Carmarthenshire LHB and Hywel Dda Trust Claire Hurlin Clinical and Service Lead Chronic Disease Management Just introduce yourself, you have 10 mins each

Interventions Baseline retrospective audit of 100 (46)patients notes admitted with a diagnosis of Heat Failure completed Heart Failure Service first year has showed – a reduction in hospital admissions by 23% -96% improvement in medicines management in relation to evidence based medicine - 37% improvement in quality of life scores. Nurse led outreach clinics – providing a service to patients closer to home working with Local Authority and GP’s What were your pilot group, why you chose them Which part of the intervention did you concentrate on first, have you managed to move on What were the successes along the way What were the main challenges and barriers and how did you over come them If someone else going to do this next, what advice would you give them

Focus group with heart failure patients x 2 Adapted Heart Failure patient check list for self management and roll out in progress across service in Carmarthenshire and Ceredigion Telephone clinics commenced Tele health research One stop diagnostic clinics improving access to echocardiogramss LES for Heart Failure training and support Locally offering CHD/CVD/CHF diploma courses

Audit results

ICD Codes

Re-admitted within 30 days?

Has the patient had an Echo?

ACE-i / ARB? N = 46

Beta Blockers? N = 46

Referred to Heart Failure Nurses for follow-up?

On CHD Register? N = 46

Flu Vaccine in the past? N = 46

Pneumonia vaccine? N = 46

Follow-up? N = 46

Conclusions Readmission rate at WWGH: 16% Documentation of presenting complaint & clinical examination (esp. JVP & peripheral oedema) is inadequate Investigations are not routinely requested or recorded (particularly ECHO, TFT, lipids) ECHO not performed in 15% of patients ACE-i / ARB use more widespread than B-blockers Treatment with ACE-I / ARB not initiated in 15% of patients

Conclusions (cont..) Treatment with B-blocker not initiated in 50% of patients as in patient Diuretics are prescribed extensively with the exception of spironolactone Smoking and alcohol status not documented adequately Specialist advice not sought routinely Involvement of HF service higher from cardiology wards 27% patients not followed up

Recommendations Increased education of medical staff on clerking and documentation – particularly in relation to symptoms, clinical signs, lifestyle factors and investigation requests and results Increased involvement of specialist nurses in all appropriate patients – improve awareness Heart Failure Service All appropriate patients should be followed up regularly Implementation – regular session on post grad lunch time meetings including information and education

Focus Groups-patient stories Safety due to continuity of care Easier access by providing the clinics closer to home Reduced stress due to easy parking, short travelling times, comfortable environment Patient comments include: “I feel safe for the first time in 12 years” “My nurse explains why I have to take my medication; she makes my life so much easier”

Successes & Challenges What have been your successes/quick wins? -improving patient satisfaction, establishing nurse led clinics in the community What challenges barriers have you encountered? -communication, time to review and reassess How have you approached/overcome these? -working with others, keeping them informed, attending their meetings, asking them to come and speak to us, understanding the need for change Tips for others -always remember need back up support from admin, keep talking, be prepared to change How are you going to take this forward from now Have you fully implemented this intervention, then compliance data measurement for 12 months If not then what are the next steps, where are you spreading to, which is your next population (one patient- one list – one speciality – one theatre department)