THE ROLE OF THE HEART FAILURE SPECIALIST NURSE

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THE ROLE OF THE HEART FAILURE SPECIALIST NURSE

• NHS Grampian Heart Failure Nurses
• November 2008

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BACKGROUND TO CHRONIC HEART FAILURE

• Chronic Heart Failure (CHF) is a common and
  debilitating condition (Gould 2002, p.189).
• It has been described as the end stage of
  cardiac illness, having a worse prognosis than
  most cancers (Stewart et al, 2001).
• It affects about 2 of the population with
  approximately 63,000 new cases in the UK each
  year (British Heart Foundation (BHF), 2008).

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BACKGROUND TO CHRONIC HEART FAILURE

• Prevalence is increasing due to a growing elderly
  population and improved medical treatments.
  Currently 1.5 - 2 of the population which
  equates to approximately 8000 patients in
  Grampian.
• Increasing financial burden which accounts for 2
  of the NHS Grampian budget.
• Associated with poor Quality of Life.

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WHAT ROLE DOES THE SPECIALIST NURSE PLAY?

• Recently published data from BHF has
• shown that a nurse led service can
• Provide education and support to patients and
  carers.
• Improve drug compliance.
• Reduce hospital admissions.
• Reduce costs to the NHS.
• Increase Quality of Life for patient and carer.

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CURRENT WORKLOAD

• Initially, GP referral of recently discharged
  patients with LVSD and complex NYHA III and IV
  patients (confirmed on Echo).
• Adjustment of concomitant evidence based therapy
  on discussion with medical colleagues.
• Education of primary care staff.

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PROBLEMS FOR CHF PATIENTS

• Confusion over changes to medication.
• Failure to get repeat prescriptions.
• Taking non prescribed medications.
• Poor concordance.
• Difficult to titrate up therapy.
• Poor social support.
• Depression.
• Poor cognitive ability.

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PROBLEM AREAS

• Delay in GPs receiving hospital discharge
  letters.
• Delay in referring to HFSN service.
• Delay in updating prescription changes.
• Added and often intensive workload associated
  with up titration of therapy.
• Dose of diuretic requiring to be adjusted soon
  after discharge.
• Discrepancies regarding discharge therapy.

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KEY ELEMENTS OF THE HEARTS FAILURE NURSE ROLE

• Regular follow up and assessment to detect early
  clinical deterioration.
• Adjustment and optimisation of therapy.
• Close monitoring of blood chemistry and rapid
  access to results.
• Education and advice about heart failure, its
  treatment and when to seek help.
• Encouraging patients to be actively involved in
  managing and monitoring their care.
• Providing a link between patients and other
  healthcare professionals and services.
• Supporting patients and carers with advanced
  heart failure.

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SUPPORT NEEDED FOR HEART FAILURE SPECIALIST NURSE.

• Clearly defined job description.
• Model of care must suit local environment.
• Clear guidelines and care pathways for referral,
  admission and discharge.
• Clear protocols and guidelines for use of
  evidence based drug therapy and good practice.
• Support from medical colleagues and
  multidisciplinary team.
• Access to educational programmes and ongoing
  training and development.

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NHS GRAMPIAN HEART FAILURE SPECIALIST NURSES

• Moray
• Jan Henderson - Dr Grays Hospital
• Mandy Davis - Community
• Aberdeenshire
• Audrey Stables Central
• Siobhan Taylor North
• Elizabeth Douglas - South
• Aberdeen City
• Roz ODwyer
• Elaine Lee

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FURTHER DEVELOPMENT

• Education about CHF and its management to primary
  care teams .
• Nurses as supplementary prescribers.
• Palliative approach both for symptom control and
  end of life care.
• Regular review of referral system and workload.

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SUMMARY

• Patients with chronic heart failure need
  access to individualised care and monitoring.
  Given sufficient funding and support, the
  recruitment of effective specialist nurses, and
  the application of carefully constructed
  protocols, a heart failure service can improve
  the health outcome of patients with chronic heart
  failure.

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ANY QUESTIONS?