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Carmarthenshire LHB and Hywel
Dda Trust
Claire Hurlin
Clinical and Service Lead Chronic
Disease Management
Interventions
• Baseline retrospective audit of 100 (46)patients notes
admitted with a diagnosis of Heat Failure completed
• Heart Failure Service first year has showed
– a reduction in hospital admissions by 23%
-96% improvement in medicines management in
relation to evidence based medicine
- 37% improvement in quality of life scores.
• Nurse led outreach clinics – providing a service to patients
closer to home working with Local Authority and GP’s
• Focus group with heart failure patients x 2
• Adapted Heart Failure patient check list for self management
and roll out in progress across service in Carmarthenshire and
Ceredigion
• Telephone clinics commenced
• Tele health research
• One stop diagnostic clinics improving access to
echocardiogramss
• LES for Heart Failure training and support
• Locally offering CHD/CVD/CHF diploma courses
Audit results
ICD Codes
Heart Failure,
unspecified
9%
Congestive
Heart Failure
48%
Left
Ventricular
failure
43%
Re-admitted within 30
days?
Yes, 5
RIP, 10
No, 31
N = 46
Has the patient had an
Echo?
40
39
35
30
25
23
20
15
12
10
7
6
5
0
Echo
Not had
Prior to
admission
During
admission
Planned on
discharge
N = 46
ACE-i / ARB?
35
33
30
25
20
15
11
10
5
2
0
Yes
No
Contraindicated
N = 46
Beta Blockers?
25
21
20
16
15
9
10
5
0
Yes
No
Contraindicated
N = 46
Referred to Heart Failure
Nurses for follow-up?
20
19
17
18
16
14
12
10
10
8
6
4
2
0
Yes
No
RIP
N = 46
On CHD Register?
18
17
16
14
12
11
10
10
8
8
6
4
2
0
Yes
No
RIP
Unknown
N = 46
Flu Vaccine in the
past?
25
25
20
15
11
10
10
5
0
0
Yes
No
RIP
Unknown
N = 46
Pneumonia vaccine?
25
23
20
15
11
10
10
5
2
0
Yes
No
RIP
Unknown
N = 46
Follow-up?
14
14
12
12
10
10
8
6
6
4
2
2
1
1
0
Medical HF Nurses
RIP
Readmitted
before
A/W
T/F'd for
surgery
No f/u
N = 46
Conclusions
• Readmission rate at WWGH: 16%
• Documentation of presenting complaint & clinical
examination (esp. JVP & peripheral oedema) is
inadequate
• Investigations are not routinely requested or
recorded (particularly ECHO, TFT, lipids)
• ECHO not performed in 15% of patients
• ACE-i / ARB use more widespread than B-blockers
• Treatment with ACE-I / ARB not initiated in 15% of
patients
Conclusions (cont..)
• Treatment with B-blocker not initiated in 50% of
patients as in patient
• Diuretics are prescribed extensively with the
exception of spironolactone
• Smoking and alcohol status not documented
adequately
• Specialist advice not sought routinely
• Involvement of HF service higher from cardiology
wards
• 27% patients not followed up
Recommendations
• Increased education of medical staff on clerking and
documentation – particularly in relation to symptoms,
clinical signs, lifestyle factors and investigation requests
and results
• Increased involvement of specialist nurses in all
appropriate patients – improve awareness Heart Failure
Service
• All appropriate patients should be followed up regularly
Implementation – regular session on post grad
lunch time meetings including information
and education
Focus Groups-patient
stories
• Safety due to continuity of care
• Easier access by providing the clinics closer to home
• Reduced stress due to easy parking, short travelling
times, comfortable environment
• Patient comments include:
• “I feel safe for the first time in 12 years”
• “My nurse explains why I have to take my
medication; she makes my life so much easier”
Successes & Challenges
• What have been your successes/quick wins?
-improving patient satisfaction, establishing nurse
led clinics in the community
• What challenges barriers have you encountered?
-communication, time to review and reassess
• How have you approached/overcome these?
-working with others, keeping them informed,
attending their meetings, asking them to come and speak
to us, understanding the need for change
• Tips for others
-always remember need back up support from admin,
keep talking, be prepared to change