Download Preventive cardiology

Preventive cardiology:
what’s in it for the nurse
Suzanne Hughes RN, BSN
Nurse Clinician
Section of Preventive Cardiology and Rehabilitation
Cleveland Clinic Foundation
Cleveland, OH
Terry Thomas RN, MSN
Clinical Instructor
Division of Cardiology
University of North Carolina School of Medicine
Chapel Hill, NC
Nancy Houston-Miller RN, BSN
Associate Director
Stanford Cardiac Rehabilitation Program
Stanford University School of Medicine
Stanford, CA
What’s in it for the nurse
Lack of effective prevention
CVD still the leading cause
of death in the US
We have an enormous
amount of data showing
that lifestyle changes can
reduce risk tremendously.
Appropriate care is received
<25% of the time
What’s in it for the nurse
Effectiveness of nurse management
Numerous studies show
effectiveness of the
nurse management
approach in preventive
cardiology
What’s in it for the nurse
New Features of ATP III
New Lipid and Lipoprotein Classification
LDL cholesterol <100 mg/dL—optimal
HDL cholesterol <40 mg/dL
Categorical risk factor
Raised from <35 mg/dL
Lower triglyceride classification cut points
More attention to moderate elevations
What’s in it for the nurse
Advantages of the nurse
Nurses are key to providing
education and skill-building
needed for patients to maintain
lifestyle changes
More time
More training in patient education
More available for follow-up
What’s in it for the nurse
A partnering relationship
Nurses can build a longer-term
relationship with patients
and engage in follow-up.
Cardiac rehabilitation programs
Lipid clinics
Nurse case management
What’s in it for the nurse
Compliance
A problem not only for the patient but for the
provider and health-care system
Providers often have trouble adhering to
guidelines
Can be a communication problem between
specialists
Nurses can be a key in titrating medications and
getting patients to goal
What’s in it for the nurse
Compliance
“I think another area we need to all work on is
asking about compliance at every visit. It’s
critically important, whether this be in the area of
trying to get people to adhere to medications or
lifestyle behaviors.”
Nancy Houston-Miller
Associate Director
Stanford Cardiac Rehabilitation Program
Stanford University School of Medicine
Stanford, CA
What’s in it for the nurse
Barriers
Most barriers to effective use of nurses are
systems barriers
Physician acceptance of a role for the nurse
beyond helping with lifestyle changes
Time constraints on patient visits
Reimbursement issues for nurses
What’s in it for the nurse
A wholly separate profession
“It always seems important to me to remember
that as nurses, none of us really want to assume
a role of being a junior doctor. A nurse is a wholly
separate profession, I think that brings something
really unique to the mix.”
Suzanne Hughes
Nurse Clinician
Section of Preventive Cardiology
and Rehabilitation
Cleveland Clinic Foundation
Cleveland, OH
What’s in it for the nurse
Patient acceptance
“A big part of acceptance by patients, in my
experience over the years, has been the physician
attitude. If the physicians promote this as an
important part of the recovery and that the nurse
is part of the team, the patients accept it
wholeheartedly.”
Terry Thomas
Clinicial Instructor
Division of Cardiology
University of North Carolina School of Medicine
Chapel Hill, NC
What’s in it for the nurse
A generation gap
Patients in younger
generations are more
accepting of the nurse
Often older patients are more
insistent on seeing a doctor
What’s in it for the nurse
Get with the guidelines
Gathering data on inpatient risk reduction and
routine adherence to guidelines
AHA: “Get with the guidelines”
program to monitor patient
therapies on arrival and discharge
Allows you to look at your hospital
and to benchmark it against other hospitals
What’s in it for the nurse
Performance measures
A comprehensive set of cardiovascular measures
are being developed in an ongoing joint project
of the AMA, JCAHO, and NCQA
Measures will be designed to be appropriate for
institutions, private practice, or managed care
These measures will be developed over the next
year or two
What’s in it for the nurse
Discharge standards
These initiatives are data
collection, not tools for
patient discharge
We want to take this one
step further and create
discharge forms for
the patients
What’s in it for the nurse
Resources
Where do you get the
resources to do this?
Many hospitals say they think
nurse management is a
good idea, but they don’t
have the resources to do it
National mandates may help:
if it’s not just nice, but
necessary, resources are
often found
What’s in it for the nurse
PCNA
http://www.pcna.net
Resources for nurses in the cardiovascular field
Manuals for clinics
Templates for documentation
Newsletters
What’s in it for the nurse
Studies on nurse case management
We are seeing more and more studies on efficacy
and effectiveness of nurse case management
Prevention, primary care, depression, etc.
Need to look at cost-effective ways for managing
chronic conditions that require more time with
the patient
What’s in it for the nurse
Future studies
Combined interventions
patients with multiple risk factors that require
intervention
Cost effectiveness
determining efficiency in reducing costs with
nurse case management
New technology
new tools and how they can be used in practice
What’s in it for the nurse
Here to stay
“Nursing case management is here to stay for
chronic disease. And that is the exciting part of
the change that we’re going to be seeing in our
health care system.”
Nancy Houston-Miller
Associate Director
Stanford Cardiac Rehabilitation Program
Stanford University School of Medicine
Stanford, CA
What’s in it for the nurse
Cost effectiveness
Congestive heart failure
management shows costeffectiveness very quickly
Preventive cardiology takes
longer to show positive
effects
What’s in it for the nurse
New approaches
The future will belong to those
who come up with creative
new ways to do things
Telephone interventions
Internet communication
Algorithms approaches
emphasizing teamwork
What’s in it for the nurse
Cost-conscious world
“We’re dealing in the reality of a very costconscious world. All of these initiatives are areas
where patients have much to gain, but we have
to be able to prove that they’re cost-effective as
well.”
Suzanne Hughes
Nurse Clinician
Section of Preventive Cardiology
and Rehabilitation
Cleveland Clinic Foundation
Cleveland, OH