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University Hospital of Wales, Acute Coronary Syndrome
(ACS)Unit.
Innovation and Research-Innovative models of care.
Victoria Williams Cardiology Nurse Practitioner Louise Birch Cardiology Nurse PractitionerMichelle Ball Cardiology Nurse Practitioner
Sarah Barnett Cardiology Nurse Practitioner
Aims of the presentation
• To outline the expanding role of the nurse practitioner within Cardiology at University Hospital of Wales (UHW)
• To Describe and illustrate the development of the role through the establishment of a nurse led Acute Coronary Syndrome (ACS) service, demonstrating innovative ways of working to improve patient care.
Learning Outcomes
• To illustrate the role of the advanced practitioner within Cardiology at UHW
• To understand how the ACS service is run and how successful outcomes have been achieved
• To consider how the role and the service will evolve and develop in the future.
Background of the NP role within Cardiology
• Established in 2010• In response to European work Time
Directive (EWTD)• To streamline the patient Journey• Improve multi-disciplinary
communication• Improve patient outcomes and
satisfaction
• Cardiology Co-ordinator established role since 2004
• Roles merged 2010
• Both practitioners undertaking MSC Advanced Practitioner Pathway
• Team has expanded to include 2 further Part-time positions
• ACS service launched in September 2010.
University Hospital of Wales
• Tertiary Cardiology centre
• Contracted to provide tertiary services to District General Hospitals within south east Wales
Aims of ACS service
• Reduce patient length of stay in both DGH & tertiary centre
• Reduce waiting times for intervention
• Meet European and NICE guidelines
• Improve patient outcomes
• Improve patient journey
Collaborative working
Cardiology Nurse PractitionersCentral point of
contact.Co-ordinating the care pathway from point of referral to discharge.
Electronic referral system
Telephone triage of ACS/Complex
transfers.Advanced Clinical Assessment Skills.
Cardiac Catheter Theatre
Allocated catheter slotsRe-organisation of consultant rota
Flexi sessions to back fill for annual leave/study leave
Cardiology Ward
Protected beds within ward areaHigh turnover of ACS patients
Increased workload and expertise.Collaborative approach between nursing
staff, NPs & MedicsNurse-led discharge protocols.
District General Hospitals
Electronic referral within strict criteriaTraining and education re: ACS protocolsPre-operative workup and investigations
Repatriation of patients awaiting follow on services
Electronic ReferralPlease complete and save with patients name as file name [email protected]
Address:Surname Ref HospForename(s) Ref ConDoB WardNHS no. Ward telHosp no. Weight Kg
ECHO
Age Creat CHFBP Heart Rate ArrestST deviation Troponin DiabetesHypertensionFamily Hist
BLOODS
HbPltWbcTrop I/T
CRPCreatinine
DATE (DD/MM/YYYY)
Free text:
©drf reeman.comFor UHW use
Date on LadderDate and time procedure performed
Accepted byDate and time tranferredWardConsultant
Clexane dose adjustment for renal function?
Smoking PreviousElevated Cholesterol
NO
300mg loading + 75mg maintenance
600mg loading + 75mg Maintenance
None given
REFERRERS DETAILS
Clopidogrel
Aspirin
Prasugrel
Other
2.65
<364
MRSA status (if known)
09/11/2011
ASSESSED AND REFERRED BY? (Full Name)
A Doctor
CONTACT DETAILS (Hosp switch and bleep)
02920 744744 (6565)
1.0 15.0
14.8260
9
Type given
unknown
NO
Risk of Death/MI (%)
In Hospital
To 6 months 4.0 23.0
Risk of Death (%)
50 to <60
Anticoagulation
No
2
Antiplatelets
I (no CHF)60 to <70
RESULTS & TREATMENT
GRACE RISK SCORE
NO
08/11/2011 10:00DD/MM/YYYY HH:MM
awaited
08/11/2011 13:0008/11/2011 13:2009/11/2011 11:00
SYMPTOM ONSET
REFERRAL TO UHW
LOCAL HOSP ARRIVAL
35 to 70
YES Elevated
A123456
PRESENTATION DETAILS
Condition for transfer NSTEACS
79Kg
2/7 hx of intermittent chest pain, initially on exertion, last episode @ rest raditing to Lt arm assoc SOB. ECG inferior TWI. PMH: Nil
CALL FOR HELP
GynaAnne
21 River St, Cardiff, CF123AB
564509/12/1958123456789
Llandough HospitalDr C Pain
CCU
Email with patient name in SUBJECT headingPLEASE NOTE: You are sending confidential patient information, this form should ONLY be sent from an NHS email address
110 to <120
Previous interventions
RISK
Major complications
History/Co-m orbidities
PATIENT DETAILS
University Hospital of Wales
Acute Coronary Syndrome Inpatient Referral form
Please complete and save with patients name as file name [email protected]
Address:Surname Ref HospForename(s) Ref ConDoB WardNHS no. Ward telHosp no. Weight Kg
ECHO
Age Creat CHFBP Heart Rate ArrestST deviation Troponin DiabetesHypertensionFamily Hist
BLOODS
HbPltWbcTrop I/T
CRPCreatinine
DATE (DD/MM/YYYY)
Free text:
Email with patient name in SUBJECT headingPLEASE NOTE: You are sending confidential patient information, this form should ONLY be sent from an NHS email address
130 to <140
Previous interventions CABG (Please include graft details)
RISK
Major complications Tachyarrythmia (not AF) (echo mandatory)
History/Co-m orbidities
PATIENT DETAILS
PainMike
32 craze Rd. Cardiff, CF321ba
564509/12/1978123456789
Llandough HospitalDr C Pain
CCU
141 to 176
YES Elevated
A123456
PRESENTATION DETAILS
Condition for transfer NSTEACS
79Kg
Chest pain.
CALL FOR HELP
08/11/2011 10:00DD/MM/YYYY HH:MM
awaited
08/11/2011 13:0008/11/2011 13:2009/11/2011 11:00
SYMPTOM ONSET
REFERRAL TO UHW
LOCAL HOSP ARRIVAL
70 to <80
Anticoagulation
No
2
Antiplatelets
III (Pulmonary oedema)90 to <100
RESULTS & TREATMENT
GRACE RISK SCORE
YES
9
Type given
unknown
YES
Risk of Death/MI (%)
In Hospital
To 6 months 76.0 86.0
Risk of Death (%)
49.0 62.0
10260
09/11/2011
ASSESSED AND REFERRED BY? (Full Name)
A Doctor
CONTACT DETAILS (Hosp switch and bleep)
02920 744744 (6565)
REFERRERS DETAILS
Clopidogrel
Aspirin
Prasugrel
Other
2.65
45155
MRSA status (if known)
Clexane dose adjustment for renal function?
Smoking PreviousElevated Cholesterol
YES
300mg loading + 75mg maintenance
300mg loading + 75mg Maintenance
None given
For UHW use
Date on LadderDate and time procedure performed
Accepted byDate and time tranferredWardConsultant
©drf reeman.com
University Hospital of Wales
Acute Coronary Syndrome Inpatient Referral form
Advanced clinical skills • All members of the team are at
different stages of their Msc pathway
• We all utilise advanced clinical skills as part of the role to enhance the service.
• Undertaking regular competency based training and assessment
Wider components of the NP role within cardiology
• Co-ordination and organisation of complex patients
• Organisation of in-patient and outpatient pacing calendar
• Reviewing A&E admissions with the Cardiology SPR.
• Assist the junior medical team and nursing staff with ward duties as necessary.
Successful outcomes
• Reduced bed days in DGH and tertiary centre
• Reduced waiting times for intervention• A more streamlined service for patients• Improved communication between all
members of the team• Improved patient satisfaction and less
complaints
Comparative information for ACS patients referred to UHW from DGHs Within the South East Cardiac Network. (Aug 2010/June
2011)
0
2
4
6
8
10
12
14
16
18
20
Average total prereferral days
Averagetotalreferral to transfer
days
Average totalUHW bed days
Average total beddays
no
of
Days
Aug-2010
Jun-2011
The future of the ACS service
• Plans to develop a cardiology assessment ward utilising 19 beds within the directorate
• accommodating all cardiology admissions and transfers
• Development of an assessment tool and pathway to be utilised in A&E by both NPs and SPR
• To streamline in house service