Role of the Specialist Nurse HEART FAILURE Usha Rajkoomar Project Manager CHD Collaborative East and North Herts 14/01/03 Heart Failure Growing incidence- ageing population, increased survival from AMI. Recent study, more than one third of patients have died within 12 months of diagnosis, Cowie et al(2000). High admission rates, re-admission rates, lengthy hospital stays, high financial burden. Why do we need specialist nurses? Patients are frail and vulnerable Devastating effect on quality of life Patient group that often has inadequate access to help and advice. Patients are often on suboptimal treatments and are not receiving the best management, thus creating a huge potential for care to be improved. •Often lack of patient education and support- Knock-on effect in terms of non-adherence both pharmacological and non-pharmacological. •54% of re-admission to hospital are preventable, Michaelsen et al (1998). •Need for health professional to coordinate what can be a complicated map of care. •Nurse led approaches to HF management have Shown to be cost effective. •Promote collaborative working not only between primary and secondary care but also incorporating A multidisciplinary approach in both areas. Meeting the NSF targets Standard 11 of the NSF states ‘doctors should arrange for people with suspected HF to be offered appropriate investigations that will confirm or refute diagnosis. For those HF is confirmed , its cause should be identified and the treatments most likely to both relieve symptoms and reduce the risk of death should be offered’. 3 possible service delivery are proposed: Outreach follow-up of HF patients following discharge from hospital Multidisciplinary support in the community for those with established HF Heart failure clinics for investigations and/or follow up. What are the needs of a HF patient? Pharmacological needs (initiation and titration) Multiple drug treatments Little or no understanding of their medications, risk of developing side-effects and possible drug interactions Patient compliance Biochemical observation (diuretics, ACE, spironolactone) Influenza and pneumococcal immunisations. Non-pharmacological needs Education and support Need of be aware of their condition, its implications on their lives Symptoms and when these are deteriorating Aim self-monitoring and self management Know when and how to contact healthcare professionals. Contd…. Lifestyles changes/adjustments. Changes in diet/fluid intake, need to self-monitor their weight, balance exercise and rest, adopt smoking cessation and moderate alcohol intake Financial and Psychosocial implications, change of occupations or may not be able to work at all HF places a great deal of stress on all forms of relationships – creating psychological issues. •Support and counselling •Palliative care. It is now recognised that the terminal phase of heart failure may be as bad as cancer, both in terms of symptoms and distress. •The aim of palliative care is to improve quality of Life, quality of dying and to ameliorate the devastating effect of dying on family and carers. •Ongoing care – management is optimised Role of the Heart Failure Nurse Majority of these needs can be met and coordinated by a HF nurse, further interventions from other disciplines is required, need for multi-disciplinary approach. Ongoing follow-up care Support and counselling, acting as patient’s advocate Contd…. •Promote communication between prim and sec care and also within multi-disciplinary team. •The HF Nurse should be considered a resource to other professionals, assisting professional Education and development Benefits of the HF Nurse Service Improved care and management Rapid response to patient problems Providing follow-up, lead to reduction in medical time Reduce hospital admissions, length of stay, financial burden, bed pressures Specialist resource- consistency of care Provision of professional education and meeting clinical governance requirements. Benefits •Optimal treatment that can be flexible and tailored to individual needs •Promotes patient empowerment •Provides patients with easy access to a professional who knows them and who is able to provide consistent care. •Regular follow-up and monitoring – whether it be clinic based, home based or by telephone contact. •Improved functional status and quality of life for patients.