THE ROLE OF THE CARDIAC NURSE PRACTITIONER Sue Sanderson MNSc(NP) July 2014 Tasmanian Health Organisation - South

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 practice Approved pathology and imaging Clinical 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 clinic Medication up-titration Support/home visits MDT NP clinic/home monitoring MDT/cardiologist support NP/CNS/GP – clinic visit frequency to be determined Pts self-managing at home

HEART FAILURE IN-PATIENT Education re salt, fluid restriction, symptom recognition deterioration Daily weigh Medications including up-titration Activity Risk factor review Follow-ups – phone, clinic, home Social circumstances – support Resources

HEART FAILURE OUT-PATIENT - with cardiologist – dual clinic Ongoing education re salt, fluid restriction, weigh mgt, risk factors Clinical assessment – BP, HR, SpO2, weight, JVP, HS, oedema, symptoms, sleeping patterns, eating patterns, activity Adherence to fluid restriction Medications and concordance, adverse effects Ongoing titration meds, monitoring renal function

HEART FAILURE ♥ Home monitoring ♥ Tele-monitoring Patient – weight daily, fluid restriction, activity levels can report concerns by phone ♥ Tele-monitoring BP, SpO2, HR, weight Response to symptom-related questions To 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 Client completes interview mytelemedic telehealth monitor Feedback from clinician Secure Communications network Monitoring and Triage

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 ♥ ASSESSMENTS Pre and post participation (RHH [CRN] and ICC [NP]) 6 months post HHP Random 6 months post RHH program 2yrs 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