Shaping a Dynamic Future in Respiratory Practice. #DFResp

Transcription

1 Shaping a Dynamic Future in Respiratory Practice #DFResp

2 The Integration of Cardiac and Respiratory Specialist Services Katy Beckford Lead for Community Cardiac and Respiratory Specialist Service (CARSS) Coley Clinic The views expressed in this presentation are those of the speaker and are not necessarily those of the meeting sponsors. This presentation may contain off-licence information. Please refer to the product SmPCs for the approved indication for use. UK/KOL/17/0023 Date of Preparation: February 2017

3 Disclosures: I have had conference attendance from Teva UK Limited Pfizer Nutricia

4 The Integration of Cardiac and Respiratory Specialist Services Katy Beckford. Services Lead

5 What did the specialist services look like? Three separate services Heart Failure, Respiratory and Cardiac Rehabilitation Three Leads Various sites No link up Duplication of visits No clear pathway for patients with multiple Long Term Conditions (LTCs) No co-ordination

6 What was needed? A more integrated approach 1. Single Cardiac Services 2. Respiratory was already integrated with Pulmonary Rehabilitation and Oxygen 3. One lead to oversee integration

7 How was this going to look?

8 Big changes! Two specialist areas Cardiac and Respiratory Two Clinical Leads One Band 8 Improved link up Reduction in duplication of visits Clear pathways for patients with multiple LTCs Co-ordinated approach

9 How did we do this?

10 Held an away day Explored opportunities of an integrated service Discussed the challenges how do we turn these into opportunities? Reviewed our processes is there a better way to do it? Got to know each other! For everybody to be involved and valued Open and honest discussion Non-judgemental safe environment No idea is a bad idea See what we have in common Have your say on the day

11 What have we achieved in 12 months?

12 We came up with the name CARSS! We moved into a clinical building with clinic space We have established specialist and integrated clinics We have worked closely with Rio to create integrated documentation We have increased provision of Cardiac and Pulmonary rehabilitation We have gone paperless We have improved awareness of other specialities Greater understanding of the roles within the teams Improved integration across services Improved integration across administration Increase use of clinical space in Coley Clinic Improved education sessions regarding LTCs across localities Improved relationships with our GP colleagues CARSS will be a placement for Nursing Students

13 Avoids unnecessary appointments travel time Quicker and easier access to up to date information Patient doesn t need to keep repeating themselves More appropriate home visits Saves admin time Helps more efficient MDTs

14 How does this help patients?

15 Case study 43 year old lady lives with her 17 year old daughter in a disabled bungalow. She suffers from anxiety, depression and agoraphobia. Daughter does not go to school and is her main carer (and also suffers from anxiety and depression). Currently weighs over 30 stone and is immobile Peripartum dilated Cardiomyopathy Medical history Bi-ventricular ICD following 2x VF arrest Hypothyroidism Pulmonary hypertension Smoker Anxiety/ depression Diabetes COPD? CA uterus Renal Failure

16 Medications Bumetanide 12mg Spironolactone 25mg od stopped due to renal function Ramipril 5mg am and 5mg pm stopped due to renal function Bisoprolol10mg od Amiodarone 200mg am and 100mg pm Ferrous fumerate bd Asprin 75mg od Throxine 200mcg od Metformin 1g am and 1g pm Diazepam 2mg-20mg od Simvastatin 20mg od Fluticasone propionate, salmeterol xinafoate inhaler bd Salbutamol 2 puffs bd Human insulin 60units bd Ferrous fumerate 210mg od Folic acid od Colecalciferol gel 800u caps daily Heart burn and acid reflux relief as required Mometasone furoate monohydrate nasal spray Paracetemol 1gm qds Doxycycline 1 tablet bd as required

17 Services involved in care Heart Failure Nurse Weekly Heart failure management Respiratory Nurse Every other week COPD management District Nurse Weekly Catheter and pressure area care Talking therapies Weekly phone calls Depression/ anxiety Occupational therapist Physiotherapist Bariatric services GP Weekly Weekly Equipment checks As required Physio on chest and leg movement Social services Daily Morning call - washing Consultant Cardiologist Monthly MDT input

18 After integration Heart Failure Nurse Weekly Heart failure management Respiratory Nurse When required (mainly physio) Advice. Physio gave chest clearance techniques District Nurse Weekly Catheter but no longer pressure area care Talking therapies Weekly phone calls Depression/ anxiety Occupational therapist Physiotherapist Bariatric services GP When required When required Equipment checks As required Social services Daily Morning call - washing Consultant Cardiologist Monthly MDT input

19 What we learnt?

20 Full staff involvement and engagement is key!

21 This was not without initial concerns Barriers and resistance to change Fear of losing identity and specialism Lead was respiratory focussed (what does she know about cardiac disease?) But

22 What do they think now? Being able to speak to each other when needed and do joint clinics has helped my patient but also improved my understanding of other diseases I was worried I would be expected to dilute my speciality but I have just enhanced it The admin time is used much more efficiently for all services I have learnt so much

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24 THANK YOU FOR LISTENING Any questions?