10th November 2021 Caption: Sandra McCarthy (DON) Karen Kelly (cANP Heart failure), Geraldine Kelly (CNS Cardiology) and Dr Sean Fleming (Consultant Cardiologist)
“The patient is at the centre of everything we do,” stresses Karen Kelly, Candidate Cardiology Advance Nurse Practitioner (cANP) at the Midland Regional Hospital Portlaoise (MRHP) in relation to the care and support they provide for heart failure patients. Karen outlines how the Heart Optimisation Team in Portlaoise empower patients’ in self-care for their illness, optimising their medication and contributing to the best quality of life: “All the care is designed individually for each patient. We work with them and their families to make sure the patient has all the support they need to manage their condition at home, avoiding hospital admission and re-admission”.
Heart Failure accounts for five per cent of all emergency admissions in Ireland. Identifying, preventing, improving care and reducing hospital stays for those with heart failure is the aim of the new Sláintecare Heart Optimisation project in MRHP. The introduction of an Advanced Nurse Practitioner (ANP) in Cardiology in Midland Regional Hospital Portlaoise is improving patient access and continuity of care. Patients can now see a number of specialities in one visit, without having to come to hospital multiple times for tests and treatments, thanks to the successful engagement the team has carried out across different clinical teams in the hospital.
This approach has resulted in excellent patient outcomes allowing for high-risk patients being seen within 24 to 48 hours. Most patients have an appointment within two weeks, while less urgent patients are seen within three to four weeks. Re-admission for heart failure has reduced by over 80% in patients attending the post discharge heart failure service.
To facilitate early intervention and diagnosis, the heart optimisation service includes a Rapid Access Risk Assessment Clinic where the ANP in cardiology works with the Consultant Cardiologist in providing urgent outpatient care. The service treats patients with/at risk of developing heart failure. This includes patients presenting to GPs with signs of heart failure. Patients attending the risk assessment clinic have a point of care lung ultrasound (POCUS) by the cANP.
In collaboration with the local community intervention team, patients can be reviewed and have blood tests by a nurse in their home when required. This service is really appreciated by patients and their carers, and has proven extremely valuable during the Covid 19 pandemic by reducing patients’ need to attend clinic, and it provides continuous assessment for patients who cannot travel.
One patient in particular who routinely would have had an 80 kilometre round trip to attend a clinic, can now have their appointment without leaving their house: “This means so much - to have everyone at the end of the phone. I am so grateful for them sending a nurse to my home when I was not up to going into the clinic after my recent loss.” Another relative added: “Thank you so much for all your care and kindness for our mother, she was most grateful for all you did, especially facilitating her to stay at home. It meant so much to all of us.”
The Heart Optimisation nurses have also introduced a new initiative, in collaboration with patientMpower, that allows remote monitoring of patients’ blood pressure, heart rate and weight at home. This has empowered patients in self-management of their health, facilitated early discharge, reduced clinic visits and admission avoidance. Patients are extremely satisfied with the service, and feedback has been very positive with one patient stating that they “ feel more confident going home, knowing I am monitored by the nurses.” Another noted that it was “great to see the graphs on my phone, it was great to reduce the need to go to clinic and good too to have medications titrated from home.” (Titration is a way to limit potential side effects by taking time to see how a patient’s body will react to a drug).
The Sláintecare funded cANP post has contributed greatly to the existing care provided, with Karen adding: ‘We are looking forward to further developing the services as part of the Enhanced Community Care programme, which is reducing our dependence on the current hospital-centric model of care and supporting capacity building in the community, key to realising the vision of Sláintecare”.