Transcript Are your patients getting the cardiac rehab they deserve?

Are our patients getting the
cardiac rehab they deserve?
Suzanne Indge CNS
2010
National Service Framework
June 2009
• Standard 6
Providing cardiac rehabilitation
Everyone with established coronary heart
disease is offered an appropriate
evidence-based cardiac rehabilitation plan
and has the high quality, multi-disciplinary
cardiac rehabilitation support they need to
achieve this plan.
Gold Standard Cardiac Rehab?
• If there is such a service what would it
look like?
• What do our patients want?
The Aneurin Bevan Experience
• Funded in the North as suggested in the SIGN
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guidelines 2002. This includes 3 band 7s, 3 band
6s and full multidisciplinary teams caring for
patients with Heart Failure, Angina, ACS and
Pre/Post Surgery. Fully compliant with BACR
Standards and Core Components for Cardiac
Rehabilitation 2007.
Underfunded in the South
One Consultant Nurse who is responsible
clinically, managerially and financially for the
service across the LHB
The Abergavenny Experience Inpatients
• Patients have access to cardiac rehab nurse specialists
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for specific advice regarding their acute care, treatment
and investigations, medication, risk factor management,
reassurance for themselves and their families and
discharge planning. The nurse specialists provide care
for patients with Heart Failure, Angina, Acute Coronary
Syndromes and Pre/Post Cardiac Surgery
When required patients are referred for specialist
interventions with the cardiac rehab occupational
therapist, physiotherapist or psychotherapist.
Post discharge
• Patients have direct access to telephone advice from
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multidisciplinary team for symptom management and
monitoring
Home/hospital visits are arranged if required
Liaison with GPs, practice nurses and other healthcare
agencies
Early access to 8 week cardiac rehab programme if
necessary
When required patients are referred for specialist
interventions with the cardiac rehab occupational
therapist, physiotherapist or psychotherapist.
Direct link via nurse specialists to Cardiology Consultant
8 week Cardiac Rehab Programme
• Twice weekly visits, for two hours, providing access to
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the comprehensive multi disciplinary team
Patients have access to physiotherapy, occupational
therapy, dietetics, pharmacy, psychotherapy and sex
therapy.
Patients physical and psychological well being is
addressed
Education regarding risk factor management,
medication, symptom recognition and treatment and
lifestyle change
Cardiac Rehabilitation should be tailored to the patient
irrespective of diagnosis to optimise adherence
Direct link via nurse specialists to Cardiology Consultant
Long term maintenance
• Patients are encouraged to continue their
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lifestyle changes long term
4 band 5 BACR fitness Instructors providing 22
community based maintenance classes in North
Gwent area
Funded by North Gwent Cardiac Rehabilitation
and Aftercare Charity
National Exercise Referral Scheme
Other local agencies i.e. Extend
Long term follow up
• All patients are referred back to their GPs and
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practice nurses for long term monitoring of their
risk factors
Complex patients remain with the nurse
specialists for medication titration, symptom
management and monitoring
Direct link via nurse specialists to Cardiology
Consultant and other healthcare specialists i.e.
lipid clinic, palliative care
Equality and Diversity
• Literature provided in large print and on audio
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CD for visually impaired patients
Loop system used for education for hearing
impaired patients
Interpreter service used for patients whose first
language is not English
Multi lingual resources from British Heart
Foundation
Staff trained in Equality and Diversity and
disability awareness
Is this a “gold standard” service?
• What about patients with arrythmias?
• Are we capturing all our patient groups?
• All goes well until staff go on leave, SIGN
guidelines for staff ratios do not appear to
allow for staff on leave
• NLIAH Yellow Belt Training Cardiac
Network
Team Developments
• Team Building
• Sharing Best Practice
• Clinical Case Presentations
• Patient Public Involvement – charities,
focus groups, patients attend staff
meetings regarding service redesign
• Good support from Aneurin Bevan
Executive Team
Where do we go from here as the
All Wales C R Working Group?
The Challenge
• How can we achieve gold standard cardiac rehab
with limited resources
• Proving cardiac rehab can be cost efficient
• Redesign
• Sharing best practice
• What can The AWCRWG do for you
• What can you do for The AWCRWG
Where do we go from here as the
All Wales C R Working Group?
Influencing the future
• British Heart Foundation Cardiac Rehab Campaign
ensuring cardiac rehab is at the top of the WAG agenda
• Audit vitally important – National Audit of Cardiac
Rehabilitation, local audit.
• Ensuring Cardiac Rehabilitation is high on the LHBs
agenda and LDPs
• Continue to work with partners Cardiac Networks, BHF,
BACR, NERS
• Develop Nursing sub group to address competencies and
standards