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

2. 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

3. 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

4. Audit results

5. ICD Codes

6. Re-admitted within 30 days?

7. Has the patient had an Echo?

8. ACE-i / ARB?
N = 46

9. Beta Blockers?
N = 46

10. Referred to Heart Failure Nurses for follow-up?

11. On CHD Register?
N = 46

12. Flu Vaccine in the past?
N = 46

13. Pneumonia vaccine?
N = 46

14. Follow-up?
N = 46

15. 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

16. 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

17. 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

18. 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”

19. 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)