The CNS team provide a Rapid Access Chest Pain Clinic (RACPC) whose aim is to provide early diagnosis, risk stratification and treatment for patients with new onset exertional angina. Patients identified as non-cardiac chest pain are reassured and discharged back to their GP. Patients are referred into the clinic by GP’s or A&E and receive an appointment within two weeks of referral. Once a confirmed diagnosis of coronary heart disease is established the patient is referred onto the Cardiac Rehabilitation Team.
The Acute Coronary Syndrome/Cardiac Rehab nurse provides an inpatient cardiac rehabilitation service for patients admitted with a diagnosis of acute coronary syndrome (ACS). Risk stratification of ACS patients is encouraged using a recognised scoring system. The nurse aims to facilitate cardiology input to aid early diagnosis, investigation / treatment and discharge. The nurse encourages the medical teams to utilise the South East London Cardiac Network inter-hospital transfer system for patients requiring inpatient coronary angiogram / percutaneous coronary intervention (PCI) / cardiac investigations / surgery at Kings College or Guy’s and St Thomas’ hospitals. The nurse ensures patients with a confirmed diagnosis of CHD access UHL cardiac rehabilitation services (home visit, CHD clinic and outpatient cardiac rehabilitation (CR) programme).
Cardiac Liaison Nurse provides an early post-discharge (phase 2) home visiting and telephone service for patients referred following MI, troponin positive chest pain, cardiac surgery (post sternotomy: CABG, valve etc.) and elective PCI (angioplasty and stent) whose GP is within the London Borough of Lewisham. The aim is to visit the patient within 7 days of discharge to provide continuity of care, and information on physical, psychological and social aspects to support recovery, rehabilitation, patient self-management and reduce the risks of future cardiac events. The nurse refers the patient onto phase 3 cardiac rehabilitation programme. The nurse liaises with The Primary Health Care Team to encourage long-term monitoring and follow-up of these patients (phase 4) and to act as a resource.
The CNS team provide a CHD clinic for post MI/ ACS /Angina patients. The MI and troponin negative ACS patients are seen within 2-3 weeks following discharge. RACPC patients and patients having a planned PCI are offered an OPA once an angiogram report has been received confirming coronary heart disease (CHD) or intervention.
The CNS team provide a comprehensive CR service. We receive referrals for our CR services from our ACS nurse, HF and Liaison Nurses, from RACPC, Cardiologists and GP’s and tertiary centres via our liaison nurse. The CR programme (Phase 3) for post MI, troponin negative chest pain with confirmed CHD, coronary artery bypass grafting (CABG) and valve replacement patients, elective PCI and some heart failure (HF) and implanted cardiac device( ICD) patients (Monday, Wednesday and Friday). They are offered between 5-8 sessions. On completion of the outpatient cardiac rehabilitation programme, patients are referred onto the Primary Health Care Team and a Phase 4 community exercise class. Teach basic life support (BLS) to patients and relatives in line with BACPR guidelines.
The HF CNS team works closely with the HF Consultant Cardiologist and Specialist Cardiology doctor and SpR’s to provide a service to diagnose patients and identify the underlying aetiology involved with the condition of heart failure. The role involves optimising heart failure treatment and working with the multidisciplinary team in primary and secondary care. To provide patient support and education, regarding lifestyle changes and treatment (i.e. compliance with medication) and deal with issues arising with polypharmacy. Patients admitted to hospital are either seen in the ward area or referred directly to the Heart Failure Clinic. On discharge from hospital there are two (from July 2013 there will be 3 clinics) HF Nurse led outpatient clinics at UHL where new and follow-up patients are reviewed. Alternatively, the patient is referred onto the community Heart Failure Nurses, who visit the patient at home within 5-10 days. Patients who are stable are discharged into the care of their GP with a continuing care management plan and should continue to be reviewed in the cardiology / heart failure clinic (as per NICE guidelines). The Heart Failure Service work / liaise closely where necessary with the UHL and community palliative care team. The aims for the future of the service are to develop a heart failure outpatient cardiac rehabilitation programme and heart failure support group.
Community Heart Failure Nurses run nurse-led heart failure clinics in the community using NICE and local guidelines / protocols for the management of heart failure. We also provide a home visiting service for heart failure patients who have difficulty getting to clinics in the community or at the hospital. Community clinics are held at Lee HC, South Lewisham HC, Sydenham Green HC and the Waldron HC. The team continue the education, support, compliance, initiation and titration (where appropriate) of heart failure medications in the community. We communicate with and involve the palliative care team as and when appropriate. We receive referrals from a variety of sources including primary and secondary care. Both the community and hospital HF nurses teams meet regularly to discuss and review the service. There are also monthly multidisciplinary meetings with the consultants and some local GP’s where patient’s management is discussed and agreed and any other relevant issues.
Arrhythmia Nurse works within the cardiology multidisciplinary team to improve quality and services for patients with arrhythmias. The nurse leads the delivery of service provision for patients with atrial fibrillation (AF) referred for cardioversion, refining existing pathways of care, policies and procedures as well as providing educational and emotional support for the patients having the procedure. Audit of this service is ongoing. Acts as a resource to medical/nursing staff in the emergency department and medical wards, giving advice, when required on management of patients presenting with arrhythmia/blackouts/atrial fibrillation. Liaises with tertiary care centre when required to help ensure patients requiring ablation/device insertion receive seamless care. She has also established a nurse-led atrial fibrillation clinic, using the NICE guidelines and locally agreed protocols as a basis for its management.
A large number of the CNS team are supported by the British Heart Foundation this helps with education and ongoing professional development.
The CNS team provide teaching sessions for UHL nursing staff in the ward and ITU setting and in clinics.
The CNS team collecting and entering data with admin support onto national data bases such as MINAP and NACR and CCAD (HF) in line with national audit requirements.
