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ADVANCED NURSE PRACTITIONER ROLE. Royal College of Nursing (2008) definition A registered nurse who has undertaken a specific course of study of at least first degree (Honours) level and who: - makes professionally autonomous decisions, for which he or she is accountable - receives patients with undifferentiated and undiagnosed problems and makes an assessment based on highly developed nursing knowledge and skills, including skills such as physical examination - makes differentia1139
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1. THE CHALLENGES OF THE ARRHYTHMIA NURSE PRACTITIONER ROLE Andréa Grieger and Eleanor Cusack
Arrhythmia Nurse Practitioners
(Supported by the British Heart Foundation)
2. ADVANCED NURSE PRACTITIONER ROLE Royal College of Nursing (2008) definition
A registered nurse who has undertaken a specific course of study of at least first degree (Honours) level and who:
- makes professionally autonomous decisions, for which he or she is accountable
- receives patients with undifferentiated and undiagnosed problems and makes an assessment based on highly developed nursing knowledge and skills, including skills such as physical examination
- makes differential diagnosis using decision-making and problem solving skills
- orders necessary investigations, and provides treatment and care both individually, as part of a team, and through referral to other agencies
3. ARRHYTHMIA NURSE PRACTITIONER British Heart Foundation supported
Degree level essential
Working towards or has obtained a Masters degree
Arrhythmia M Level module
Nurse prescribing?
4. Assess new patients with palpitations, syncope or abnormal ECG
Run nurse-led DC cardioversion service
pre- EP procedure advice – telephone/ clinic visit
Counsel patients who are referred for permanent pacemaker (PPM)/ implantable cardioverter defibrillator (ICD)/ cardiac resynchronisation therapy (CRT)
Inherited Cardiac Conditions Service – coordinate clinic/ investigations, fam hx SCD, HCM, DCM, ARVD, Long QT, Brugada.
Assess new patients with palpitations, syncope or abnormal ECG
Run nurse-led DC cardioversion service
pre- EP procedure advice – telephone/ clinic visit
Counsel patients who are referred for permanent pacemaker (PPM)/ implantable cardioverter defibrillator (ICD)/ cardiac resynchronisation therapy (CRT)
Inherited Cardiac Conditions Service – coordinate clinic/ investigations, fam hx SCD, HCM, DCM, ARVD, Long QT, Brugada.
5. AF SERVICE
6. CHALLENGES – ARRHYTHMIA CLINICS Triaging referrals
Documented evidence on ECG
Timely access to diagnostics
Managing patient expectation and anxiety levels
Time to definitive diagnosis
Phone call support
- Not always clear if the referral is routine or not
or holter monitoring- Not always clear if the referral is routine or not
or holter monitoring
7. CHALLENGES - TREATING AF NICE guidance in the treatment of AF (2006)
Local protocols and care pathways
Choice of drug treatment – pharmacological cardioversion
Increasing awareness of EP interventions - when, how and who to refer
Initiating treatment through GP
Nurse prescribing essential to arrhythmia nurse role, importance of personal development.
Dr and patient preference
Nurse prescribing essential to arrhythmia nurse role, importance of personal development.
Dr and patient preference
8. CHALLENGES – AF FOLLOW UP Clinic support
Patient population
Coordinating tests locally (ECG, holter monitor)
Outreach clinics
Post AF ablation 3 months/ 6 months/ 1 year then annually
Educating patients on what to expect post procedure
Ref: HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Personnel, Policy, Procedures and Follow up (2007)
Patient population – age, geographical location, distance to travel, tests performed locally
Outreach clinics- local protocols, obtaining results
Patient population – age, geographical location, distance to travel, tests performed locally
Outreach clinics- local protocols, obtaining results
9. CHALLENGES – DC CARDIOVERSION DC cardioversion service – nurse led since mid 2009
Competencies – consent
Nurse sedation - training
Location/ access to Cardiology support
Managing waiting list Consenting process
Interpreting rhythm in between shocks
When to call for Cardiology support
Waiting list – time consuming need for admin support/ healthcare assistant
Consenting process
Interpreting rhythm in between shocks
When to call for Cardiology support
Waiting list – time consuming need for admin support/ healthcare assistant
10. CHALLENGES - ANTICOAGULATION Patient compliance with Warfarin
Educating patients
Relationship with anticoagulation services (hospital and GP)
CHADS2 score
Referral and waiting times
Weekly INR inconvenient for some and older patients, hard to keep records
Weekly INR inconvenient for some and older patients, hard to keep records
11. FUTURE CHALLENGES Expansion of the service
Developing the arrhythmia nurse practitioner’s role
Outreach clinics
Arrhythmia clinics in primary care
Specific AF clinics
Nurse prescribing/ Patient Group Directions
Expansion – which direction with the current population group
AF clinics – previous GPsI, now nurses
Working within own sphere of knowledge and skills
Coordinating referrals and investigations between primary care and secondary care
Research opportunities
Administrative assistance/ health care assistan
tLink with anticoagulation services
Expansion – which direction with the current population group
AF clinics – previous GPsI, now nurses
Working within own sphere of knowledge and skills
Coordinating referrals and investigations between primary care and secondary care
Research opportunities
Administrative assistance/ health care assistan
tLink with anticoagulation services