Nurse-Led Clinics in Cardiology
| Description | Nurse-led clinics for heart attack and invasive investigations including surgery. |
|---|---|
| Setting | Secondary care |
| Populationting | Patients who have had a heart attack, angiogram, angioplasty or coronary artery bypass graft (CABG). |
| Intervention summary | The clinics ensure patients are seen by a specialist nurse with the knowledge and skills to assist the patient in making empowered decisions about their recovery and future. |
| Outcome Summary | Not available |
| Startup Cost | Unknown |
| Running Cost | One Specialist Nurse salary of £33 000 per annum. Also the salaries of the administration staff (unknown). |
| Funding | The Acute Hospital Trust pays the salary for the nurse and administration. |
| Started | 2002 |
| Ended | Hopefully will continue and expand |
| Location | West London, England |
| Contact |
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Background
The Nurse-Led Clinics in Cardiology were developed and set up in 2002. This was a new initiative and both challenging and exciting. The specialist nurse undertook training in clinical assessment skills and has an MSc in Rehabilitation counselling. Templates are developed for the clinic and remain in the patient’s clinical notes. GPs are informed of the consultation and any further plans. It is anticipated that these patients will be empowered to make lifestyle changes, which will lead to a healthier approach to living.
What is the problem you are trying to solve?
It is recognised that coronary heart disease (CHD) can have a significant impact on the patient, those around them and ultimately economically. We also wanted to address the problem of increasing clinic wait times.
What local organisations are involved?
The consultants in cardiology; the out patient team including administration; the ECG Department; the Tertiary Centre for Diagnostics; and the Heart Support Group.
Information is shared with the GPs in primary care and students, both medical and nursing, are involved from a teaching point of view.
How many people are running this project and who are they?
One Specialist Nurse (MSc RN).
What local population are you targeting?
Any person who has had a heart attack, angiogram, angioplasty or coronary artery bypass graft (CABG).
How many people are you targeting?
I run three clinics per week and see an average of 15 to 17 patients per week. All patients have booked appointments.
Interventions
What interventions are you using to address the problem?
The clinics, through the use of templates, identify the problem. The templates use a structured approach to follow-up.
The nurse will assess, plan, monitor and evaluate the clinic consultation. The ultimate aims of the clinic are to assess, reassure, rehabilitate and empower the patient and their families.
Risk factors are discussed and modifications encouraged regarding:
- Raised blood pressure
- Smoking
- Diabetes
- Obesity
- Familial History
- Raised lipids.
Lifestyle modification is discussed at length regarding:
- Medications
- Driving
- Flying
- Diet
- Exercise
- Return to work
- Sex
- Alcohol
- Tobacco.
Adjuncts such as written literature and models are used to support verbal information.
All patients are given nurse contact details.
Is the project design based on evidence? If so, please state reference.
The specialist nurse in coronary heart disease prevention: evidence for effectiveness 1 ; evidence based healthcare on the Bandolier website 2 ; Nurse-led cardiac clinics for adults with coronary heart disease 3 ; and Psychological assessment during cardiac rehabilitation 4 .
Outcome
What outcomes or planned outcomes are you measuring?
A clinical audit has been carried out on the satisfaction of the patients who are seen in these clinics. This has been shared by the clinical governance and effectiveness team and the cardiology team.
Do you have any outcomes or results yet? If so, what are they?
The patient satisfaction survey was well received by users.
Is your project relevant to a government target or guideline?
The National Service Framework (NSF) for coronary heart disease 5 , and current National Institute for Health and Clinical Excellance guidelines 6 .
Feedback
What obstacles did you have to overcome to set up this project?
There were some people who were sceptical but in time people can see the clear benefits of the clinics. Patients have been very positive verbally about clinic visits which has been fortunate for me.
What have you learned about the project so far?
Why did we not do it sooner! The patients say they really value the service; the rapport developed is both professional and respectful. It is essential to value your responsibilities, ask the patients what they need (they will tell you), encourage questions, and to check you have facilitated their pathway to recovery.
What would you do differently?
N/A
References:
- Wright L. The specialist nurse in coronary heart disease prevention: evidence for effectiveness. Shared care - a better way of working. 2001:11-4.
- Bandolier website. http://www.jr2.ox.ac.uk/Bandolier (accessed 26 April 2007).
- Briggs J. Nurse Led cardiac clinics for adults with coronary heart disease. Nursing Standard. 2006; 20(28): 46-50.
- Harrison R. Psychological assessment during cardiac rehabilitation. Nursing Standard. 2005; 19(27): 33-36.
- Department of Health. The National Service Framework (NSF) for Coronary Heart Disease. 2000. www.dh.gov.uk (search for 16602).
- National Institute for Health and Clinical Excellence. Coronary heart disease: Guidance for implementing preventive aspects of National Service Framework. National Institute for Health and Clinical Excellence. June 2001. Can be accessed at http://www.nice.org.uk/page.aspx?o=501951 (accessed 26 April 2007).