compliance

The Paediatric Outreach Service TTH

LONG TERM GOALS

bullEnsure all suspected cases of ARF are reported to NoCS

bullAssist in the accurate diagnosis ARF as per 2012 Guidelines

bullPrevent ARF recurrences

bullMaximise prophylaxis (100) to

- prevent recurrent ARF and progression of RHD and

- allow for resolution of early stages of valvular disease

bullPrevent progression of RHD

bullContinue to achieve 100 prophylaxis compliance