Preventive cardiology: what’s in it for the nurse

1. 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 ThomasRN, MSN Clinical Instructor Division of Cardiology University of North Carolina School of Medicine Chapel Hill, NC Nancy Houston-MillerRN, BSN Associate Director StanfordCardiac Rehabilitation Program Stanford University School of Medicine Stanford, CA

2. 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

3. What’s in it for the nurse Effectiveness of nurse management • Numerous studies show effectiveness of the nurse management approach in preventive cardiology

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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

19. 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

20. 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

21. What’s in it for the nurse Cost effectiveness Congestive heart failure management shows cost-effectiveness very quickly Preventive cardiology takes longer to show positive effects

22. 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

23. What’s in it for the nurse Cost-conscious world • “We’re dealing in the reality of a very cost-conscious 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