Preventive cardiology: whats in it for the nurse

1
Preventive cardiology whats in it for the nurse
Suzanne Hughes RN, BSN Nurse Clinician Section of
Preventive Cardiology and Rehabilitation
Cleveland Clinic Foundation Cleveland, OH Terry
Thomas RN, MSN Clinical Instructor Division of
Cardiology University of North Carolina School of
Medicine Chapel Hill, NC Nancy Houston-Miller
RN, BSN Associate Director Stanford Cardiac
Rehabilitation Program Stanford University School
of Medicine Stanford, CA
2
Lack of effective prevention
Whats in it for the nurse

• CVD still the leading cause of death in the US
• We have an enormous amount of data showing that
  lifestyle changes can reduce risk tremendously.
• Appropriate care is received lt25 of the time

3
Effectiveness of nurse management
Whats in it for the nurse

• Numerous studies show effectiveness of the nurse
  management approach in preventive cardiology

4
Whats in it for the nurse
New Features of ATP III
New Lipid and Lipoprotein Classification LDL
cholesterol lt100 mg/dLoptimal HDL cholesterol
lt40 mg/dL Categorical risk factor Raised from lt35
mg/dL Lower triglyceride classification cut
points More attention to moderate elevations
5
Whats in it for the nurse
Advantages of the nurse
Nurses are key to providing education and
skill-building needed for patients to maintain
lifestyle changes More time More training in
patient education More available for follow-up
6
Whats in it for the nurse
A partnering relationship
Nurses can build a longer-term relationship with
patients and engage in follow-up. Cardiac
rehabilitation programs Lipid clinics Nurse case
management
7
Whats in it for the nurse
Compliance
A problem not only for the patient but for the
provider and health-care system Providers often
have trouble adhering to guidelines Can be a
communication problem between specialists Nurses
can be a key in titrating medications and getting
patients to goal
8
Whats in it for the nurse
Compliance

• I think another area we need to all work on is
  asking about compliance at every visit. Its
  critically important, whether this be in the area
  of trying to get people to adhere to medications
  or lifestyle behaviors.
• Nancy Houston-Miller
• Associate Director
• Stanford Cardiac Rehabilitation Program
• Stanford University School of Medicine
• Stanford, CA

9
Whats in it for the nurse
Barriers
Most barriers to effective use of nurses are
systems barriers Physician acceptance of a role
for the nurse beyond helping with lifestyle
changes Time constraints on patient
visits Reimbursement issues for nurses
10
Whats in it for the nurse
A wholly separate profession

• It always seems important to me to remember
  that as nurses, none of us really want to assume
  a role of being a junior doctor. A nurse is a
  wholly separate profession, I think that brings
  something really unique to the mix.
• Suzanne Hughes
• Nurse Clinician
• Section of Preventive Cardiology
• and Rehabilitation
• Cleveland Clinic Foundation
• Cleveland, OH

11
Whats in it for the nurse
Patient acceptance

• A big part of acceptance by patients, in my
  experience over the years, has been the physician
  attitude. If the physicians promote this as an
  important part of the recovery and that the nurse
  is part of the team, the patients accept it
  wholeheartedly.
• Terry Thomas
• Clinicial Instructor
• Division of Cardiology
• University of North Carolina School of Medicine
• Chapel Hill, NC

12
Whats in it for the nurse
A generation gap
Patients in younger generations are more
accepting of the nurse Often older patients are
more insistent on seeing a doctor
13
Whats in it for the nurse
Get with the guidelines
Gathering data on inpatient risk reduction and
routine adherence to guidelines AHA Get with
the guidelines program to monitor patient
therapies on arrival and discharge Allows you
to look at your hospital and to benchmark it
against other hospitals
14
Whats in it for the nurse
Performance measures
A comprehensive set of cardiovascular measures
are being developed in an ongoing joint project
of the AMA, JCAHO, and NCQA Measures will be
designed to be appropriate for institutions,
private practice, or managed care These measures
will be developed over the next year or two
15
Whats in it for the nurse
Discharge standards
These initiatives are data collection, not tools
for patient discharge We want to take this one
step further and create discharge forms for the
patients
16
Whats in it for the nurse
Resources
Where do you get the resources to do this? Many
hospitals say they think nurse management is a
good idea, but they dont have the resources to
do it National mandates may help if its not
just nice, but necessary, resources are often
found
17
Whats in it for the nurse
PCNA
http//www.pcna.net
Resources for nurses in the cardiovascular
field Manuals for clinics Templates for
documentation Newsletters
18
Whats in it for the nurse
Studies on nurse case management
We are seeing more and more studies on efficacy
and effectiveness of nurse case
management Prevention, primary care, depression,
etc. Need to look at cost-effective ways for
managing chronic conditions that require more
time with the patient
19
Whats in it for the nurse
Future studies
Combined interventions patients with multiple
risk factors that require intervention Cost
effectiveness determining efficiency in reducing
costs with nurse case management New
technology new tools and how they can be used in
practice
20
Whats in it for the nurse
Here to stay

• Nursing case management is here to stay for
  chronic disease. And that is the exciting part of
  the change that were going to be seeing in our
  health care system.
• Nancy Houston-Miller
• Associate Director
• Stanford Cardiac Rehabilitation Program
• Stanford University School of Medicine
• Stanford, CA

21
Whats in it for the nurse
Cost effectiveness
Congestive heart failure management shows
cost-effectiveness very quickly Preventive
cardiology takes longer to show positive effects
22
Whats in it for the nurse
New approaches
The future will belong to those who come up with
creative new ways to do things Telephone
interventions Internet communication
Algorithms approaches emphasizing teamwork
23
Whats in it for the nurse
Cost-conscious world

• Were dealing in the reality of a very
  cost-conscious world. All of these initiatives
  are areas where patients have much to gain, but
  we have to be able to prove that theyre
  cost-effective as well.
• Suzanne Hughes
• Nurse Clinician
• Section of Preventive Cardiology
• and Rehabilitation
• Cleveland Clinic Foundation
• Cleveland, OH