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