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

2. 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)

3. DOMAINS CLINICAL – pt focus RESEARCH – evidence base
LEADERSHIP – service development
EDUCATION – professional development

4. SCOPE OF PRACTICE Approved formulary – PBS schedules
Specific classes related to area of practice
Approved pathology and imaging
Clinical supervision for collaborative practice

5. 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

6. 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

7. CLINICAL DOMAIN
Holistic, comprehensive assessments - physical, psychosocial, behavioural
Interventions and management of outcomes within SoP – diagnostics
Pharmacotherapy – prescribe, up-titrate, monitor, consult
Referral pathways

8. 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

9. 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

10. 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

11. 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

12. 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?

13. Home monitoring system
mytelemedic monitor
Weight scale
Blood pressure monitor
Pulse oximeter

14. Generic telehealth system
Client completes interview
mytelemedic
telehealth
monitor
Feedback from clinician
Secure
Communications
network
Monitoring and Triage

15. 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

16. 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

17. 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

18. 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